PPS Provider Appeals - DY1 Q3

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PPS Provider Name: Care Compass Network (formally United Health) Appeal 1 of 1

Conclusion:
Provider successfully appealed the Independent Assessor´s findings relative to Cultural Competency and Health Literacy Milestone 1.

Independent Assessor initially failed the PPS Provider for Cultural Competency and Health Literacy Milestone 1 which required the PPS to submit a Cultural Competency and Health Literacy Strategy which captured key components, including but not limited to: 1. Identifying priority groups experiencing health disparities, 2. Identified key factors to improve access to quality primary, behavioral health, and preventive health care, 3. Plans for two-way communication with the population and community groups through specific community forums, 4. Assessments and tools to assist patients with self-management of conditions, 5. Community-based interventions to reduce health disparities and improve outcomes." The PPS strategy document submitted during the initial Quarterly Report submission did not directly include all of the specific key components as specified in the guidelines and during remediation the PPD failed to clarify how its submitted material captured the key components of the milestone.

Upon appeal, the PPS presented narratives explaining where it had evidence to support that it had addressed and successfully met each of the key components. For each of the key components, the PPS included language addressing each component from its previously submitted documentation, and cited specifically where this was contained in the source documentation. As a result the IA overturned its initial determination.