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Cover Page

State of New York Department of HealthDelivery System Reform Incentive Payment (DSRIP) Program

Project Design Grant Application

There will be no extensions for this application. Any application submitted past the due date will not be considered.

Section 1 Lead Applicant Info & Project Point of Contact Section 6 List of VendorsSection 2 Partner Organization - Contact Info Section 7 Design Grant TimelineSection 3 Partner Organizations & Service Area Section 8 Data RequestSection 4 Project Program Overview & Description Section 9 Design Grant BudgetSection 5 Community Needs Assessment & Stakeholder Engagement ** Section 10

Special Terms & Conditions Attachment I Attachment J

(Recommend) - PowerPoint/Webinar

DSRIP LINK:

Application Due on: June 17, 2014

Project Advisory Committee (PAC) Form - (RELOCATED)

^ Due to changes, this section has been RELOCATED and made as a separate form which still needs to be filled out and can be found on the DSRIP website under "DSRIP Project Design Grant Application".

To understand the Project Design Grant Application, carefully and thoroughly read through the Instructions before completing this application.

As a reminder and an addition to the instructions, you MUST read through the following state documents which are provided on the DSRIP website (see link below).

https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm


NYS DOH DSRIP_Project Design Grant Application Section 1 Applicant Info_Project Contact_Partner Organizations

Project Point of ContactLead Applicant Information Primary Contact

Contact Person: Terence M. O'Brien1.1) Organization Name: Catholic Health Services of Long Island, co-established operator of Mercy Medical Center Address City State Zip Code

Operating Certificate # (Opcert): 2909000H Organization Address: 992 North Village Avenue Rockville Centre NY 11570Provider Type: Voluntary Hospital (Non CAH, Non Sole Community Provider) Contact Phone Number: (516) 705-3712 Extension:

Provider Type - OTHER: 02996725 Contact Email: terence.o'[email protected]: 02996725 1.4)

Billing Entity ID: Secondary ContactNPI #1: 1659330173 Contact Person: Robert D. GinsbergNPI #2: Address City State Zip Code

Federal Employer ID (FEIN): Organization Address: 992 North Village Avenue Rockville Centre NY 11570Contact Phone Number: (516) 705-3807 Extension:

Contact Email: [email protected]

1.2) Please provide a brief statement as to why the lead organization is qualified to serve in this capacity. ( Restricted to 3000 characters)

Characters used: 2997

1.3)

OR

#1 Is the lead applicant one of the following providers? None of the above %

OR Select One

%A. 2A 51.31%

YES

B. 2B 33.38%

OR

#3 Select One 3

For Safety-net definition, please see link:

Catholic Health Services of Long Island is an IDS that includes the safety net hospital Mercy Medical Center as well as St. Francis and St. Joseph Hospitals in Nassau, 3 hospitals in Suffolk, 3 nursing homes, home care, hospice and a center for special needs. There are 17,000 staff and 3,300 medical professionals within the system. CHS’s Suffolk County entities, including St. Catherine of Sienna, St. Charles and Good Samaritan Hospitals are partners in the Stony Brook Medicine PPS. CHS has strong alliances with other providers who share the mission to care for the underserved and a vision for an Integrated Delivery System supported by a strong community based population health management. Two important partners in PPS leadership will be St. John's Episcopal Hospital (SJE) and Visiting Nurse Service of NY (VNSNY). St. John's Episcopal Hospital (SJE) has served a diverse population with many social, economic and medical needs for over 100 years. It is a safety net hospital – over 90% of the services provided are to the Medicaid, dually-eligible and uninsured population. CHS has been providing (with the support of the NYS DOH) consulting and clinical services for over a year to improve the financial viability and quality of care of this critical safety net hospital--the only hospital in the Rockaways. CHS and SJE have already set the stage through several agreements for what is anticipated to be an increasing cooperative relationship.VNSNY has served vulnerable, at-risk, and chronically-ill populations across New York City and its knowledge of and experience in delivering patient-centered, innovative care in the community. VNSNY is a key provider in Queens and Nassau, particularly in the isolated geographic region of the Rockaways, and brings its community expertise and CBO network to this relationship.Major participants in the PPS are South Nassau Communities Hospital, the Addabbo network of FQHCs in Queens, and the Beacon Health Partners ACO and IPA. In managing a successful Medicare Shared Savings Program and ACO-like contracts with a number of major payors, Beacon has developed skill and expertise in the use of population health analytics and the management of risk.CHS brings qualified experience in merging the governance structures of multiple entities through its activities over the past 17 years integrating 6 hospitals and other health care facilities into its system, enabling care of high quality and reasonable cost. CHS, SJE and VNS, along with their combined network of over 100 other health and social service organizations including FQHCs, social service agencies, behavioral health programs, nursing homes, adult homes and private practitioners, will form the PPS led by CHS. Nassau University Medical Center (NUMC) has agreed to be a partner organization in the CHS PPS and CHS has agreed to be a partner in NUMC’s. CHS is engaged in a continuing dialogue with NUMC with the expectation of extending our collaborative relationship.

Based on the lead applicant provider type, please fill out the applicable section below to verify that you meet the DSRIP safety- net definition (Either Hospital OR Non-hospital based) :

Hospital: A hospital must meet one of the three following criteria to participate in a performing provider system: Non-Hospital Based Provider - Must meet the following criteria:

Not participating as part of a state-designated Health Home, must have at least 35 percent of all patient volume in their primary lines of business and must be associated with Medicaid, uninsured and Dual Eligible individuals. (Please indicate what %)

#2 - Must pass both A & B test (Please indicate what % for both tests)

At least 35 percent of patient volume in their outpatient lines of business must be associated with Medicaid, uninsured, and Dual Eligible individualsAt least 30 percent of inpatient treatment associated with Medicaid, uninsured, and Dual Eligible individuals

Must serve at least 30 percent of all Medicaid, uninsured and Dual Eligible members in the proposed county or multi-county community. (The state will use Medicaid claims and encounter data as well as other sources to verify this claim. The state reserves the right to increase this percentage on a case by case basis so as to ensure that the needs of each community's Medicaid members are met.(Please indicate what %)

https://www.health.ny.gov/health_care/medicaid/redesign/docs/safety_net_definitions.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/docs/safety_net_definitions.pdf


NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

2.1) Partner Organizations - Contact Information

1 Organization Name: 2 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip Code

Organization Address: Organization Address:Contact Person: Contact Person:

Contact Phone Number: Extension: Contact Phone Number: Extension:Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):


Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One


NPI #1: NPI #1: NPI #2: NPI #2:







NPI #1: NPI #1: NPI #2: NPI #2:







NPI #1: NPI #1: NPI #2: NPI #2:



NYS DOH DSRIP_Project Design Grant Application Section 3 Partner Organizations Service Area

Partner Organizations

3.1)Select One

Provide explanation (Restricted to 2000 characters):


Service Area3.2) Briefly describe the proposed service area for your entire emerging Performing Provider System below. (e.g. general overview, geographic location, any notable characteristics specific to your population, etc.) ( Restricted to 3000 characters)


Do any regulations need to be waived to accomplish a DSRIP partnership within your emerging Performing Provider System?

CERTIFICATE OF NEED (CON): This PPS will seek relief from requirements of the CON regulations, with specific waivers to be identified after DSRIP planning and design has concluded. Emphasis will be on streamlining and expediting the CON review process; limiting circumstances under which review is required. CO-LOCATION AND BEHAVIORAL HEALTH: Waiver is sought for co-location restrictions for services that integrate behavioral and physical health care and private physician practice and for a consistent set of operational & recordkeeping requirements across all NYS licensing agencies. DATA SHARING: Waiver sought on restrictions on data sharing, esp’ly in the behavioral health fields (OASAS, OMH), among PPS network partners. PATIENT TRANSITIONS, DISCHARGES, TRANSFERS AND CARE COORDINATION: Various agencies have regulations governing patient transitions, some duplicative or conflicting. These include but not ltd to: (a) Impediments to smooth, rapid transition of patients between care levels - admission, discharge, transfer regulations within DSRIP provider networks; (b) Care coordination regs that limit or delay referral of patients to Partners within the network; (c) Hospice need requirements and geographic limitations (This has been the subject of previous PHHPC recommendations); (d) Allowance for medical directors, nurse practitioners, and physician assistants to sign orders for home care. ANTI-TRUST: If NYS is unable to issue timely final regs allowing for PPSs to apply either for COPA or as Medicaid ACOs, this PPS network will request waivers of anti-trust regulations, creation of state-enacted safe harbors, and state action immunity from federal antitrust liability. SCOPE OF PRACTICE: To increase access & reduce cost, this PPS network will request that DOH work with the NYS Ed. Dept. to limit scope of practice requirements among licensed staff within PPS networks, provided limitations will not compromise patient safety.

The PPS's service area includes the Rockaways, sections of southeast Queens and many communities in the southern portion of Nassau County. It includes 40 zip codes with a population of 744,000 including about 236,000 Medicaid recipients. There is a high concentration of poverty accompanied by high medical and behavioral health needs in these two counties. The Rockaways is a community characterized by geographic isolation and poor health. The closure of Peninsula Hospital and the devastation by Superstorm Sandy in 2012 further compromised the community. SJE is the only hospital on the Rockaway Peninsula and residents' reliance on SJE has increased since Long Beach Hospital was shuttered by Sandy. The age distribution of the service area is atypical; with a high proportion of youths and seniors. Approximately 30% of the population is under the age of 20, significantly higher than in Queens County and all of New York City. The aged population is also disproportionately represented, primarily due to the prevalence of nursing and adult homes. The SJE service area has a higher percentage of individuals below the Federal Poverty Level than the rest of Queens and NYC. Minorities account for 65.4% of the population. The health of the Rockaways is poor when compared to Queens County and New York City on almost every measure, particularly for cardiovascular disease, obesity, diabetes and respiratory disease. 22.3% of adults have received counseling and/or took medication for a mental health problem. This is higher than adults in Queens (12.5%) and NYC (15.2%) over all. The incidence of substance abuse and chemical dependency are also higher. Many members of the community use the ED when health issues arise and are not connected to primary care services. To get positive engagement, health care services must be local and easily accessible. One in four residents rated their health as fair to poor. Located in south central Nassau County, Mercy’s service area is quite diverse, as more than half the population belong to ethnic minorities. The area includes four of the eight highest poverty zip codes in the county. These zip codes alone accounted for 30% of total discharges and 48% of ED visits in 2012. Fully 45% of all individuals in the county below the poverty level live in Mercy's primary service area. Significant needs in the Mercy service area are diabetes education and control; obesity prevention, control and treatment; and the promotion of prenatal and early childhood health care. South Nassau Communities Hospital serves many of the same geographic areas as does Mercy. It has played a critical role in meeting the health needs of the residents of the South Shore since Superstorm Sandy shuttered Long Beach Hospital. Developing collaborative initiatives with SJE, directly west of Long Beach Island through our emerging PPS will significantly fill the gap in health care resources resulting from the closure of Long Beach Hospital.


NYS DOH DSRIP_Project Design Grant Application Section 3 Partner Organizations Service Area

3.3) Check off with a "X" of all the counties that are within your emerging Performing Provider System proposed service area.

Albany Herkimer Richmond (Staten Island)Allegany Jefferson RocklandBronx Kings (Brooklyn) Saint LawrenceBroome Lewis SaratogaCattaraugus Livingston SchenectadyCayuga Madison SchoharieChautauqua Monroe SchuylerChemung Montgomery SenecaChenango X Nassau SteubenClinton New York (Manhattan) SuffolkColumbia Niagara SullivanCortland Oneida TiogaDelaware Onondaga TompkinsDutchess Ontario UlsterErie Orange WarrenEssex Orleans WashingtonFranklin Oswego WayneFulton Otsego WestchesterGenesee Putnam WyomingGreene X Queens YatesHamilton Rensselaer

Please type in the letter "X" OR you can use the drop down menu:


NYS DOH DSRIP_Project Design Grant Application Section 4 Project Program Overview/Description

Project Program Overview

DSRIP Projects - Must choose a Minimum of 5, Maximum of 10:

Domain 2 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list B or C.Domain 3 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list A, B, C, D, E, F, G or H.Domain 4 - Must select 1 project, Maximum of 2 - At least 1 from sub list A, B, C or D.** Please see Appendix B in the Instructions for details of each Domain. For further information, see link below for the DSRIP Project Toolkit**

DSRIP Project Toolkit:

4.1)

Project #1- Sub-list A I.S.

2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

Project #2- Sub-list B or C I.S.

2.B.II Development of co-located primary care services in the emergency department (ED) 40

Project #3 I.S.

2.B.IV Care transitions intervention model to reduce 30 day readmissions for chronic health conditions 43

Project #4 I.S.

2.B.VII Implementing the INTERACT project (inpatient transfer avoidance program for SNF) 41

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 2 (Restricted to 4000 characters)


4.2)

Project #1- Sub-list AI.S.

