Friday, October 10, 2014

NEW VITAL ACCESS PROVIDER APPEAL DEADLINE; STATE DOH NOTES MANY MORE PROVIDERS MUST NOW APPLY FOR VAP EXCEPTION

Good afternoon,

The state Health Department reports that its deadline to apply for a Vital Access Provider Exception form is now extended to 5 p.m. Friday, Oct. 17 instead of the previously reported Tuesday, Oct. 14 deadline.

Additionally, all providers whose Safety Net status is pending, as listed below, must now file a Vital Access Provider Exception Form by the deadline.

Lists of providers are here:
 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip_safety_net_definition.htm) 
 
 as well as

(However the state's website has not yet been updated yet with this information.) 
Although the state health department has said that these lists are pending approval, and the completion of this form is a cautionary measure; and VAP Exception instructions state that if your list is pending approval, you will be granted a VAP Exception pending approval and you do not need to submit this form, IT IS IMPORTANT TO NOTE THAT THIS IS NO LONGER CORRECT. 

The Center for Medicaid and Medicare Services (CMS) approval process for special safety net lists (see list of impacted provider types above) has been delayed.  Therefore, to ensure that as many providers as possible are included in the Safety Net process, this form must be submitted in the case that these lists are not approved; or if the process is further delayed.
 
The Vital Access Provider (VAP) Exception form is posted on the DSRIP website here (scroll down toward bottom of page until you see VAP Exception Form Instructions and VAP Exception Form links; clicking on the links will open the relevant documents):
(http://www.health.ny.gov/health_care/medicaid/redesign/dsrip_safety_net_definition.htm):
Again, despite the dates listed on the form, the form is due by 5:00 pm, October 17, 2014.

The Vital Access Provider (VAP) Exception is an appeal process that is open 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. Note that 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. 

A facility may appeal for a VAP exception under the following three conditions:

  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.


If questions arise related to the Vital Access Provider Exception or DSRIP safety net process, please send an email to BVAPR@health.state.ny.us . All other questions can be directed to DSRIP@health.ny.gov.


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