PPS Provider Appeals - DY1 Q4

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PPS Provider Name: Albany Medical Center Appeal 1 of 2

Conclusion:
PPS successfully appealed the Independent Assessor´s findings relative to Workforce Strategy Spending.

Albany Medical Center appealed the IA´s Workforce Strategy Spending of Fail on the basis that it believed that the March 14, 2016 State guidance on Workforce communicated that the PPS would receive "an automatic 25% reduction in the DY1 baseline commitment and as such the AMCH Workforce Spend exceeded 80% of its DY1 commitment." The IA acknowledged that the guidance can lead one to assume that the 25% would be automatically applied although that was not the intent. In a situation where the guidance issued is ambiguous, the IA must apply the guidance in a manner favorable to the PPS. With the 25% reduction considered, the PPS met the requirement to spend at least 80% of its adjusted DY1 Workforce baseline commitment, the IA must overturn its initial determination and award AMCH the Achievement Value for Workforce Strategy Spend.

PPS Provider Name: Albany Medical Center Appeal 2 of 2

Conclusion:
PPS successfully appealed the Independent Assessor´s findings relative to Active Engagement of patients in Project 3.a.ii.

Albany Medical Center´s Project 3.a.ii had an initial determination Fail. On appeal, the PPS cited guidance regarding Reporting of Actively Engaged for Crisis Stabilization - Project 3.a.ii as issued by the State on April 25, 2016 which allowed the PPS to "report actively engagement patients for Behavioral Crisis Stabilization as an aggregate number. However, if the nature of the engagement is anonymous, the PPS would only need to track and report the number of anonymous engagements completed by network partners." Upon further clarification by the PPS on how its reporting aligned with the State guidance the IA overturned its original decision.