3.A.I Integration of primary care services and behavioral health 39

Project #2- Sub-list A - HI.S.

3.B.I Evidence based strategies for disease management in high risk/affected populations (adult only) 30

https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_project_toolkit.pdf

Domain 2 (System Transformation) - Applicants must select a minimum of two projects, maximum of 4 from this domain (one of which must be from sub-list A and one of which must be from sub-list B or C)

(REQUIRED) Must choose 1 from sub list A-->

(REQUIRED) Must choose 1 from sub list B or C-->

(NOT REQUIRED) Can choose 1 from sub list A, B or C-->

(NOT REQUIRED) Can choose 1 from sub list A, B or C-->

2A.i – Creating an integrated delivery system is the linchpin of the DSRIP program. CHS has many of the required elements as its constituent entities include hospitals, home care, hospice, etc. CHS, in partnership with other hospitals, is in the process of acquiring a 50% share of a large ACO which operates in Nassau, Suffolk and Queens Counties. This successful ACO has a proven track record in managing hospital utilization through effective care management, has made significant use of population health tools, and has generated significant savings by reducing hospital utilization in the Medicare and commercial population. CHS will collaborate with VNSNY to provide community based care coordination across the myriad medical, behavioral and social providers serving PPS members to ensure the right care is delivered to patients at the right time and in the most appropriate setting. This emerging ACO is expected to serve all populations and payors in the Nassau, Suffolk and Queens marketplace.2bii – Development of co-located primary care services in the emergency department (ED). Patients will often present in an ED because they are unaware of more appropriate alternatives. Past explorations of community need have identified access to primary care as a key barrier to well being. CHS has included an urgent care company in its PPS to explore building an urgent care center on the grounds of the partner hospitals or directly adjacent to the hospital campus. A triage system will be developed so that patients with non-emergencies can be directed to the urgent centers, avoiding higher ED utilization and possible avoidable admissions. This urgent care delivery model will refer patient s back to their primary care physician. The care coordination provided by VNSNY can help patients connect to a PCP if they do not have their own. Resources can also be provided to assist patients in selecting a PCP and/or enrolling in a Medicaid PHSP or managed care plan. 2bIV Care TransitionsTransition from the institutional setting is a very vulnerable period with a high proportion of discharged patients being readmitted within 30 days. Effective care management is a guiding principle of the integrated approach the PPS has chosen to take. VNSNY is a major collaborator in the PPS and will be directly involved in using evidence-based care transition techniques to reduce the readmission rate of the population. VNSNY has extensive experience in reducing readmissions by working with hospital partners in implementing enhanced transitional care services. 2.b.VII – INTERACT: With many SNFs in our PPS, CHS has a significant opportunity to impact these specific types of avoidable readmissions. CHS and its partners have a robust history of implementing large-scale quality improvement programs with formalized leadership, training and implementation. The Rockaway peninsula in particular has a total of 17 nursing homes - the highest concentration of nursing homes in any part of New York State. This nursing home population has greater health needs than the norm of nursing home residents. The health care needs of these individuals are not managed optimally so that there is a very high rate of transfers between the nursing homes and the hospital. Due to the lack of preventive care available to many Rockaway residents the readmission rate for chronic health conditions is high. The PPS will implement a number of community-based initiatives to decrease the frequency of such readmissions. The PPS will be partnering with a company that has years of expertise in assessing the acuity of nursing home patients and providing physician and nurse practitioner services in the nursing home so that residents can receive more of the basic primary services needed to limit the need to be admitted to the hospital on a frequent basis. VNSNY’s transitional care expertise may also be leveraged in these efforts..

Domain 3 ( Clinical Improvement) – Applicants must select at least two projects from this domain (one of which must be A. Behavioral Health), but can submit up to 4 projects from Domain 3 for scoring purposes

(REQUIRED) Must choose 1 from sub list A-->

(REQUIRED) Must choose 1 from sub list A, B, C, D, E, F, G or H-->

https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_project_toolkit.pdf



Project #3- Sub-list A - H I.S.

3.C.I Evidence-based strategies for disease management in high risk/affected populations (adults only) 30

Project #4- Sub-list A - H I.S.

Select One 0 0



4.3)

Project #1- Sub-list A-D I.S.

4.A.I Promote mental, emotional and behavioral (MEB) well-being in communities 23

Project #2- Sub-list A-D I.S.

Select One 0 0



(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or

H-->

(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or

H-->

3a1 Integration of primary and behavioral health–The relationship between unmet behavioral health needs and avoidable hospitalization is well documented. In recent community service plan developed by SJE, the Rockaways had more than twice the rate of substance abuse than in Queens and higher than all of NYC. Many of the PPS communities have a large number of residents with unmet medical and behavioral health needs. Data has shown that many patients visiting their PCP have untreated psychological issues. Similarly, many patients accessing mental health services on a regular basis are not getting any medical care. The PPS has identified physicians, clinics and FQHCs which will develop communication strategies and programs with neighborhood behavioral health providers so that more needs are met. Many patients treated medically by St. John's present with mental health comorbidities. This contributes to the high number of E.D. visits and inpatient admissions, many of which are avoidable. Length of stay and readmit rates are also above the norm due to the dual diagnosis nature of these patients. St. John's will continue to collaborate with behavioral health providers in the Rockaways as well as increasing its own capabilities in maintaining and improving the health status of these patients so that they can better cope in their environment, thus limiting the need for acute interventions for emotional problems. 3. B.i. Cardiac disease is a major health problem in the Rockaways due to a higher prevalence of risk factors in the population. CHS has already begun to address this problem by providing cardiac services to the Rockaway community through a clinical relationship between St. Francis Hospital (the Heart Center) and St. John's. St. Francis Hospital is a nationally recognized leader in cardiovascular care (ranked 8th nationally in US News and World Report). St. Francis cardiologists run the cardiac clinics and provide diagnostic and consultative services to both the inpatient and outpatient programs. As further needs are identified, additional cardiac programs can be established. VNSNY also has a center of excellence in cardiovascular disease management. 3.C.i Diabetes Care – Mercy has a centralized diabetes care center with a strong local presence which is currently being enhanced. Poor glycemic control is associated with an increase in emergency room visits, hospitalizations, and length of stay (HANYS, 2011). Four communities in Nassau County - Roosevelt, Uniondale, Hempstead and Freeport - have the highest rates of hospitalization for Type 2 diabetes and are in Mercy’s primary service area. The rate of hospital admissions for uncontrolled diabetes for these areas is 275% of the expected admissions rate in New York State, and that for African-Americans 362%, according to the New York State Prevention Quality Indicators website. In 2007, 286 residents of the Rockaways died from diabetes mellitus which is more than 2 times higher than the Queens rate and nearly 2 times higher than the NYS rate. The implementation of diabetes self-management education in these service areas has a great potential to yield positive clinical and behavioral outcomes and reduce avoidable emergency room visits and hospitalizations.

Domain 4 (Population-wide Strategy Implementation) – Applicants must select at least one project from this domain, but can submit up to 2 projects from Domain 4 for scoring purposes.

(REQUIRED) Must choose 1 from sub list A, B, C, or D-->

(NOT REQUIRED) Can choose 1 from sub list A, B, C, or D-->

The PPS recognizes that maintaining the mental, emotional and behavioral well-being of the population will result in lower utilization of medical and behavioral health services. We are committed to working with all community resources, including those that do not provide services reimbursed by Medicaid, to improve the quality of life, and through that the wellness, of the people residing in our service area.



Project Description

4.4)


4.5)


4.6)

Provide a brief executive summary of your emerging Performing Provider System's vision and goals and how your emerging Performing Provider System hopes to sustain these achievements beyond the DSRIP program timeframe. (Restricted to 3000 characters)

The vision and goal of the CHS PPS is to develop an integrated delivery system that achieves better quality, lower cost and improved patient experience for the Medicaid and indigent populations in its service area. CHS will also expand the IDS to serve all populations and payors. It envisions a delivery system that is patient centered, transparent, collaborative, accountable, and value driven. By leveraging DSRIP, the PPS will develop the infrastructure to identify population health needs, implement a robust community care management program, build access to primary care, integrate behavioral health, and promote patient centric policies to fully engage patients in their care.The PPS will establish a governance structure that enables partnering providers to develop integrated data systems, share common protocols, and oversee the implementation of DSRIP projects. The PPS will evolve into a network of providers that have aligned incentive payments to ensure care is delivered in the most appropriate, cost effective setting focusing on primary care and community-based services. It will agree on outcome metrics, performance standards, funding distribution formulas, and transparent reporting requirements. The funding distribution formulas will focus rewarding downstream providers and community-based services.The PPS will have a workforce plan that will train and hire staff that has been displaced from hospitals. The transformation in the delivery system will require trained staff to support the needs of population care management, community-based care coordination, and increased primary care access.The PPS will be sustained in the future by developing risk and value-based contracts with payers and managed care entities. CHS management has extensive experience in managing shared and full risk contracts with many managed care companies, including PHSPs. This payment source should be sufficient to support the population health infrastructure and PPS network created through the DSRIP process. Through engagement with partners and community stakeholders, sharing of a common vision and goals, and achievement of positive outcomes, we are confident that the DSRIP transformation will be sustained in the future.

Why does your emerging Performing Provider System, as a whole, feel uniquely qualified to participate in DSRIP and serve the area you have proposed? (Restricted to 3000 characters)

The CHS PPS includes an extensive network of providers in the Rockaways, southeastern Queens, and Nassau. These providers offer an array of safety net services for the Medicaid and uninsured populations including primary care, mental health services, substance abuse treatment, supportive housing, community-based care coordination and long term care. In the spirit of collaboration, CHS has joined forces with VNSNY in the Rockaways and consolidated its emerging PPS with the Rockaway Wellness Partnership. This partnership brings together over 80 community-based organizations that have been pioneering an innovative grass roots care management initiative. This model uses the framework of the IHI Triple Aim Collaborative and has created a public health coaching program in key community hot spots. VNSNY will lead the care management efforts for the CHS PPS. VNSNY is uniquely positioned to serve as an integrator of care among the array of partners in the CHS PPS. VNSNY has invested major resources in population health and developing integrated care delivery teams supported by Altruista Guiding Care, a care coordination platform that helps providers develop and share care plans that assess each patient’s level of risk and reduce variations in care.In addition, the CHS PPS includes the leading safety net providers that are trusted by its community. The Joseph P Addabbo FQHC has a long history of serving the Rockaway community with 5 centers that provide primary and specialty care to over 20,000 Medicaid recipients. St. John’s and the Addabbo Centers have a strong collaboration and partnership in the delivery of health care services in this community. St. John’s has been a cornerstone of health care on the Rockaway peninsula for many years. With the closure of Peninsula Hospital in 2012 it has become the sole hospital serving the Rockaway population that has a heavy concentration of Medicaid members. Mercy Hospital is also a leading, trusted safety net provider. Serving southern Nassau, Mercy, in addition to its own ambulatory care programs, has linkages with programs for primary, specialty and mental health services. The Hospital has links with a significant provider network serving the Medicaid population.

What specific challenges does your emerging Performing Provider System foresee that could hinder the implementation of its DSRIP Project Plan? (Restricted to 3000 characters)

Providers that have various levels of capacity and experience in collaboration will have to work together to achieve common goals. Separate and competing entities with varying cultures will have to learn new ways of cooperating. They will have to change the way care is delivered, driving care to outpatient settings and lower cost alternatives. Change is difficult and this is going to take a level of commitment that may not be universally accepted by the various partners. This will take leadership and continuous education. Partners will also need to agree on the DSRIP projects and the respective roles they will play in each project. Balancing the need to develop common protocols and to be inclusive of all parties will be a challenge. Not all partners will have the same capacity to adapt to the changes, and to produce the needed outcomes. Partners may be concerned that they will lose market share if they are not included in projects.Care coordination will require data sharing in real time in a manner that does not presently exist. Sharing data among multiple providers at various levels of automation is a significant challenge. This will take a tremendous investment in IT resources and commitment.Designing the flow of funds will be another challenge. There needs to be sufficient incentive for providers to get the level of attention needed to bring about change. The various partners have to agree on the distribution methodology. This will require compromise and collaboration.


NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

Community Needs Assessment

Examples of items to include in the descriptions can be found in the instructions.

Description

5.1)

Planning and Organizing


Description

Description - Each box is restricted to 5000 characters.

