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| 9/23/2014 Analysis of OTHER for - SELF ATTESTATION Delivery System Reform Incentive Payment Plan |
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| Total | 118 | 100.00% |
| Qualified | 70 | 59.32% |
| OTHER | Condition 1 - Volume | |||||||
|---|---|---|---|---|---|---|---|---|
| Volumes >= 35% | Final Result |
|||||||
| Provider Type | License # | MMIS | NPI | FACILITY NAME | Utilization Rate | Result | ||
| Other | 1708667 | 1952504417 | Hickok Center for Brain Injury, Inc. | 100.00% | TRUE | TRUE | By Appeal | |
| ADHC | 7002335N | 20th Street AIDS Day Treatment | 100.00% | TRUE | TRUE | By Appeal | ||
| Community Based Service Agency | A Reflection of You Counseling & Support Services, (ARYCSS) LLC | 100.00% | TRUE | TRUE | By Appeal | |||
| DOH | 1797662 | AIM Independent Living Center | 100.00% | TRUE | TRUE | By Appeal | ||
| OP Services (822 program) Specialized Services (824 program) | 822: 160711786 | Belvedere Health Services, LLC | 100.00% | TRUE | TRUE | By Appeal | ||
| OP Services (822 program) Specialized Services (824 program) | 824: 150111684 | Belvedere Health Services, LLC | 100.00% | TRUE | TRUE | By Appeal | ||
| Community Based Organization | 1243521 | 1669642211 | Bronx AIDS Services d/b/a BOOM!Health | 100.00% | TRUE | TRUE | By Appeal | |
| DOH | Catholic Charities Care Coordination Services (formerly Catholic Charities AIDS Services) | 100.00% | TRUE | TRUE | By Appeal | |||
| 1190629 | 1902018971 | Catholic Charities Community Services | 100.00% | TRUE | TRUE | By Appeal | ||
| 3060515 | Catholic Charities Diocese of Rochester dba Catholic Charities Community Services | 100.00% | TRUE | TRUE | By Appeal | |||
| 3060515 | Catholic Charities Diocese of Rochester dba Catholic Charities Community Services | 100.00% | TRUE | TRUE | By Appeal | |||
| TBI | 3060515 | Catholic Charities Diocese of Rochester dba Catholic Charities Community Services | 100.00% | TRUE | TRUE | By Appeal | ||
| OPWDD certified programs | 71460438-7146074 | 0 | 1699842070, 1215004353, 1316014475, 1598832669, 1710054887, 1770650855, 1982771077, 1922175017, 1063589166, 1356419808, 1376610485 | Catholic Guardian Services | 100.00% | TRUE | TRUE | By Appeal |
| MLTCP | 2710185 | 1528226610 | CenterLight Healthcare Inc | 100.00% | TRUE | TRUE | By Appeal | |
| PACE | 2710185 | 1528226610 | CenterLight Healthcare Inc | 100.00% | TRUE | TRUE | By Appeal | |
| Targeted Care Mgmt Agency | DIASPORA COMMUNITY SERVICES | 100.00% | TRUE | TRUE | By Appeal | |||
| Community Based Service Agency | 0189282; 03314550 | 1902165194 | ElderChoice, Inc. | 100.00% | TRUE | TRUE | By Appeal | |
| Part of DOH medicaid waiver program including FIDA, TBI & NHTD waiver services. The agency provides ILST, PBIS, & CIC under these waiver programs. | 3352063 | Gallub Services for TBI, LLC | 100.00% | TRUE | TRUE | By Appeal | ||
| DOH - NHTD Medicaid Waiver Program | 3035843 | 1518101815 | Hamaspik of Rockland County Inc. | 100.00% | TRUE | TRUE | By Appeal | |
| DOH TBI Medicaid Waiver Program | 3035843 | 1518101815 | Hamaspik of Rockland County Inc. | 100.00% | TRUE | TRUE | By Appeal | |
| ADHC | 5957303N | Hebrew Hospital Home INC | 100.00% | TRUE | TRUE | By Appeal | ||
| Care Coordination Provider | Iris House, Inc. | 100.00% | TRUE | TRUE | By Appeal | |||
| Care Coordination | 3439925 | 1295006526 | National Association on Drug Abuse Problems, Inc. (NADAP, Inc.) | 100.00% | TRUE | TRUE | By Appeal | |
| TBI and NHTD Waiver Provider | 3106136 | 0 | North Shore Tbi Services, Inc. | 100.00% | TRUE | TRUE | By Appeal | |
