Safety Net Appeal Process

VAP Exception Appeals Approval Process

New York is pleased to announce that the Centers for Medicare and Medicaid Services (CMS) has approved nine entities to participate in DSRIP as safety net providers as lead entities in a performing providers system (PPS). The link below contains the CMS approval letter.

The Department is continuing to work with the Centers for Medicare & Medicaid Services (CMS) staff to make determinations on the remaining safety net appeals. As information is received, we will post the information and send an announcement through our MRT listserv.

The Department has recommended that the federal Centers for Medicare and Medicaid Services (CMS) approve 503 providers for DSRIP safety net status through the Vital Access Provider (VAP) Exception process. If these providers are not approved, it could directly impair the ability of the individual PPS and the statewide DSRIP program to be successful.

Attached in the VAP Exception for CMS Review file, you will find the summary list of providers, the criteria used to determine safety net status (both through the original appeals and the VAP Exception), the Public comment listing and the backup lists by provider specific listings of exceptions received.

Please note that the approval of these exception appeals is contingent upon obtaining final approval from CMS. Once approval is received from CMS, the safety net lists will be updated.

VAP Exception Appeals Public Comment Lists

The Vital Access Provider (VAP) Exception appeal process ended on October 24, 2014 for all Medicaid providers, physicians and pharmacies for facilities that did not qualify by the Safety Net Definition by calculation or by appeal. If the exception is granted, then the applicant will be qualified and can fully participate in the DSRIP program. Non-qualifying facilities are limited; they may only receive up to 5% (as a group) of their PPS's award.

The VAP Exception is defined in STC 2 of the DSRIP Section of the Partnership Plan Special Terms and Conditions (STCs) as a part of the Safety Net Definition (below). There are three categories that a facility may appeal for a VAP exception under:

  1. A community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.
  2. Any hospital is uniquely qualified to serve based on services provided, financial viability, relationships within the community, and/or clear track record of success in reducing avoidable hospital use.
  3. Any state-designated health home or group of health homes.

The following VAP Exception appeals are being provided for a 30 day public comment period ending on December 3, 2014. The Department is currently reviewing the attached VAP Exceptions and making recommendations for inclusion in the DSRIP safety net process. The approval of these exception appeals is contingent upon obtaining approval from the federal Centers for Medicare and Medicaid Services (CMS).

Comments may be submitted electronically to bvapr@health.ny.gov.

Safety Net Definition

Eligible safety net providers are defined in the Special Terms and Conditions (STCs) 2 of the DSRIP Section of the Partnership Plan STCs. The definition as written in the STCs, and the lists of eligible providers are posted below. In the attached documents, providers with "True" in the FINAL RESULT column meet the DSRIP criteria for safety net providers; those with "False" in the FINAL RESULT column do not meet the DSRIP criteria for safety net providers. If you have any questions related to the DSRIP Safety-Net lists provided below, please submit the inquiry to BVAPR@health.ny.gov with "Facility Name – DSRIP Safety Net Definition" as the subject.

Vital Access Provider (VAP) Exception

The Vital Access Provider (VAP) Exception is an appeal process opening on September 29, 2014 for all Medicaid providers, physicians and pharmacies for facilities that did not qualify by the Safety Net Definition by calculation or by appeal. If the exception is granted, then the applicant will be qualified and can fully participate in the DSRIP program. Non-qualifying facilities are limited; they may only receive up to 5% (as a group) of their PPS's award.

This appeal process will be used for any provider type that is not currently considered a safety net provider (See Safety Net Definition below) and intends to be a lead for the DSRIP Project Plan application. This may be your only opportunity to obtain the required safety net status to be a lead.

The VAP Exception is defined in Special Terms and Conditions (STC) 2 of the DSRIP Section of the Partnership Plan STC as a part of the Safety Net Definition (below). There are three categories that a facility may appeal for a VAP exception under:

  1. A community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.
  2. Any hospital is uniquely qualified to serve based on services provided, financial viability, relationships within the community, and/or clear track record of success in reducing avoidable hospital use.
  3. Any state-designated health home or group of health homes.

For the first two categories, VAP Exception applicants must adequately demonstrate how, within a particular PPS, they meet the specific conditions described in the categories above.

The third category, health homes, will be evaluated on whether or not the applicant is a health home, regardless of the PPS they will join.

Please refer to the updated safety net providers lists to see if you already qualify as a safety net provider. The DSRIP VAP Exception form is due by 5:00pm, October 24, 2014. Late appeals will not be accepted. If you are already included on an approved safety net list, there is no need to apply for more than one list type unless your identifier (opcert, license, agency code, etc) does not include other services that you wish to be included.

Please note that the Department has created two VAP Exception forms expressly for the HCBS/1915i service providers and the State designated Health Homes and Downstream Care Management Agencies. The Health Home and Downstream exception form is for Health Homes and Downstream providers. The use of this form implies that you are using the third exception category: Any state-designated health home or group of health homes.

The HCBS-1915i provider exception form is for pending 1915i OMH, OASAS and Harm Reduction Providers. The use of this form implies that you are using the first exception category: A community will not be served without granting the exception because no other eligible provider is willing or capable of serving the community.

VAP Exception Appeal Forms and Instructions

Safety Net Appeal Forms