~ Keep in mind, the description box will expand as you type ~

The PPS will create an Executive Committee to design, structure and develop the Community Needs Assessment (CNA). Committee members will consist of representatives of the lead organizations—St. John's Episcopal Hospital, CHS, South Nassau Communities Hospital, VNSNY—and other key partners such as the Addabbo FQHC, Beacon Health Partners ACO and leading behavioral health and substance abuse providers. This Executive Committee will form the basis of an enduring health improvement council that will establish a culture of wellness and set a shared vision for eliminating disparities and improving access to quality, coordinated care. The Executive Committee will meet frequently during the CNA phase to monitor progress and to identify system level improvement opportunities. The objective will be to emerge with a sustainable business model in partnership with key community stakeholders.Preliminary tasks include the review of currently available data through the state and other public sources. A review will also be conducted of existing needs assessments formulated by participating organizations such as hospital community service plans. This initial assessment will guide the leadership in defining the scope and approach for conducting a comprehensive assessment of the needs of the community. A project plan for conducting the CNA will be developed in early July to enable time to complete the assessment that will guide project selection by September.An important step will be to identify community stakeholders that should be involved in the process. Community stakeholders will consist of a broad range of community leaders and representatives that reflect the ethnic diversity of the service area. Strategies to engage stakeholders to obtain input will be developed, and will include surveys, public meetings and focus groups. Ongoing reporting back of the CNA process to stakeholders is also critical. We expect that VNSNY will play a key role in the CNA. It has already begun the process of community activation through the formation of the Rockaway Wellness Partnership, a network of over 80 community organizations.



5.2)Characters used: 3284

Description

5.3)

Data Collection


Description

5.4)

Reporting


Needs Assessment Methodology

The Guide for Conducting Community Needs Assessment recommends gathering data from an extensive set of state and other sources, with a specific focus on the Medicaid and uninsured population. These data need to be tied to specific DSRIP projects and metrics that match the assessment findings to CHS’s chosen projects. The data will include demographics, health status and greatest health risks among residents, health service challenges, and other required information. These data will be mapped to determine which geographic areas have the highest needs. Health care and pertinent community based resources will be identified and mapped. A key component will be hearing the “voice of the community’ through focus groups and meetings with providers and community members. A preliminary assessment of existing data will be shared with the PPS leadership and partners to refine what additional measures need to be collected. Initially the process will include:1. Demographics: A comprehensive assessment of the demographics and health needs of the population; description of community to be served; a. Population health status and distribution of identified health issuesb. Identification of the main health and health service challenges facing the community, including causes of poor health status and broad determinants of health2. Asset Mapping: An inventory of health care and community resources available in the service area including providers’ capacity, service area, Medicaid status, areas of expertise, as well as data on availability, accessibility, affordability, and acceptability of available health services. 3. Qualitative Data: Conduct surveys, focus groups and town hall meetings 4. Evaluation of gaps in service5. Assessment of which projects could best fit the need identified 6. Documentation of the process and methods used to conduct the assessment, sources and time periods of data used & information on how the preliminary findings of the assessment were shared with collaborating organizations.A key component of the CNA will be the collection of qualitative data from community providers and Medicaid recipients. Collecting data from their perspective is critical to understanding access gaps and social determinants of health—behavioral risk factors, socioeconomic factors, transportation barriers, and lack of basic resources such as affordable housing. As mentioned above, key stakeholders are being identified and engaged in the process. A survey will be developed and conducted with stakeholders to determine access issues for low-income residents. The survey will probe coordination issues and social determinants of health. A major focus will be on primary care and behavioral health access issues. Project staff will also conduct focus groups with consumers and service providers. This information will enrich findings by providing examples of challenges residents face in obtaining the right care and in following through with care plans. These conversations will also solicit peoples’ beliefs about what constitutes “good care” and how health care providers can best engage community residents. Project staff will create user-friendly reports to share with the public and other providers and upload them to CHS’s website.

CHS will engage an expert consultant to guide the CNA process. CHS is considering a proposal from the VNSNY Center for Home Care Policy and Research to lead this effort. The Center has extensive experience in conducting needs assessment across the country and collecting and interpreting qualitative and quantitative data. Publically available data will be thoroughly researched, focusing on Medicaid recipients and the underinsured. It will be important to drill down to zip code level data, as the CHS service area of the Rockaways, southeast Queens and Nassau are subsets of counties and represent geographically isolated and distinct populations. To uncover “hot spots” it may be necessary to consider census tracts. Achieving this level of granularity and to ensure consistency may require the purchase of data.

The CHS PPS will hold regular meetings with providers and community organizations to provide updates on the progress of the health needs assessment, preliminary findings and next steps. CHS will encourage feedback to assure that health care providers and other stakeholders are continually integrated into the assessment and planning process. The PPS will develop a website where reports and findings will be posted as well as frequently asked questions. Stakeholders will be invited to join the CHS PPS mailing lists where weekly updates will be sent as well as information on upcoming meetings and webinars.



Stakeholder Engagement

5.5) As an emerging Performing Provider System, please explain the process on how you plan to engage the key stakeholders to develop your DSRIP Project Plan? (Restricted to 3000 characters)

(Key stakeholders should not be a part of the emerging Performing Provider System) - See instructions for examples of key stakeholders


CHS appreciates the importance of stakeholder engagement and has sought the assistance of the VNSNY as an integrator of community activation. CHS and VNSNY will jointly lead a process of engaging the stakeholders in rethinking the future and developing a shared vision. The CHS PPS will define a business model that is sustainable and transformative.The process of stakeholder engagement has already begun. On June 12, CHS and VNSNY kicked off the process by engaging a wide coalition of community providers in the Rockaways to participate in a visioning process. Community thought leaders began to scope out the future health care delivery system and gave input on current access and disparity issues. This type of town hall meeting will continue throughout the needs assessment process to ensure the broadest input from across the community. Formal governance of the PPS will include an Executive Committee, technical workgroups, and regional hub workgroups. The CNA will include surveys, focus groups and town hall meetings to gather information and provide feedback on the process. A website will be established to report on the progress and obtain feedback. Regular communication via social media will augment other engagement strategies. Stakeholders will be given the opportunity to comment on the project plan as well as key findings.


NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

List of Vendors

6.1)

1 Organization Name Welsh Analytics LLC 2 Organization Name Brown and Weinraub, PLLCAddress City State Zip Code Address City State Zip Code

Organization Address 1017 Onondaga Road Niskayuna New York 12309 Organization Address 50 State Street, 4th Floor Albany New York 12207Contact Person James B. Welsh,PhD Contact Person Neil Benjamin

Contact Phone Number 518-256-8798 Extension: Contact Phone Number 518-427-7350 Extension:

Contact Email [email protected] Contact Email

Characters used: 993 Characters used: 2033 Organization Name Beacon Health Partners 4 Organization Name CareNext LLC


Organization Address 1600 Stewart Avenue Westbury NY Organization Address 2500 Westchester Avenue Purchase NY 10577Contact Person Jonathan Goldstein Contact Person Richard Kaplan

Contact Phone Number (516) 570-3580 Extension: 11590 Contact Phone Number (914) 251-0300 Extension:

Contact Email [email protected] Contact Email [email protected]

Characters used: 216 Characters used: 1415 Organization Name VNSNY Center for Home Care Policy and Research 6 Organization Name Cicero Consulting Associates


Organization Address 1250 Broadway New York NY 10001 Organization Address 710 Westchester Avenue White Plains NY 10604Contact Person Sarah Larson Contact Person Frank T. Cicero, MD

Contact Phone Number 212-609-7563 Extension: Contact Phone Number (914) 582-8895 Extension:

Contact Email Contact Email [email protected]

CCA will be engaged to assist in the planning and development of various DSRIP projects.

Characters used: 988 Characters used: 88

Applicant must list contact information of any vendor they plan to contract with to assist in their DSRIP planning efforts. **The state maintains the right to approve any vendor used in the DSRIP program.**

[email protected]

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Welsh Analytics is a single-member LLC established in 2011 and dedicated to the analysis of health care needs, resources, and opportunities for innovation. The principal, Dr. James Welsh, has provided such analysis for health systems, non-profits, behavioral health advocates, public entities, and others, after a 24-year career in policy analysis and planning at the New York State Departments of Social Services and Health. He holds a doctorate in social psychology from Harvard University and undertook post-doctoral training in clinical research on behavioral health at The University of Chicago and Michael Reese Medical Center. Welsh Analytics will assist the PPS in the Community Needs Assessment (CNA), by preparing data files from Census Bureau ACS, SPARCS, agency service locations, etc.; presenting summaries to CNA participants to inform the CNA; advising on the design, execution and analysis of surveys; assessing available data from PPS partners and DoH; and related tasks.





Brown and Weinraub, with an extensive practice in Health law and regulation, will provide assistance to the PPS Network in completing the DSRIP Application including the DSRIP Project Design Application.





Successful experience in managing a Medicare Shared Savings Plan ACO and commercial managed care contracts through its IPA. Beacon will assist in the planning and development of the PPS's Integrated Delivery System.





Extensive experience in managing nursing homes CareNext will offer assistance in integrating the nursing homes into the PPS delivery system.

[email protected]





The mission of the VNSNY Center for Home Care Policy and Research (CHCPR) is to conduct scientifically rigorous, practice- and policy-relevant research and to support informed decision making by providers, policy makers, purchasers and consumers. Unique in the home care industry, CHCPR draws its strength from its ability to both synthesize and enhance the programmatic, clinical, technical and administrative resources of this rapidly evolving field. A broad network of collaborations with other health care researchers, schools of nursing and medicine, and practitioners across the US is central to the Center's work. CHCPR focuses its activities in four main areas: 1) improving the quality, management, and outcomes of health servies at home; 2) informing post-acute and long-term care policy; 3) serving vulnerable populations; and 4) preparing communities for an aging population. CHCPR's 29 member staff includes six PhD investigators and 13 master's level trained researchers





mailto:[email protected]

mailto:[email protected]


NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

7 Organization Name 8 Organization NameAddress City State Zip Code Address City State Zip Code

Organization Address Organization AddressContact Person Contact Person

Contact Phone Number Extension: Contact Phone Number Extension:

Contact Email Contact Email

Characters used: 0 Characters used: 09 Organization Name 10 Organization Name





Characters used: 0 Characters used: 011 Organization Name 12 Organization Name





Characters used: 0 Characters used: 0


























NYS DOH DSRIP_Project Design Grant Application Section 7 Design Grant Timeline

Design Grant Timeline7.1)

Date (MM/DD/YYYY) Action/Decision/Milestone6/26/2014 Action Submission of DSRIP Planning Grant Application7/3/2014 Action Schedule initial PAC meeting7/6/2014 Milestone Engage vendor for community needs assessment7/7/2014 Milestone First meeting of PAC Executive Committee

7/15/2014 Milestone First PAC meeting7/22/2014 Milestone Present recommended projects to PAC7/31/2014 Decision Vendor selected for population health7/31/2014 Milestone Creation of website8/1/2014 Action Review feedback from NYS on application

8/11/2014 Decision Meeting with Exec. Comm. To adjust project selection as necessary8/13/2014 Action PAC meeting to present project selection for comment8/14/2014 Action Schedule meeting with stakeholders to review project selection and solicit feedback8/15/2014 Milestone Completion of community needs assessment8/19/2014 Action Review community needs assessment8/22/2014 Action Begin review of draft template application

8/22/2014 DecisionBased on community needs assessment determine if preliminary project selections should be adjusted

8/27/2014 Action Review project selection with Exec. Committee8/29/2014 Milestone Community surveys distributed as part of Community Needs Assessment process

9/1/2014 Action9/3/2014 Milestone Present recommended projects to stakeholders

9/10/2014 Milestone Determine metrics for selected projects9/15/2014 Action Review metrics with Exec. Comm.9/19/2014 Action Review metrics with PAC9/22/2014 Milestone Submit comments on draft application to state9/22/2014 Action Schedule meetings with appropriate partners to outline each DSRIP project9/30/2014 Milestone First drafts developed for each project with metrics selected10/1/2014 Action Begin preparation of final DSRIP Plan

10/15/2014 Action Executive Committee Meeting10/18/2014 Action PAC meeting 10/22/2014 Action Stakeholder meetings11/3/2014 Decision Select managed care partner(s) for development of risk agreements

11/12/2014 Action Executive Committee Meeting11/20/2014 Action PAC meeting 12/15/2014 Action Submit DSRIP Plan12/17/2014 Action Executive Committee Meeting12/18/2014 Milestone Begin review of applications posted to web12/19/2014 Action PAC meeting 12/22/2014 Decision Determine if major changes to approach necessary12/23/2014 Action Stakeholder meetings1/13/2015 Action Executive Committee Meeting1/15/2015 Action PAC meeting 1/20/2015 Milestone Submit comments on plan applications2/18/2015 Action Executive Committee Meeting2/20/2015 Action PAC meeting 2/25/2015 Action Stakeholder meetings2/28/2015 Action Review assessor comments on submitted applications3/18/2015 Action Executive Committee Meeting3/20/2015 Action PAC meeting

Select OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

Description (Up to 1200 characters)

Initiate discussions with PHSPs and HMOs regarding establishment of risk agreements for Medicaid members


NYS DOH DSRIP_Project Design Grant Application Section 8 Data Request

Data Request

8.1) Please identify any additional data that would be helpful in completing your DSRIP Project Plan. For additional help, please see link below.

