PPS Provider Appeals - DY1 Q3

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PPS Provider Name: Albany Medical Center Hospital PPS Appeal 1 of 2

Conclusion:
Provider successfully appealed the Independent Assessor´s findings relative to Budget Milestone 1.

Independent Assessor initially failed the Albany Medical Center Hospital PPS on Budget Milestone 1 which required the PPS to submit documentation in response to a sample request of the universe of meetings the PPS provided to the IA. The documentation provided in response to the sample request appeared to be vague as there was no specific information to suggest that actual committee business was discussed.

Upon appeal, the PPS presented narratives that the documentation submitted to support the sample request satisfied the established criteria. Upon further review, the IA agreed with the PPS and overturned its initial determination.

PPS Provider Name: Albany Medical Center Appeal 2 of 2

Conclusion:
Provider unsuccessfully appealed the Independent Assessor´s findings relative to Governance Milestone 6.

Independent Assessor initially failed the Albany Medical Center Hospital PPS for Governance Milestone 6 which required the PPS to demonstrate that it had finalized partnership agreements/contracts with the CBOs it had engaged. Out of the CBOs the PPS had engaged for this milestone, there were one or more CBOs without contracts. Upon remediation and appeal, the PPS failed to identify that all CBOs engaged had partnership contracts currently in place.

Upon appeal, the PPS presented narratives that 2 partnership contracts were submitted to satisfy the milestone, which should have been sufficient. The IA upheld its decision based on the rationale that the PPS had not finalized all partnership agreements/contracts with engaged CBOs and until such time the milestone cannot be marked as complete.