| Congregate Treatment Program | 7567435 (Unit Code 435) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| Congregate Treatment Program | 7567431 (Unit Code 431) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| Congregate Treatment Program | 7567434 (Unit Code 434) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| Congregate Treatment Program | 7567430 (Unit Code 430) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| Congregate Treatment Program | 7567437 (Unit Code 437) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| TBD | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | |||
| Congregate Treatment Program | 7567438 (Unit Code 438) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| Congregate Treatment Program | 7567432 (Unit Code 432) | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | ||
| TBD | Options for Community Living, Inc. | 100.00% | TRUE | TRUE | By Appeal | |||
| ADHC | 7002353N | Rivington House AIDS Day Treatment Program | 100.00% | TRUE | TRUE | By Appeal | ||
| Bridges To Health ( B2H) Medicaid Waiver Program | C-025925 | 3143322 | The House of the Good Shepherd | 100.00% | TRUE | TRUE | By Appeal | |
| Other | 2730 | 1571851 | 1124224084 | The Sayville Project - Stony Brook University | 100.00% | TRUE | TRUE | By Appeal |
| Licensed Community Residence | 16110 | 1304530 | 1134253263 | Transitional Services of New York for Long Island, Inc. | 100.00% | TRUE | TRUE | By Appeal |
| OMH Congegate Care. Transitional Housing, Health Home | 2996692 | 1649333485 | Unity House of Troy, Inc. | 99.97% | TRUE | TRUE | By Appeal | |
| PROS | 7957018A | 3421029 | 101320374 | Mental Health Association of New York City | 99.94% | TRUE | TRUE | By Appeal |
| Adult Day Health Center | 7000317N | 31942 | 1467526160 | Jewish Home Lifecare, Bronx Adult Day Health Center | 99.90% | TRUE | TRUE | By Appeal |
| ADHC | 1404300N | Schofield Adult Day Health Care Program (ADHCP) | 98.64% | TRUE | TRUE | By Appeal | ||
| ADHC | 7097007A | Jawonio Inc | 98.60% | TRUE | TRUE | By Appeal | ||
| ADHC | 3227305N | St. Luke's Home Adult Day Health Care Program | 98.46% | TRUE | TRUE | By Appeal | ||
| Adult Day Health Center | 5909302N | 1957991 | 1457426579 | Jewish Home Lifecare, Sarah Neuman Adult Day Health Center | 98.46% | TRUE | TRUE | By Appeal |
| ADHC | 7002335N | VillageCare Adult Day Care Program | 98.09% | TRUE | TRUE | By Appeal | ||
| ADHC | 3227304N | Charles T. Sitrin Health Care Center, Inc. | 96.22% | TRUE | TRUE | By Appeal | ||
| Adult Day Health Center | 7002340N | 1171824 | 1427123546 | Jewish Home Lifecare, Manhattan Adult Day Health Center | 96.10% | TRUE | TRUE | By Appeal |
| ADHC | 3801000N , PFI 5537 | A.O. Fox Memorial Adult Day Center | 95.70% | TRUE | TRUE | By Appeal | ||
| Program of All- inclusive Care for the Elderly (PACE) | 7002191R | 3114514 | 1619109089 | Catholic Managed Long Term Care, Inc. | 94.04% | TRUE | TRUE | By Appeal |
| ADHC | 2124301N | Valley Health Services, Inc. | 93.88% | TRUE | TRUE | By Appeal | ||
| ADHC | 1451304N | Rosa Coplon Jewish Home & Infirmary | 93.51% | TRUE | TRUE | By Appeal | ||
| Other | 6820 | 1571851 | 1124224084 | The Sayville Project - Stony Brook University | 92.99% | TRUE | TRUE | By Appeal |
| Article 16 clinic and employment and habilitative services | OPWDD: 6445400, 6445160, 6445650 2467214, 2467227, 2467229, 2467235, 2467237, 2467416, 2467900 SED: 2617 0116 7030 | 00 357 240 | 126 550 9491 | The Rochester School of the Holy Childhood, Inc. | 92.91% | TRUE | TRUE | By Appeal |
| Licensed Home Care Service Agency | 1555L001 | 1982843124 | All Care Home Health Services | 92.58% | TRUE | TRUE | By Appeal | |