Type of Data

DSRIP Resources Link:See pages 87-92

Explanation of why this additional data will be helpful (Up to 1500 characters in each line)

https://www.health.ny.gov/health_care/medicaid/redesign/docs/waiver_amendment_update_present.pdf

https://www.health.ny.gov/health_care/medicaid/redesign/docs/waiver_amendment_update_present.pdf


NYS DOH DSRIP_Project Design Grant Application Section 9 Design Grant Budget

Design Grant Budget9.1)

* Only include direct expenses related to developing your DSRIP Project Plan application.

Budget Cost Category Amount

Community Needs Assessment Costs:Contractors/Vendors $ 50,000 Data Analysis $ 50,000

Other:

Total Community Needs Assessment Costs: $ 100,000

Stakeholder Engagement Costs:AdvertisingWebsite Design $ 30,000 Meeting Costs $ 20,000

Other:

Total Stakeholder Engagement Costs: $ 50,000

Application Development Costs:Other:

Total Application Development Costs: $ -

Other Category: Management StaffProject Director $ 60,000 Director of Finance $ 100,000

Total $ 160,000

Other Category: ConsultingCommunity outreach $ 50,000 Planning $ 30,000 Geriatric care management $ 25,000 Long term care, sub acute care analysis $ 25,000 PCP engagment, PCMH development $ 30,000 Data review and evaluation $ 30,000

Total $ 190,000

Grand Total $ 500,000



Capital Needs

9.2) Yes

If so, how much ? (Estimate): $ 60,000,000

If you selected 'Yes' or 'Maybe' in 9.2, please answer questions 9.3 and 9.4:

9.3)

Category Dollar Amount ($) Category Dollar Amount ($)Renovation $ 20,000,000 Construction $ 15,000,000 IT Development $ 20,000,000 Equipment $ 5,000,000

9.4)

Does your emerging Performing Provider System anticipate needing capital funding to achieve the goals of your DSRIP Project Plan?

Please use the grid to state which types of costs the capital funds would be utilized for (e.g. construction, renovation) as well as approximately how much funding would be needed for each potential category.

Please describe which DSRIP projects these capital funds would be applied to and how the capital funds will help the emerging Performing Provider System achieve its project specific DSRIP objectives. (Restricted to 3500 characters)

Funds will be used for 1) completion of the emergency department renovation at SJEH (6 million), 2) critical infrastructure upgrades at SJEH (6 million), 3) construction and renovation funds to facilitate the collocation of primary care and urgent care services in the emergency departments, 4) enable partner FQHCs, clinics and group practices to include behavioral health services at their current locations, 5) create interoperablity and health information linkages with appropriate systems and providers across the PPS, including linking physicians, FQHCs, behavioral health services, 6)obtain nursing home and populatin health systems to manage process.


DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

State of New York Department of Health

Delivery System Reform Incentive Payment (DSRIP) Program

** Please read instructions for ease of use **

1 2 3 4 5 6 7 8 9 10

Organization Name Address City State Zip Person Phone # Extension Email

1 Long Island Living Center Y 431 Beach 20th Street Far Rockaway NY 11691 Amar Shetrit 718-327-2700 [email protected] Nursing Sisters Home Visiting Services N 110 Bi-County Boulevard, Suite 114 Farmingdale NY 11735 Terence O'Brien 516-705-3712 terence.o’[email protected] Visiting Nurse Service of New York Y 1250 Broadway, 4th floor New York NY 10001 Sarah Larson 212-609-7563 [email protected] FEGS Home Attending Services, Inc. Y 424 East 147th Street Bronx NY 10455 Gabe Sofos 212-491-6000 301 [email protected] Certificate for Comprehensive Community of Hospice Parker Jewish Insti N 271-11 76th Avenue New Hyde Park NY 11040 Stuart Almer 718-289-2352 [email protected] Primary Healthcare Plus, Inc. Y 1209 Hempstead Turnpike Franklin Square NY 11010 Jacqueline Delmont 516-610-8014 [email protected] Samaritan Village Y 138-02 Queens Blvd Queens NY 11435 Doug Apple 718-206-2000 1252 [email protected]

8Public Health Solutions/MIC Women's Health Services

Y40 Worth Street, 5th Floor New York NY 10013 Avital Havusha 646-619-6530 [email protected]


Y295 Flatbush Avenue Brooklyn NY 11201 Avital Havusha 646-619-6530 [email protected]


Y1873 Eastern Parkway Brooklyn NY 11233 Avital Havusha 646-619-6530 [email protected]

11 The Joseph P. Addabbo Family Health Center, Inc. Y 6200 Beach Channel Drive Arverne NY 11692 Robert P. Fliegel 718-945-7150 1308 [email protected] The Joseph P. Addabbo Family Health Center, Inc. Y 1288 Central Avenue Far Rockaway NY 11691 Robert P. Fliegel 718-945-7150 1308 [email protected] The Joseph P. Addabbo Family Health Center, Inc. Y 114-39 Sutphin Boulevard Jamaica NY 11434 Robert P. Fliegel 718-945-7150 1308 [email protected] The Joseph P. Addabbo Family Health Center, Inc. Y 118-11 Guy Brewer Boulevard Jamaica NY 11434 Robert P. Fliegel 718-945-7150 1308 [email protected] The Joseph P. Addabbo Family Health Center, Inc. Y 105-32 Rockaway Boulevard Ozone Park NY 11417 Robert P. Fliegel 718-945-7150 1308 [email protected] HELP/PSI Services Corp (FQHC, HIV Adult Day Healthcare) Y 105-04 Sutphin Boulevard Jamaica NY 11435 Sara Gillen 718-681-8700 3264 [email protected] Long Island FQHC, Inc. Y 380 Nassau Road Roosevelt NY 11575 David Nemiroff 516-572-0086 [email protected]

18Parker Jewish Institute for Health Care and Rehabilitation

Y1 Delaware Drive Lake Success NY 11042 Stuart Almer 718-289-2352

[email protected]

19Visiting Nurse Assocation of Long Island, Inc. N 100 Garden City Plaza Garden City NY 11530 Orael M. Keenan 516-739-1270 203 [email protected]

20 Queens Nassau Rehabilitation and Nursing Center Y 520 Beach 19th Street Far Rockaway NY 11691 Joshua Teitelbaum 718-471-7400 [email protected] Peninsula Center for Extended Care Y 50-15 Beach Channel Drive Far Rockaway NY 11691 Leo Friedman 347-481-2177 [email protected] Promenade Rehab Y 140 Beach 114th Street Rockaway Park NY 11694 Peter Gross 718-945-460023 West Lawrence Care Center Y 1410 Seagirt Blvd. Far Rockaway NY 11691 Jack Cytryn 718-471-7000 [email protected] Brookhaven Rehabilitation and Healthcare Center Y 250 Beach 17th Street Far Rockaway NY 11691 Gladys Cadet 718-471-7500 101 [email protected] Beacon Rehab and Nursing Y 140 Beach 113th Street Rockaway Park NY 11694 718-945-6350 [email protected]

2.1) Partner Organizations - Contact Information General Provider Types

Fill out this form for the specific provider types we have listed in columns L & M

For all "Other" provider types, use the 2nd tab - Section 2.2_Partner Org_"Other".

SN Qualified (Y/N)



26 Haven Manor Health Care Center Y 1441 Gateway Boulevard Far Rockaway NY 11691 Joseph Fass 718-471-1500 [email protected] Horizon Care Center Y 64-11 Beach Channel Drive Arverne NY 11692 Nicole Markowitz 718-945-0700 [email protected] (Attn: Ms. Nicole28 Rockaway Care Center Y 353 Beach 48th Street Far Rockaway NY 11691 Mitchell Wechter 718-471-5000 [email protected] Bishop Charles Waldo MacLean Episcopal Nursing Home Y 1711 Brookhaven Avenue Far Rockaway NY 11691 Michael Biderman 718-869-8033 [email protected] Barnwell Nursing and Rehabilitation Center Y 3230 Church St Valatie NY 12184 Michael Schrieber 917-846-6680 [email protected] Carillon Nursing and Rehabilitation Center Y 830 Park Avenue Huntington NY 11747 Michael Schrieber 917-846-6680 [email protected] East Neck Nursing and Rehabilitation Center Y 134 Great East Neck Road West Babylon NY 11704 Michael Schrieber 917-846-6680 [email protected] Mills Pond Nursing and Rehabilitation Center Y 273 Moriches Road St. James NY 11780 Michael Schrieber 917-846-6680 [email protected] New Sea Crest Health Care Center N 3035 West 24th Street Brooklyn NY 11224 Michael Schrieber 917-846-6680 [email protected] Parker Jewish Institute for Health Care & Rehabilitation Y 271-11 76th Avenue New Hyde Park NY 11040 Lorraine Breuer 718-289-2102 [email protected] Sayville Nursing and Rehabilitation Center N 300 Broadway Sayville NY 11788 Michael Schrieber 917-846-6680 [email protected] Shore View Nursing Home Y 2865 Brighton 3rd Street Brooklyn NY 11235 Michael Schrieber 917-846-6680 [email protected] Workmens Circle Multicare Center Y 3155 Grace Ave Bronx NY 10469 Michael Schrieber 917-846-6680 [email protected] New Surfside Nursing Home Y 22-41 New Haven Avenue Far Rockaway NY 11691 Saul Feintuch 718-471-3400 [email protected] Rockaway Care Center Y 353 Beach 48th Street Far Rockaway NY 11691 Leo Friedman 347-481-2177 [email protected] Woodmere Rehabilitation and Health Care Center Y 121 Franklin Place Woodmere NY 11598 Debbie Flack 516-374-9300 [email protected] Forest Hills Care Center Y 7144 Yellowstone Blvd Forest Hills NY 11375 Boris Nisanov/Controller 718-544-4300 [email protected] Mercy Medical Center - Family Counseling Services Y 385 Oak Street Garden City NY 11530 David Flomehaft 516-705-3400 2004 [email protected] Bridge Back to Life Center, Inc. Y 4271 Hempstead Tpke Bethpage NY 11714 Gary Butchen 212-679-4960 [email protected] Catholic Charities Diocese of Rockville Centre - Chemical Dependence SerY 30C Carlough Road Bohemia NY 11716 Kathleen Brown 631-543-6200 318 [email protected] Catholic Charities Diocese of Rockville Centre - Chemical Dependence SerY 155 Indian Head Road Commack NY 11725 Kathleen Brown 631-543-6200 318 [email protected] Catholic Charities Diocese of Rockville Centre - Chemical Dependence SerY 31 East Main Street Hampton Bays NY 11946 Kathleen Brown 631-543-6200 318 [email protected] Phoenix Houses of New York, Inc. Y 34-25 Vernon Blvd Long Island City NY 11106 Dr. Steve Margolies 917- 572-4451 [email protected] Phoenix Houses of New York, Inc. Y 164 West 74th Street New York NY 10023 Dr. Steve Margolies 917- 572-4451 [email protected]

50Bridge Back to Life Center, Inc

Y3044 Coney Island Avenue, 3rd Fl Brooklyn NY 11235 Gary Butchen 212-679-4960

[email protected] Bridge Back to Life Center, Inc Y 1688 Victory Blvd Staten Island NY 10314 Gary Butchen 212-679-4960 [email protected] Bridge Back to Life Center, Inc Y 4271 Hemstead Tpke Bethpage NY 11714 Gary Butchen 212-679-4960 [email protected] Bridge Back to Life Center, Inc Y 500 8th Avenue, Ste 906 New York NY 10018 Gary Butchen 212-679-4960 [email protected] Bridge Back to Life Center, Inc Y 175 Remsen Street, 10th Fl Brooklyn NY 11201 Gary Butchen 212-679-4960 [email protected] Five Towns Community Center Inc Y 270 Lawrence Ave Lawrence NY 11559 Bertha Pruitt 516-239-6244 [email protected] Catholic Charities Neighborhood Services (CCNS) Y 91-14 37th Avenue Jackson Heights NY 11372 Holly Jaskiewicz 718-779-1600 [email protected] Rockaway Mental Health Services Y 18-47 Mott Avenue Far Rockaway NY 11691 Helene 718-722-625858 Peninsula Counseling Center Y 50 W. Hawthorne Avenue Valley Stream NY 11580 Lois Goldsmith 516-204-1385 [email protected] PSCH Y 142-02 20th Avenue Flushing NY 11351 Robert Hettenbach 718-559-0535 [email protected] St. John's Episcopal Hospital - Blended Case Man Y 329 Beach 19th Street Far Rockaway NY 11691 Richard Brown 718-869-7320 [email protected] FEGS Y 175 Fulton Avenue Nassau NY 11550 Boris Vilgorin 212-366-8566 [email protected] FEGS Y 315 Hudson Street New York NY 10013 Kristin Woodlock 212-366-8402 [email protected] Pederson-Krag Center, Inc Y 55 Horizon Drive Huntington NY 11743 Dean Weinstock 631-920-8009 [email protected] Family Service League, Inc. Y 790 Park Avenue Huntington NY 11743 Jeff Steigman 631-427-3700 227 [email protected] Pilgrim Psychiatric Center - IP N 998 Crooked Hill Rd. West Brentwood NY 11717 Douglas J. Shelters Jr. 631-761-3802 [email protected] Pilgrim Psychiatric Center - OP N 998 Crooked Hill Rd. West Brentwood NY 11717 Douglas J. Shelters Jr. 631-761-3802 [email protected] Pilgrim Psychiatric Center - Yaphank N 31 Industrial Blvd. Medford NY 11763 Douglas J. Shelters Jr. 631-761-3802 [email protected] Pilgrim Psychiatric Center - ACT N 3 Grove Avenue Patchogue NY 11772 Douglas J. Shelters Jr. 631-761-3802 [email protected] Pilgrim Psychiatric Center - Peconic N 550 E. Main Street Suite 103 Riverhead NY 11901 Douglas J. Shelters Jr. 631-761-3802 [email protected] Mercy Medical Center - Outpatient Behavioral Health Clinic Y 385 Oak Street Garden City NY 11530 David Flomehaft 516-705-3400 2004 [email protected] Mercy Medical Center - Partial Hospitalization Program Y 385 Oak Street Garden City NY 11530 David Flomehaft 516-705-3400 2004 [email protected] Catholic Charities Diocese of Rockville Centre-Mental Health Outpatient Y 333 North Main Street Freeport NY 11520 Howard Duff 516-634-0012 126 [email protected] Catholic Charities Diocese of Rockville Centre-Mental Health Outpatient CY 9 Fourth Avenue Bay Shore NY 11706 Howard Duff 516-634-0012 126 [email protected] Catholic Charities Diocese of Rockville Centre-Mental Health Outpatient CY 1727 North Ocean Avenue Medford NY 11763 Howard Duff 516-634-0012 126 [email protected] New Horizon Counseling Center, Inc./Case Management Program Y 115-02 Ocean Promenade Rockaway Beach NY 11694 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Central Avenue Clinic Y 1622 Central Avenue Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Day Treatment Program Y 720 Beach 20th Street Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Far Rockaway Clinic Y 720 Beach 20th Street Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected]



79 New Horizon Counseling Center, Inc./Park Inn Home for Adults Clinic Y 115-02 Ocean Promenade Rockaway Beach NY 11694 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Ozone Park Clinic Y 108-19 Rockaway Blvd Ozone Park NY 11420 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Wavecrest Home for Adults Clinic Y 242 Beach 20th Street Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./West Rockaway Clinic Y 88-02 Rockaway Beach Blvd Rockaway Beach NY 11693 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./New Haven Manor for Adults Clinic Y 15-26 New Haven Avenue Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected] New Horizon Counseling Center, Inc./Elm York Home for Adults Y 100-30 Ditmars Blvd East Elmhurst NY 11369 Herrick Lipton 718-845-2620 [email protected] Federation of Organizations Y 2830 Pitkin Ave Brooklyn NY 11208 Elizabeth Galati 631-669-5355 1144 [email protected] Jewish Board of Family and Children's Services (JBFCS) Y 5030 Broadway New York NY 10037 Todd Schenk 212-632-4776 [email protected] OHEL Children's Home and Family Services Y 2925A Kings Highway Brooklyn NY 11229 Asher Fogel 718-435-5533 [email protected] Postgraduate Center for Mental Health (PCMH) Y 71 West 23rd Street, Suite 704 New York NY 10010 Charles Pearson 212-576-4116 [email protected] Services for the Underserved (SUS) Y 17-19 Montrose Avenue Brooklyn NY 11206 Donna Colonna 917-408-1600 [email protected] Transitional Services for New York, Inc. Apartment Program Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Bronx II Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Clinic Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Hazel House Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Hope House I Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Hope House II Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Phase I N 2 Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Phase I South 1 Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. Phase I South 2 Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected] Transitional Services for New York, Inc. PROS Y 10-16 162nd Street Whitestone New York 11357 Dr. Larry S. Grubler 718-746-6647 11 [email protected]

100 New Horizon Counseling Center, Inc./OPWDD Programs Y 720 Beach 20th Street Far Rockaway NY 11691 Herrick Lipton 718-845-2620 [email protected] Terence Cardinal Cooke Health Care Center Y 1249 Fifth Avenue New York NY 10029 Neil Pollack 212-360-3999 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/Y 1504 DePaul Street Elmont NY 11003 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/Y 30 Brinkerhoff Lane Manhasset NY 11030 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 70 McKeon Avenue Valley Stream NY 11580 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 380 Ed's Road Southold NY 11971 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 27 North Carll Avenue Babylon NY 11702 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 24 Gardiner's Lane Hampton Bays NY 11946 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 4 Hilton Court Aquebogue NY 11931 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 258 Deauville Blvd Copiague NY 11726 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 3 Lombardi Place Amityville NY 11701 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 3 Forest Place Huntington St NY 11746 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 662 Albin Avenu West Babylon NY 11704 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-People w/DY 339 County Line Road Amityville NY 11701 Diane Ammirati 631-665-3434 [email protected] Terence Cardinal Cooke Health Care Center Y 1249 Fifth Avenue New York NY 10029 Neil Pollack 212-360-3999 [email protected] Nassau University Medical Center Y 2201 Hempstead Turnpike East Meadow NY 11554 Dr. Victor Politi 516-572-6011 [email protected] Coney Island Hospital Y 2601 Ocean Parkway Brooklyn NY 11235 Shirley Appelhans 718-616-5351 [email protected] Elmhurst Hospital Center Y 79-01 Broadway Elmhurst New York 11373 Irene Kaufmann 718-334-1141 [email protected] Queens Hospital Center Y 82-68 164th Street Jamaica New York 11432 Irene Kaufmann 718-883-2275 [email protected] Bezalel Rehabilitation and Nursing Center Y 29-38 Far Rockaway Boulevard Far Rockaway NY 11691 Yossi Kraus 718-471-2600 106 [email protected] Nassau Extended Care Facility Y 1 Greenwich Street Hempstead NY 11550 Mitchell Teller 516-565-4800 3155 [email protected] Townhouse Center for Rehabilitation & Nursing Y 755 Hempstead Turnpike Uniondale NY 11553 David Lesser 516-565-1900 [email protected] Grandell Rehabilitation and Nursing Center Y 645 West Broadway Long Beach NY 11561 Marty Dicker 516-889-1100 [email protected] Rockville Skilled Nursing & Rehabilitative Center Y 50 Maine Ave Rockville Centre NY 11570 Susan Welge 516-536-8000 [email protected] The Grand Pavilion for Rehab & Nursing at RC Y 41 Maine Ave Rockville Centre NY 11570 Estredida Martin 516-536-7730 1010 [email protected] Park Nursing Home Y 128 Beach 115th Street Rockaway Beach NY 11694 Sue Zimet 718-474-6400 17 [email protected] Hempstead Park Nursing Home Y 800 Front Street Hempstead NY 11550 Israel Melnicke 516-705-9700 202 [email protected] Sands Point Center For Health & Rehabilitation Y 1440 Port Washington Blvd. Port Washington NY 11050 John Chowske 516-719-9400 3106 [email protected] Oceanview Nursing & Rehabilitation Center LLC Y 315 Beach 9th Street Far Rockaway NY 11691 Jake Hartstein 718-471-6000 120 [email protected] A. Holly Patterson Extended Care Facility Y 875 Jerusalem Avenue Uniondale NY 11553 Robert Heatley 516-572-1695 [email protected] Beach Terrace Care Center Y 640 West Broadway Long Beach NY 11561 Martin Zwick 516-431-4400 [email protected] Oceanside Care Center Y 2914 Lincoln Ave Oceanside NY 11572 Daniel Kret 516-536-2300 [email protected] St. Francis Hospital N 100 Port Washington Boulevard Roslyn NY 11576 Terence O'Brien 516-705-3712 terence.o’[email protected]



133 St. John's Episcopal Hospital - Main Y 329 Beach 19th Street Far Rockaway NY 11691 Richard Brown 718-869-7320 [email protected] St. John's Episcopal Hospital - ESRD Y 329 Beach 19th Street Far Rockaway NY 11691 Richard Brown 718-869-7320 [email protected] St. John's Episcopal Hospital - IP Psych Y 329 Beach 19th Street Far Rockaway NY 11691 Richard Brown 718-869-7320 [email protected] Mercy Medical Center Y 1000 North Village Avenue Rockville Centre NY 11570 Terence O'Brien 516-705-3712 terence.o’[email protected] Winthrop-University Hospital N 259 First Street Mineola NY 11501 Diane Bachor 516-663-4918 [email protected] South Nassau Communities Hospital N One Healthy Way Oceanside NY 11572 Richard J. Murphy 516-632-3939 [email protected] St. Joseph Hospital N 4295 Hempstead Turnpike Bethpage NY 11714 Terence O'Brien 516-705-3712 terence.o’[email protected] The Brooklyn Hospital Center Y 121 Dekalb Avenue Brooklyn New York 11201 Joan Clark 718-250-8588 [email protected] Mount Sinai Hospital of Queens Y 2510 30TH AVENUE LONG ISLAND CITYNY 11102-2448 Brian Radbill, MD 718-808-7441 Brian.Radbill@mountsinai.org142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186



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Assisted Living Facility OASAS (Article 32) Provider

OMH (Article 31) Provider

Critical Access Hospital (CAH) OPWDD (Article 16) provider

Public Hospital

Skilled Nursing Facility

Nursing Home

"OTHER" Providers - Fill out Section 2.2 11 12 13 15 16

Provider Type MMIS OPCERT NPI #1 NPI #2

Assisted Living Facility 590-F-328Certified Home Health Agency 00321935 2914600 1780670711Certified Home Health Agency 00299604 7002655 7002655 1528059805Certified Home Health Agency 00922270 9659L001 1619047131 1912164120Certified Home Health Agency 01865296 7003602F 1275609190Diagnostic & Treatment Center (Non FQHC) 02525803 2950209R 1194785824Diagnostic & Treatment Center (Non FQHC) 141211829, 16031121548347719 1982878757

02999737 7002296R 1467529529

02999737 7002296R 1467529529

02999737 7002296R 1467529529

Federally Qualified Healthcare Center (FQHC) 00990152 7003234R 1497700736Federally Qualified Healthcare Center (FQHC) 00990152 7003234R 1871848234Federally Qualified Healthcare Center (FQHC) 00990152 7003234R 1467708107Federally Qualified Healthcare Center (FQHC) 00990152 7003234R 1750638961Federally Qualified Healthcare Center (FQHC) 00990152 7003234R 1134476443Federally Qualified Healthcare Center (FQHC) 02952821 7000277R 1003093436Federally Qualified Healthcare Center (FQHC) 00331034 2908201R 1396059499 1962716050

009120657003902L

1184799587

02998089 2905900L 1932262383

Nursing Home 00310352 7003361N 1134231632Nursing Home 00332834 7003308N 1114922689Nursing Home 00308907 7003386N 1992856751Nursing Home 00312905 7003403N 1063401404Nursing Home 02046826 7003399N 1477609188Nursing Home 00310807 7003401N 1154314573

Provider Type: ONLY choose from the following:

Certified Home Health Agency

Diagnostic & Treatment Center (Non FQHC)

Federally Qualified Healthcare Center (FQHC)

Long Term Home Health Care Provider

Sole Community Provider (SCP)

Voluntary Hospital (Non CAH, Non Sole Community Provider)








Nursing Home 7003378N 1356339105Nursing Home 00308594 7003389N 1528052180Nursing Home 00309522 7003362N 1720249493 1780674192Nursing Home 00337242 7003356N 1215006960Nursing Home 00310632 1023301N 1609863232Nursing Home 00308383 5153306N 1265429856Nursing Home 00876444 5150303N 1235138165Nursing Home 00312029 5157316N 1780994046Nursing Home 00308865 7001390N 1154504405Nursing Home 00313511 7003307N 1851467369 1932275427Nursing Home 01374230 5154325N 1225374911Nursing Home 00310696 7001342N 1336134915Nursing Home 00311000 7000390N 1710328380Nursing Home 7003373N 1063419612Nursing Home 1780674192Nursing Home 2950315N 1861495202Nursing Home 7003394N 1639177272OASAS (Article 32) Provider 02996725 160310608 1659330173OASAS (Article 32) Provider 01439087 160310678 1518918101OASAS (Article 32) Provider 170510494OASAS (Article 32) Provider 03005263 150310585 1831222819OASAS (Article 32) Provider 03005245 160310586 1164555140OASAS (Article 32) Provider 140410033 1134297153OASAS (Article 32) Provider 160110034 1134297153