| Licensed Home Care Service Agency | 1555L001 | 1982843124 | All Care Home Health Services | 92.58% | TRUE | TRUE | By Appeal | |
| ADHC | 2124301N | Valley Health Services, Inc. | 92.40% | TRUE | TRUE | By Appeal | ||
| Adult Day Health Care Program | 3702309N | 1407538 | 1467534974 | St. Luke Adult Day Health Care Program | 91.73% | TRUE | TRUE | By Appeal |
| Health Home Care Management Provider, Legacy COBRA Provider, NYSDOH CSP | 1295394 | 1841339728 | Hudson Valley Community Services, Inc. | 89.16% | TRUE | TRUE | By Appeal | |
| Adult Day Health Care (42) | 3301321N | 614764 | 1336289909 | St. Camillus Residential Health Care Facility | 88.53% | TRUE | TRUE | By Appeal |
| ADHC | 7003307N | Parker Jewish Institute for Health Care and Rehabilitation | 88.12% | TRUE | TRUE | By Appeal | ||
| CSS - Psychosocial Clubhouse | 6110503 | FOUNTAIN HOUSE, INC. | 86.49% | TRUE | TRUE | By Appeal | ||
| LTHHP | 2952903L | Familiy Care Certified Services, A Division of Tri-Borough Certified Health Systems of NY | 80.79% | TRUE | TRUE | By Appeal | ||
| LHCSA | 9849L002 | 1053585208 | Gurwin Home Care Agency, Inc. | 65.82% | TRUE | TRUE | By Appeal | |
| ADHC | 1451304N | Rosa Coplon Jewish Home & Infirmary | 65.69% | TRUE | TRUE | By Appeal | ||
| Community Based Medical Transportation Services (026) | 29404 | 614764 | 1336289909 | St. Camillus Residential Health Care Facility | 50.72% | TRUE | TRUE | By Appeal |
| Supportive Housing Provider | 78940 | Lantern Community Services, Inc. | 47.52% | TRUE | TRUE | By Appeal | ||
| ACF and ALP | 030-E-039 | 1945399 | 1245405489 | IDEAL SENIOR LIVING CENTER | 47.33% | TRUE | TRUE | By Appeal |
| Medicaid Transportation provider | NYSDOT Operating Authority #31562 | 814457 | 1700937794 | Medical Motor Service of Rochester and Monroe County Inc. | 45.55% | TRUE | TRUE | By Appeal |
| Primary Care Group Practice | Independence at Home -- Physician House Calls for the Homebound, P.C. | 41.12% | TRUE | TRUE | By Appeal | |||
| Hospice | 7002504F | MJHS Hospice and Palliative Care, Inc. | 39.54% | TRUE | TRUE | By Appeal | ||
| Multi-Speciality Group Dental | American Dental Offices, PLLC | 24.53% | FALSE | FALSE | ||||
| Hospice | 7003503F | 2023403 | 1396756524 | Calvary Hospital Hospice | 23.60% | FALSE | FALSE | |
| Licensed Hospice | 0721501F | CareFirst NY, Inc. | 22.07% | FALSE | FALSE | |||
| Hospice | 4429501F | 977028 | 1497758080 | Hospice of St. Lawrence Valley, Inc. | 21.99% | FALSE | FALSE | |
| Primary Care | Finger Lakes Medical Associates | 21.28% | FALSE | FALSE | ||||
| Hospicare & Palliative Care Services | 5401501F | 1730185737 | Hospicare & Palliative Care Services | 16.32% | FALSE | FALSE | ||
| LHCSA | 9849L001 | 1053585208 | Gurwin Home Care Agency, Inc. | 15.41% | FALSE | FALSE | ||
| Coordination, | 3439925 | 1295006526 | National Association on Drug Abuse Problems, Inc. (NADAP, Inc.) | 5.58% | FALSE | FALSE | ||
| INTERNAL MEDICINE PRIVATE OFFICE | 193836 | 1675290 | 1013188986 | ARTHUR R DOVE MD PC | 0.00% | FALSE | FALSE | |
| CBO - Health Home Care Mgmt Agency, Housing Provider | 1552134 | 1659594075 | CAMBA, Inc. | 0.00% | FALSE | FALSE | ||
| Care Management Agency - Health Home | 1552134 | 1659594075 | CAMBA, Inc. | 0.00% | FALSE | FALSE | ||
| Community - Based | 40900 | Compeer, Inc. / NYS Office | 0.00% | FALSE | FALSE | |||
| 501 C 3 | Comprehensive Interdisciplinary Developmental Services, Inc. | 0.00% | FALSE | FALSE | ||||
| Independent Family Support | 2622195 | Finger Lakes Parent Network Inc. | 0.00% | FALSE | FALSE | |||
| PROS | 6329003A | Goodwill Industries of Greater New York and Northern New Jersey, Inc. | 0.00% | FALSE | FALSE | |||