OASAS (Article 32) Provider01439087

1411112541518918101

OASAS (Article 32) Provider 01439087 141110677 1518918101OASAS (Article 32) Provider 01439087 160310678 1518918101OASAS (Article 32) Provider 01439087 160611342 1518918101OASAS (Article 32) Provider 01439087 141211343 1518918101OASAS (Article 32) Provider 02784169 170611513 1235265265OASAS (Article 32) Provider OMH (Article 31) Provider 00244624 6487101A 1548373921OMH (Article 31) ProviderOMH (Article 31) Provider 00244817 6797100A 1437262839OMH (Article 31) Provider 01456495 7401032A 1932125721OMH (Article 31) Provider 02237718 7001024H 1417245226OMH (Article 31) Provider 00257805 6287104A 1699714618OMH (Article 31) Provider 00257805 6287112A 1699714618OMH (Article 31) Provider 02993575 6816100A 1013964170OMH (Article 31) Provider 02996069 7171001 1528093242OMH (Article 31) Provider 00476715 1370811A 1578627485OMH (Article 31) Provider 00769228 1370512A 1578627485OMH (Article 31) Provider 00769228 1370493A 1578627485OMH (Article 31) Provider 00769228 1373951A 1578627485OMH (Article 31) Provider 00769228 1370431A 1578627485OMH (Article 31) Provider 02996725 6794100A 1659330173OMH (Article 31) Provider 02996725 6794320A 1659330173OMH (Article 31) Provider 00403181 6814107A 1831110972OMH (Article 31) Provider 00668864 68141008A 1124034558OMH (Article 31) Provider 03005254 68141002A 1437170537OMH (Article 31) Provider 02738301 1336347251OMH (Article 31) Provider 00688220 7442-101 1366430563OMH (Article 31) Provider 00688220 7442-300A 1366430563OMH (Article 31) Provider 00688220 7442-113 1366430563



OMH (Article 31) Provider 00688220 7442-111A 1366430563OMH (Article 31) Provider 00688220 7442-100A 1366430563OMH (Article 31) Provider 00688220 7442-112A 1366430563OMH (Article 31) Provider 00688220 7442-005A 1366430563OMH (Article 31) Provider 00688220 7442-110A 1366430563OMH (Article 31) Provider 00688220 7442-100B 1366430563OMH (Article 31) Provider 03011790 8032007A 1316006042OMH (Article 31) Provider 02996918 6709116A 1689755662OMH (Article 31) Provider 02149177 7637100A 1861465239OMH (Article 31) Provider 00244257 6728100A 1629127725OMH (Article 31) Provider 01304338 7320430 1881816643OMH (Article 31) Provider 0739762 6841433 145718337OMH (Article 31) Provider 0739762 6841437 145718337OMH (Article 31) Provider 0739762 6841101A 145718337OMH (Article 31) Provider 0739762 6841014 145718337OMH (Article 31) Provider 0739762 6841434 145718337OMH (Article 31) Provider 0739762 6841436 145718337OMH (Article 31) Provider 0739762 6841006 145718337OMH (Article 31) Provider 0739762 6841007 145718337OMH (Article 31) Provider 0739762 6841008 145718337OMH (Article 31) Provider 0739762 6841012A 145718337OPWDD (Article 16 Provider) 00688220 1366430563OPWDD (Article 16) provider 03001829 6660100 121510045OPWDD (Article 16) provider 02245930 6186445 1134240863OPWDD (Article 16) provider 06186443 6186443 1134240863OPWDD (Article 16) provider 02245930 6186447 1134240863OPWDD (Article 16) provider 02245898 6186446 1164540522OPWDD (Article 16) provider 02245930 6186450 1134240831OPWDD (Article 16) provider 02245930 6186449 1134240831OPWDD (Article 16) provider 02245930 6186447 1134240831OPWDD (Article 16) provider 02245930 6186444 1134240831OPWDD (Article 16) provider 02245930 6186441 1134240831OPWDD (Article 16) provider 02245930 6186442 1134240831OPWDD (Article 16) provider 02245930 6186453 1134240831OPWDD (Article 16) provider 02245930 61864521 1134240831OPWDD (Article 16) provider 03001829 6660100 1215100458Public Hospital 01962156 2950002H 1801857172Public Hospital 0246066 7001009H 1124032982Public Hospital 0246075 7003000H 1063426377Public Hospital 0246153 7003007H 1803903Skilled Nursing Facility 00806771 7003352N 1720159379Skilled Nursing Facility 01582269 2906305N 1437222163Skilled Nursing Facility 01701651 2950318N 1306875141Skilled Nursing Facility 00308883 2902304N 1851486914Skilled Nursing Facility 01934812 2909304N 1093708646Skilled Nursing Facility 00309655 2909305N 1811982705Skilled Nursing Facility 7003363n 7603364N 1154584886Skilled Nursing Facility 01860599 2906304N 1548346265Skilled Nursing Facility 01032920 2951304N 1225105364Skilled Nursing Facility 00310563 7003354N 1568452548Skilled Nursing Facility 0378703 2950302N 1497716534Skilled Nursing Facility 0309857 2902303N 1508893025Skilled Nursing Facility 2950314 1275521064Voluntary Hospital 00244046 2953000H 1043279565



Voluntary Hospital 00729382 7001024H 1346274537Voluntary Hospital 03005612 7001024H 1700049145Voluntary Hospital 03005603 7001024H 1528221959Voluntary Hospital 02996725 2909000H 1659330173Voluntary Hospital 00244211 2908000H 1114925567Voluntary Hospital 02999659 2950001H 1922079094Voluntary Hospital 01949875 2952006H 1881799153Voluntary Hospital 0243614 7001003H 1326046467Voluntary Hospital 2998570 7002024H 1245248939




1 2 3 4 5 6 7 8 9 10

Organization Name Address City State Zip Person Phone # Extension Email

1 Heritage Adult Care, Inc N 86-01 Rockaway Beach Boulevard Rockaway Beach NY 11693 Oleg Yavorouswy 718-318-0100 [email protected] The Abraham & Henrietta Malamut Community Health Center-Adult Day N 1 Delaware Drive Lake Success NY 11042 Stuart Almer 718-289-2352 [email protected] Park Inn Adult Home N 11502 Ocean Permanade Far Rockaway NY 11694 Hinda Burstin 718-634-3400 [email protected] Lakeville Ambulete Transportation, LLC Y 271-11 76th Avenue New Hyde Park NY 11040 Christopher Lynch 718-289-2275 [email protected] Harlem Dowling West Side Center Y 1603 Central Ave Suite 200 Queens NY 11691 Patricia Traynor 718-471-3303 405 [email protected] EAC Network Y 50 Clinton Street Hempsted NY 11550 Dr. Merrill Rotter 914-558-1691 [email protected] Catholic Charities Diocese of Rockville Centre - Meals-On-Wheels N 333 North Main Street Freeport NY 11520 Izabela Sliwowska 631-789-5219 2 [email protected] Catholic Charities Diocese of Rockville Centre - Women, Infants & Childre N 1000 N. Village Ave Rockville Centre NY 11570 Amy Agiato 516-733-7071 [email protected] Catholic Charities Diocese of Rockville Centre - Maternity Services N 29 Kirkwood Avenue Merrick NY 11566 Kathleen Ryan 516-223-7888 [email protected]

10 Catholic Charities Diocese of Rockville Centre-MHRS N 333 North Main Street Freeport NY 11520 Howard Duff 516-634-0012 126 [email protected] Catholic Charities Diocese of Rockville Centre - Senior Case Management N 333 North Main Street Freeport NY 11520 Paulette Jones 516-771-3861 [email protected] Catholic Charities Diocese of Rockville Centre - Senior Community Service N 379 Linden Street Massapequa Park NY 11762 Linda Pellicane 516-733-5805 [email protected] Catholic Charities Diocese of Rockville Centre - Visually Impaired ProgramN 12 St. James Place Lybrook NY 11563 Linda Pellicane 516-733-5805 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Mary's Manor Senior Housing Inwood NY 11096 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Peternana Terrace Freeport NY 11520 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Bishop Daly Gardens Uniondale NY 11553 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre - Commodity Supplemental N 38 St. John's Place Freeport NY 11520 Amy Agiato 516-733-7071 [email protected] Catholic Charities Diocese of Rockville Centre-MHRS-Teaching Family Ho N 38 St. John's Place Freeport NY 11520 Howard Duff 516-634-0012 126 [email protected] Catholic Charities Diocese of Rockville Centre-Parish Social Ministry NassaN 90 Cherry Lane Hicksville NY 11801 Jan Jamroz 516-733-7059 [email protected] Catholic Charities Diocese of Rockville Centre - Senior Community Service N 619 Fenworth Blvd. Franklin Square NY 11010 Linda Pellicane 516-733-5805 [email protected] Catholic Charities Diocese of Rockville Centre - Senior Community Service N 80 Anchor Avenue Oceanside NY 11572 Linda Pellicane 516-733-5805 [email protected] Catholic Charities Diocese of Rockville Centre-Congregate Meal Site-SenioN 1309 Wantagh Avenue Wantagh NY 11793 Linda Pellicane 516-733-5805 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Bishop Kellenberg Oceanside NY 11572 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N St. Agnes Village Uniondale NY 11553 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N St. Hedwig's Floral Park NY 11001 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre - Commodity Supplemental N 66 North 19th Street Wyandanch NY 11798 Amy Agiato 516-733-7071 [email protected] Catholic Charities Diocese of Rockville Centre N 143 Schleigel Blvd. Amityville NY 11701 Amy Agiato 516-733-7071 [email protected] Catholic Charities Diocese of Rockville Centre - Meals-On-Wheels N 143 Schleigel Blvd. Amityville NY 11701 Izabela Sliwowska 631-789-5219 2 [email protected] Catholic Charities Diocese of Rockville Centre-MHRS-Siena Residence N 12 Mechanicsville Road Bay Shore NY 11706 Howard Duff 516-634-0012 126 [email protected] Catholic Charities Diocese of Rockville Centre-Residential Svcs-Medicaid N 143 Schleigel Blvd. Amityville NY 11701 Diane Ammirati 631-665-3434 [email protected] Catholic Charities Diocese of Rockville Centre-Congregate Meal Site N 8100 Second Avenue Brentwood NY 11717 Izabela Sliwowska 631-789-5219 2 [email protected] Catholic Charities Diocese of Rockville Centre-Congregate Meal Site N 702 St. Paul's Court Brentwood NY 11717 Izabela Sliwowska 631-789-5219 2 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N St. Joseph's Village Seldon NY 11784 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N George Link Apartments Coram NY 11727 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Bishop Ryan Village Hampton Bays NY 11946 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Msgr.Henry Reel I Medford NY 11763 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N St. Paul's Gardens Brentwood NY 11717 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Msgr.Henry Reel II Medford NY 11763 Jay Korth 516-733-7081 [email protected]

2.2) Partner Organizations - Contact Information"OTHER" Provider Types

SN Qualified (Y/N)



39 Catholic Charities Diocese of Rockville Centre-Senior Housing N Bishop McGann Central Islip NY 11722 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N St. Anne's Gardens Brentwood NY 11717 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Cabrini Gardens Coram NY 11727 Jay Korth 516-733-7081 [email protected] Catholic Charities Diocese of Rockville Centre-Senior Housing N Thea Bowman Amityville NY 11701 Jay Korth 516-733-7081 [email protected] God's Love We Deliver, Inc N 630 Flushing Avenue 7th fl Brooklyn NY 11206 Alissa Wassung 212-294-8171 [email protected] Public Health Solutions/Nurse-Family Partnership N 103-24 Roosevelt Ave, 2nd Fl Corona NY 11368 Marci Rosa 646-619-6524 [email protected] HELP/PSI Inc (Health Home Care Management) Y 89-31 161 Street Jamaica New York 11432 Sara Gillen 718-681-8700 3264 [email protected] Far Rockaway/ Aurverne Non Profits Coalition N 19-20 Mott Avenue Room 4 Far Rockaway NY 11691 Kelsey Adolphs 608-213-7631 [email protected] Jewish Association for Services for the Aged N 247 West 37th Street New York NY 10018 Kathryn Haslanger 2122735270 [email protected] NS-LIJ SBHC N 821 B25th Street Far Rockaway NY 11691 Maryann desilva 718-337-9441 [email protected] Queens Community Recovery Coalition N 20-29 Seagirt Blvd Far Rockaway NY 11691 Shivon Anderson 347-685-8941 [email protected] Swim Strong Foundation, Inc. N 30-17 89th Street E. Elmhurst NY 11369 Shawn Slevin 646 269-7897 shawn.slevin@theSwimStrongFoundat51 The Community Bridge Inc N 710 Beach 19th Street Far Rockaway NY 11691 Courtney Brown 718-450-4827 [email protected] Bed-Stuy Campaign Against Hunger Y 2010 Fulton Street Brooklyn NY 11233 Naomi Hopkins 718-773-3551 118 [email protected] Ocean Bay Community Development Corporation Y 434 Beach 54th Street Far Rockaway NY 11692 Patricia Simon 718-945-8640 214 [email protected] New York Road Runners N 156 W. 56th Street-3rd Fl New York NY 10019 Nikki Kalavitis 212-423-2217 [email protected] Doctors of the World N Noah Barth [email protected] New York City Housing Authority N Sonia Sarimento [email protected] Jewish Community Council of the Rockaway Peninsula N Kathy Rosenberg 718-327-7755 6119 [email protected] SCO Family Of Services N 338 Beach 38th Street Far Rockaway NY 11691 Tom Cocks 917-838-0512 [email protected] FEGS Y 175 Fulton Avenue Nassau NY 11550 Boris Vilgorin 212-366-8566 [email protected] Queens Coordinated Care Partners Y 60 Madison Avenue, 5th Floor New York NY 10010 Elizabeth Howell (212) 545-2404 [email protected] JMB-Home Health Aid Training School N 1931 Mott Avenue Far Rockaway NY 11691 Julia Blair 718-868-0002 [email protected] Good Shepherd Hospice N 110 Bi-County Boulevard, Suite 114 Farmingdale NY 11735 Terence O'Brien 516-705-3712 terence.o’[email protected] VNSNY Hospice and Palliative Care Y 1250 Broadway, 4th floor New York NY 10001 Sarah Larson 212-609-7563 [email protected] Hospice of New York, LLC Y 45-18 Court Square, Suite 500 Long Island City NY 11101 Martha Heller 347-226-4812 [email protected] Beacon Health Partners, LLP N 1600 Stewart Avenue, Suite #401 Westbury NY 11590 Jacqueline Delmont 516-570-3580 [email protected] 66 Rockaway Manor Home Care N 150 Beach 9th Street Far Rockaway NY 11691 Alan Chen 516-239-8693 209 [email protected] Long Term Recovery Group N 1526 Central Avenue Far Rockaway NY 11691 Dr. Edward Williams 347.387.6916 [email protected] AgeWell New York, LLC N 1991 Marcus Ave. Ste M201 Lake Success NY 11042 Tara Buonocore-Rut 7182892669 [email protected] Mental Health Association of New York City Y 50 Broadway New York NY 10004 Kathryn Salisbury 212-964-5253 796 [email protected] Mental Health Association of Nassau County Y 16 Main Street Hempsted NY 11550 John Javis 516-489-2322 1101 [email protected] Family Residences and Essential Enterprises, Inc. Y 191 Bethpage Sweet Hollow Road Old Bethpage NY 11804 Anu Arnold 516-870-1623 [email protected] Cornerstone Medical Arts Center Hospital Y 159-05 Union Turnpike Fresh Meadows NY 11366 Paul Creary 718-906-6700 3086 [email protected] Rockaway Supermarket Corp N 87-15 Rockaway Beach Blvd Rockaway Beach NY 11693 Rafael Diego 718-945-5200 [email protected] Premier Care of Lynbrook N 585 Merrick Road Lynbrook NY 11563 David Kim [email protected] Long Beach – CityMD N 904 West Beech Street Long Beach NY 11561 David Kim [email protected]



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11 12 15 16

"OTHER"- Provider Type MMIS NPI #1 NPI #2

Adult Day Care 1487097051Adult Day Care 912065 1811063290Adult HomeAmbulete 2975313 1295965606Child WelfareCommunity Non Profit 02249145 1346302346Community Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non Profit 01303497 1124063862Community Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non Profit 03007687 1932226222Community Non Profit 01996809Community Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non Profit



Community Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non Profit 1467646281Community Non Profit 2999782 1942491691Community Non Profit 2995339 1346464989Community Non ProfitCommunity Non Profit 00848164-7 1861570517Community Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitCommunity Non ProfitDisaster Recovering Case Management/Child Welfare ServicesHealth Home 00257805 1912164120Health Home 1215292305Home Health Training SchoolHospice 01243585 1992131635Hospice 01049476 1215928510Hospice 1792052 1013001197IPA 1235479312Licensed Home Care Service Agency 1447457148Long Term Recovery GroupMLTCP 3481927 1740520949Personalized Recovery Oriented Services 03421029 1013230374Personalized Recovery Oriented Services 03186752 1215268206Personalized Recovery Oriented Services 01542369 1497943757Substance Abuse 273056 1639197551SupermarketUrgent CareUrgent Care


DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

1 Jacqueline Delmont Physician Delmont Medical Care Y 1922050749 02641014 Queens 55 N Main St Freeport NY 11520 Jacqueline Delmont 516-610-80142 Dr. Alexander Vaysman Physician Dr. Alexander Vaysman Queens 493 Beach 20th Street Far Rockaway NY 11691 Marina/Dr. Vaysman 516-236-04953 Dr. Mounir Tawadrous, MD Physician Dr. Mounir Tawadrous, MD Queens 496 Beach 20th Street Far Rockaway NY 11691 Dr. Mounir Tawadrous, MD 718-327-56074 Gupta Gastro Associates Physician Gupta Gastro Associates Queens 238 Beach 20th Street Far Rockaway NY 11691 Cara Denti 718-327-25555 Jean-Pierre Barakate M.D. Physician Jean-Pierre Barakate M.D. Queens 712 Beach 20th Street Far Rockaway NY 11691 Jean-Pierre Barakate 347-246-65756 Multiviz Health Services Physician Multiviz Health Services Queens 5-29 Beach 20th Street Far Rockaway NY 11691 718-327-73077 Seagirt Medical Plaza Physician Seagirt Medical Plaza Queens 2004 Seagirt Blvd Far Rockaway NY 11691 Dr. M. Gzopovski 718-868-86688 Seagirt Medical Plaza Physician Seagirt Medical Plaza Queens 2004 Seagirt Blvd Far Rockaway NY 11691 Dr. Rankova 718-868-86689 Court House Medical Arts Complex (Rockaway Arts DevePhysician Court House Medical Arts Complex (Rockaway Arts Developm9342511 Queens 122-18 Rockaway Beach Blvd. Rockaway Park NY 11694 Mark Gelwan 917-696-3192/ 718-636-3300

10 B.Raines Optical Company LLC DBA Wavecrest Optical Physician B.Raines Optical Company LLC DBA Wavecrest Optical Queens 257 B. 20th Street Far Rockaway NY 11691 Bary Raines 718-327-202011 Queens Long Island Renal Institute Physician Queens Long Island Renal Institute 3265029 7003271R Queens 271-11 76th Avenue New Hyde Park NY 11040 Georgienne Kenny 718-289-210812 Benzaquen Psychological Services, PLLC Physician Benzaquen Psychological Services, PLLC Queens 143 Maple Avenue Cedarhurst NY 11516 Joy Benzaquen 516-665-253013141516171819202122232425262728293031323334353637383940414243444546474849505152

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

5354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899

100101102103104






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

469470471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506507508509510511512513514515516517518519520






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

521522523524525526527528529530531532533534535536537538539540541542543544545546547548549550551552553554555556557558559560561562563564565566567568569570571572






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

573574575576577578579580581582583584585586587588589590591592593594595596597598599600601602603604605606607608609610611612613614615616617618619620621622623624






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

625626627628629630631632633634635636637638639640641642643644645646647648649650651652653654655656657658659660661662663664665666667668669670671672673674675676






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

677678679680681682683684685686687688689690691692693694695696697698699700701702703704705706707708709710711712713714715716717718719720721722723724725726727728






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

729730731732733734735736737738739740741742743744745746747748749750751752753754755756757758759760761762763764765766767768769770771772773774775776777778779780






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

781782783784785786787788789790791792793794795796797798799800801802803804805806807808809810811812813814815816817818819820821822823824825826827828829830831832






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

833834835836837838839840841842843844845846847848849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

885886887888889890891892893894895896897898899900901902903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

937938939940941942943944945946947948949950951952953954955956957958959960961962963964965966967968969970971972973974975976977978979980981982983984985986987988






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

989990991992993994995996997998999

10001001100210031004100510061007100810091010101110121013101410151016101710181019102010211022102310241025102610271028102910301031103210331034103510361037103810391040






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1041104210431044104510461047104810491050105110521053105410551056105710581059106010611062106310641065106610671068106910701071107210731074107510761077107810791080108110821083108410851086108710881089109010911092






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1093109410951096109710981099110011011102110311041105110611071108110911101111111211131114111511161117111811191120112111221123112411251126112711281129113011311132113311341135113611371138113911401141114211431144






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1145114611471148114911501151115211531154115511561157115811591160116111621163116411651166116711681169117011711172117311741175117611771178117911801181118211831184118511861187118811891190119111921193119411951196






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1197119811991200120112021203120412051206120712081209121012111212121312141215121612171218121912201221122212231224122512261227122812291230123112321233123412351236123712381239124012411242124312441245124612471248






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1249125012511252125312541255125612571258125912601261126212631264126512661267126812691270127112721273127412751276127712781279128012811282128312841285128612871288128912901291129212931294129512961297129812991300






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1301130213031304130513061307130813091310131113121313131413151316131713181319132013211322132313241325132613271328132913301331133213331334133513361337133813391340134113421343134413451346134713481349135013511352






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1353135413551356135713581359136013611362136313641365136613671368136913701371137213731374137513761377137813791380138113821383138413851386138713881389139013911392139313941395139613971398139914001401140214031404






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1405140614071408140914101411141214131414141514161417141814191420142114221423142414251426142714281429143014311432143314341435143614371438143914401441144214431444144514461447144814491450145114521453145414551456






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1457145814591460146114621463146414651466146714681469147014711472147314741475147614771478147914801481148214831484148514861487148814891490149114921493149414951496149714981499150015011502150315041505150615071508






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1509151015111512151315141515151615171518151915201521152215231524152515261527152815291530153115321533153415351536153715381539154015411542154315441545154615471548154915501551155215531554155515561557155815591560






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1561156215631564156515661567156815691570157115721573157415751576157715781579158015811582158315841585158615871588158915901591159215931594159515961597159815991600160116021603160416051606160716081609161016111612






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1613161416151616161716181619162016211622162316241625162616271628162916301631163216331634163516361637163816391640164116421643164416451646164716481649165016511652165316541655165616571658165916601661166216631664






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1665166616671668166916701671167216731674167516761677167816791680168116821683168416851686168716881689169016911692169316941695169616971698169917001701170217031704170517061707170817091710171117121713171417151716






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1717171817191720172117221723172417251726172717281729173017311732173317341735173617371738173917401741174217431744174517461747174817491750175117521753175417551756175717581759176017611762176317641765176617671768






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1769177017711772177317741775177617771778177917801781178217831784178517861787178817891790179117921793179417951796179717981799180018011802180318041805180618071808180918101811181218131814181518161817181818191820






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1821182218231824182518261827182818291830183118321833183418351836183718381839184018411842184318441845184618471848184918501851185218531854185518561857185818591860186118621863186418651866186718681869187018711872






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1873187418751876187718781879188018811882188318841885188618871888188918901891189218931894189518961897189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976






1 2 3 4 5 6 7 8 9 10 11 12 13 14 15




SN Qualified (Y/N)

197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000



16

Email

[email protected]@[email protected]

[email protected]@[email protected]@aol.com

[email protected]@optonline.net



16

Email


DSRIP Project Design Grant Application Section 2.4 Pharmacy List

2.4) Pharmacy - Contact Information


Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15

Pharmacy Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension Email

1 Evers Pharmacy N 1023339454 Queens 142-02 Rockaway Blvd Jamaica NY 11436 Anthony Varikos RPh 914-216-9825 [email protected] GR Pharmacy , Inc N 1043307507 3103142 Queens 8815 Rockaway Beach Blvd Far Rockaway NY 11693 Ravi Unopre 718-945-43003 Mott Pharmacy N 1447345764 Queens 2119 Mott Avenue Far Rockaway NY 11691 P. Patel 718-237-2511 [email protected] SMK Pharmacy Corp Y 1023037256 2721488 Queens 8702 Rockaway Beach Blvd Rockaway Beach NY 11693 Marc Kassman 718-474-1600 [email protected] Thriftway Pharmacy N Queens 2102 Mott Avenue Far Rockaway NY 11691 David Matir 718-327-3652 [email protected]

1011121314151617181920212223242526272829303132333435363738394041424344454647

SN Qualified (Y/N)





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15

Pharmacy Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension EmailSN Qualified (Y/N)

4849505152535455565758596061626364656667686970717273747576777879808182838485868788899091929394





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


9596979899

100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188





Pharmacy List

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189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235