| DOH-NHTD Medicaid Waiver Program | 3106118 | Hamaspik of Kings County, Inc. | 0.00% | FALSE | FALSE | |||
| 8490650 | 2002142 | Lifespan of Greater Rochester | 0.00% | FALSE | FALSE | |||
| CDPAP FI | Medical Solutions, Inc | 0.00% | FALSE | FALSE | ||||
| Crisis Services, Centralized Access and Referral Services and Family Support | 3421029 | 101320374 | Mental Health Association of New York City | 0.00% | FALSE | FALSE | ||
| 202 Housing for the Elderly and Disabled | MVP Housing Development Fund Company Inc | 0.00% | FALSE | FALSE | ||||
| Targeted Case Mgmt | Narco Freedom, Inc. | 0.00% | FALSE | FALSE | ||||
| Targeted Case Mgmt | Narco Freedom, Inc. | 0.00% | FALSE | FALSE | ||||
| Targeted Case Mgmt | Narco Freedom, Inc. | 0.00% | FALSE | FALSE | ||||
| Supported Housing | Unit Code 630 | Options for Community Living, Inc. | 0.00% | FALSE | FALSE | |||
| Supported Housing | Unit Code 631 | Options for Community Living, Inc. | 0.00% | FALSE | FALSE | |||
| Supported Housing | Unit Code 634 | Options for Community Living, Inc. | 0.00% | FALSE | FALSE | |||
| Supported Housing | Unit Code 635 | Options for Community Living, Inc. | 0.00% | FALSE | FALSE | |||
| Park Housing for the Elderly and Disabled | Park Housing Development Fund Company Inc | 0.00% | FALSE | FALSE | ||||
| 202 Housing for the Elderly and Disabled | Scheur Gardens Limited Partnership | 0.00% | FALSE | FALSE | ||||
| 202 Housing for the Elderly and Disabled | Scheur Plaza Limited Partnership | 0.00% | FALSE | FALSE | ||||
| Supporting Housing Provider | SCO Family of Services | 0.00% | FALSE | FALSE | ||||
| Home and Community Based Service Provider of Services for Seniors | Selfhelp Community Services, Inc. | 0.00% | FALSE | FALSE | ||||
| Accredited Clubhosue | Sky Light Center | 0.00% | FALSE | FALSE | ||||
| Nurse practitioner | St James Pediatrics | 0.00% | FALSE | FALSE | ||||
| Community Based Service - Social Day Program | 614764 | 1336289909 | St. Camillus Residential Health Care Facility | 0.00% | FALSE | FALSE | ||
| Hospital based clinic, Pediatric office | St. Jame's Mercy Health Pediatrics Office | 0.00% | FALSE | FALSE | ||||
| Emergency Mental Health Outreach | Suicide Prevention and Crisis Service, Inc | 0.00% | FALSE | FALSE | ||||
| 18 Bed HTP (Hard to Place) Institution | Contract # C-025925 | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 18 Bed HTP (Hard to Place) Institution | RID 2085 / VID 00A09202 B9 | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 18 Bed HTP (Hard to Place) Institution | RID 20381378 / VID 00A10127 B10 | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 18 Bed HTP (Hard to Place) Institution | RID 1658 / VID 00A01012 B | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| Foster Boarding Home | Multiple-Each home has unique Cert # | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 22-Bed Regular Institution | RID 1658/VID 00A01012 B | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 9-Bed Group Emergency Institution | RID 2085/VID 00A09202 B9 | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| 18 Bed Hard To Place Institution ( HTP) | RID 20381378/VID 00A10127 B10 | 3143322 | The House of the Good Shepherd | 0.00% | FALSE | FALSE | ||
| Other | 2620 | 1571851 | 1124224084 | The Sayville Project - Stony Brook University | 0.00% | FALSE | FALSE | |
| Accredited Clubhosue | Venture House | 0.00% | FALSE | FALSE | ||||
| Downstream HH | 1539335 | 1063573152 | Village Center for Care | 0.00% | FALSE | FALSE | ||
Highlighted Facility Names Indicate Medicaid Utilization of 35% or greater
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