Pharmacy List

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236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506507508509510511512513514515516517





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


518519520521522523524525526527528529530531532533534535536537538539540541542543544545546547548549550551552553554555556557558559560561562563564





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


565566567568569570571572573574575576577578579580581582583584585586587588589590591592593594595596597598599600601602603604605606607608609610611





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


612613614615616617618619620621622623624625626627628629630631632633634635636637638639640641642643644645646647648649650651652653654655656657658





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


659660661662663664665666667668669670671672673674675676677678679680681682683684685686687688689690691692693694695696697698699700701702703704705





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


706707708709710711712713714715716717718719720721722723724725726727728729730731732733734735736737738739740741742743744745746747748749750751752





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


753754755756757758759760761762763764765766767768769770771772773774775776777778779780781782783784785786787788789790791792793794795796797798799





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


800801802803804805806807808809810811812813814815816817818819820821822823824825826827828829830831832833834835836837838839840841842843844845846





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


847848849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884885886887888889890891892893





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


894895896897898899900901902903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936937938939940





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


941942943944945946947948949950951952953954955956957958959960961962963964965966967968969970971972973974975976977978979980981982983984985986987





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


988989990991992993994995996997998999

10001001100210031004100510061007100810091010101110121013101410151016101710181019102010211022102310241025102610271028102910301031103210331034





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


10351036103710381039104010411042104310441045104610471048104910501051105210531054105510561057105810591060106110621063106410651066106710681069107010711072107310741075107610771078107910801081





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


10821083108410851086108710881089109010911092109310941095109610971098109911001101110211031104110511061107110811091110111111121113111411151116111711181119112011211122112311241125112611271128





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


11291130113111321133113411351136113711381139114011411142114311441145114611471148114911501151115211531154115511561157115811591160116111621163116411651166116711681169117011711172117311741175





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


11761177117811791180118111821183118411851186118711881189119011911192119311941195119611971198119912001201120212031204120512061207120812091210121112121213121412151216121712181219122012211222





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


12231224122512261227122812291230123112321233123412351236123712381239124012411242124312441245124612471248124912501251125212531254125512561257125812591260126112621263126412651266126712681269





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


12701271127212731274127512761277127812791280128112821283128412851286128712881289129012911292129312941295129612971298129913001301130213031304130513061307130813091310131113121313131413151316





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


13171318131913201321132213231324132513261327132813291330133113321333133413351336133713381339134013411342134313441345134613471348134913501351135213531354135513561357135813591360136113621363





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


13641365136613671368136913701371137213731374137513761377137813791380138113821383138413851386138713881389139013911392139313941395139613971398139914001401140214031404140514061407140814091410





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


14111412141314141415141614171418141914201421142214231424142514261427142814291430143114321433143414351436143714381439144014411442144314441445144614471448144914501451145214531454145514561457





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


14581459146014611462146314641465146614671468146914701471147214731474147514761477147814791480148114821483148414851486148714881489149014911492149314941495149614971498149915001501150215031504





Pharmacy List

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15051506150715081509151015111512151315141515151615171518151915201521152215231524152515261527152815291530153115321533153415351536153715381539154015411542154315441545154615471548154915501551





Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15


15521553155415551556155715581559156015611562156315641565156615671568156915701571157215731574157515761577157815791580158115821583158415851586158715881589159015911592159315941595159615971598





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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

Section 10Project Advisory Committee - PAC

10.1) How will the Project Advisory Committee assist the emerging Performing Provider System in the development of its DSRIP Project Plan? (Restricted to 4500 characters)Characters used: 588

Each emerging Performing Provider System (PPS) is required to form a Project Advisory Committee (PAC). The PAC will advise emerging Performing Provider Systems on all elements of their DSRIP Project Plans and should include representation from each of the emerging PPS partners as well as workers and/or relevant unions. Unless an alternative structure is being proposed. Project Advisory Committee representatives should be determined using the following process:

1. Organizational representatives:a. Emerging PPS partners with more than 50 employees are required to have an organizational (managerial) representative participate in the PAC.b. Emerging PPS partners with less than 50 employees have the option of selecting an organizational (managerial) representative to participate in the PAC.

2. Worker representatives:a. Partner organizations that are not unionized and have over 50 employees must develop a process to elect a worker (non-managerial employee) representative to participate in the PAC. b. For non-unionized partner organizations with less than 50 employees, the employees have the option of electing a worker (non-managerial employee) representative to participate in the PAC if they so choose.

3. Union Representatives:a. Partner organizations that are unionized and have over 50 employees must designate a union representative to participate in the PAC. If a particular union represents workers from multiple emerging PPS partners, one representative from that union is sufficient to satisfy PAC requirements. b. For unionized partner organizations with less than 50 employees, the union has the option of designating a union representative to participate in the PAC if they so choose.

The PAC will be an integral part of the development, monitoring and evaluation components of the PPS's efforts to develop projects and implement them to meet the goals of reducing preventable hospital admissions and ED visits. The group will meet monthly and be fully briefed on the progress of PPS activities. The PAC will be engaged in the community needs assessment. The PAC will also be a source for identifying and connecting with stakeholders in the service area. It is critical to the success of the endeavor that partner organizations be continuously involved through the PAC.



Flexibility in the Project Advisory Committee (Q's 10.2 & 10.3)

10.2) Are you proposing an alternative structure for your Project Advisory Committee? No

If you answered "Yes" then:

- Answer question 10.3If you answered "No", then please skip 10.3

10.3) Please give an explanation of how your emerging PPS will be structuring your Project Advisory Committee? (Restricted to 5000 characters)~ See instructions for further clarification Characters used: 778

^ The proposed alternative structure must still represent all key parties(Partner Organization/Union/Worker representatives) within the PPS. ^ Any alternative proposal must be approved by the state during the DSRIP design Grant application process.

For an emerging Performing Provider System with over 20 partnering organizations, qualifying PPS may propose an alternative PAC structure that will allow for a leaner committee as long as the proposed structure is still representative of all key parties within the PPS.

- Your emerging PPS must contain over 20 partnering organizations

Although the PPS is not proposing an alternative structure for the PAC, we plan to create an executive committee since the number of partner organizations to be represented by both management and labor is so large. This executive committee will include approximately 24-32 individuals including management and worker representatives, both union and non-union. Management members shall include representatives from CHS, Mercy Medical Center, St. John's Episcopal Hospital, South Nassau Communities Hospital and VNS. The Committee will also include representatives from Catholic Charities, Beacon Health Partners ACO, nursing homes, labor unions (including 1199, NYSNA, etc.) behavioral health providers, safety net physicians and the Joseph P. Addabbo Family Health Centers.



10.4)List all the worker representatives, union representatives and Performing Provider System partner organization representatives that will be part of the emerging Performing Provider Systems Project Advisory Committee.~ Please see instructions for clarification

(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NameWorker Representative Terence Cardinal Cooke Health Care CenterWorker Representative A. Holly Patterson Extended Care FacilityUnion Representative AgeWell New York, LLC

Worker Representative B.Raines Optical Company LLC DBA Wavecrest OpticalWorker Representative Barnwell Nursing and Rehabilitation CenterWorker Representative Beach Terrace Care CenterWorker Representative Beacon Health Partners, LLPWorker Representative Beacon Rehab and NursingWorker Representative Bed-Stuy Campaign Against HungerWorker Representative Benzaquen Psychological Services, PLLCWorker Representative Bezalel Rehabilitation and Nursing CenterWorker Representative Bishop Charles Waldo MacLean Episcopal Nursing HomeWorker Representative Bridge Back to Life Center, Inc Worker Representative Brookhaven Rehabilitation and Healthcare CenterWorker Representative Carillon Nursing and Rehabilitation CenterWorker Representative Catholic Charities Diocese of Rockville CentreWorker Representative Catholic Charities Neighborhood Services (CCNS)Union Representative Certificate for Comprehensive Community of Hospice Parker Jewish Institute

Worker Representative Coney Island HospitalWorker Representative Cornerstone Medical Arts Center Hospital Worker Representative Court House Medical Arts Complex (Rockaway Arts Development)Worker Representative Doctors of the WorldWorker Representative Dr. Alexander VaysmanWorker Representative Dr. Mounir Tawadrous, MDWorker Representative EAC NetworkWorker Representative East Neck Nursing and Rehabilitation CenterWorker Representative Elmhurst Hospital CenterWorker Representative Evers PharmacyWorker Representative Family Residences and Essential Enterprises, Inc.Worker Representative Family Service League, Inc.Worker Representative Far Rockaway/ Aurverne Non Profits CoalitionWorker Representative Federation of OrganizationsWorker Representative FEGSWorker Representative Five Towns Community Center IncUnion Representative Forest Hills Care Center

Worker Representative God's Love We Deliver, IncWorker Representative Good Shepherd HospiceWorker Representative GR Pharmacy , IncWorker Representative Grandell Rehabilitation and Nursing CenterWorker Representative Gupta Gastro AssociatesWorker Representative Harlem Dowling West Side CenterWorker Representative Haven Manor Health Care CenterWorker Representative HELP/PSI Inc (Health Home Care Management)Worker Representative HELP/PSI Services Corp (FQHC, HIV Adult Day Healthcare)Worker Representative Hempstead Park Nursing HomeWorker Representative Heritage Adult Care, IncWorker Representative Horizon Care CenterWorker Representative Hospice of New York, LLCWorker Representative Jacqueline Delmont

Partner Organization Representative/Union Representative*/Worker Representative

INDEX SCOREDomain 2 System Transformation Projects

2A. Create Integrated Delivery Systems (required)2B. Implementation of care coordination and transitional care programs2C. Connecting system

Select One2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

2.A.II Increase certification of primary care practitioners with PCMH certification and/or Advanced Primary Care Models (as developed under the New York State Health Innovation Plan (SHIP)) 372.A.III Health Home At-Risk Intervention Program –Proactive management of higher risk patients not currently eligible for Health Homes through access to high quality primary care and support services. 462.A.IV Create a medical village using existing hospital infrastructure 542.A.V Create a medical village/ alternative housing using existing nursing home 42

Select One2.B.I Ambulatory ICUs 36

2.B.II Development of co-located primary care services in the emergency department (ED) 402.B.III ED care triage for at-risk populations 432.B.IV Care transitions intervention model to reduce 30 day readmissions for chronic health conditions 432.B.V Care transitions intervention for skilled nursing facility residents 41

2.B.VI Transitional supportive housing services 472.B.VII Implementing the INTERACT project (inpatient transfer avoidance program for SNF) 41

2.B.VIII Hospital-Home Care Collaboration Solutions 452.B.IX Implementation of observational programs in hospitals 36

2.C.I Development of community-based health navigation services 372.C.II Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services 31

Select One2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

2.A.II Increase certification of primary care practitioners with PCMH certification and/or Advanced Primary Care Models (as developed under the New York State Health Innovation Plan (SHIP)) 372.A.III Health Home At-Risk Intervention Program –Proactive management of higher risk patients not currently eligible for Health Homes through access to high quality primary care and support services. 462.A.IV Create a medical village using existing hospital infrastructure 542.A.V Create a medical village/ alternative housing using existing nursing home 422.B.I Ambulatory ICUs 36

2.B.II Development of co-located primary care services in the emergency department (ED) 402.B.III ED care triage for at-risk populations 432.B.IV Care transitions intervention model to reduce 30 day readmissions for chronic health conditions 432.B.V Care transitions intervention for skilled nursing facility residents 41

2.B.VI Transitional supportive housing services 472.B.VII Implementing the INTERACT project (inpatient transfer avoidance program for SNF) 41

2.B.VIII Hospital-Home Care Collaboration Solutions 452.B.IX Implementation of observational programs in hospitals 36

2.C.I Development of community-based health navigation services 372.C.II Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services 31

Domain 3 Clinical Improvement Projects3A. Behavioral Health (Required)3B. Cardiovascular Health3C. Diabetes Care3D. Asthma3E. HIV3F. Perinatal3G. Palliative Care3H. Renal Care

Select One3.A.I Integration of primary care services and behavioral health 39

3.A.II Behavioral health community crisis stabilization services 373.A.III Implementation of evidence based medication adherence program (MAP) in community based sites for behavioral health medication compliance 293.A.IV Development of withdrawal management (ambulatory detoxification) capabilities within communities 363.A.V Behavioral Interventions Paradigm in Nursing Homes (BIPNH) 403.B.I Evidence based strategies for disease management in high risk/affected populations (adult only) 30

3.B.II Implementation of evidence-based strategies in the community to address chronic disease -- primary and secondary prevention projects (adult only) 263.C.I Evidence-based strategies for disease management in high risk/affected populations (adults only) 30

3.C.II Implementation of evidence-based strategies in the community to address chronic disease – primary and secondary prevention projects (adults only) 263.D.I Development of evidence-based medication adherence programs (MAP) in community settings –asthma medication 28

3.D.II Expansion of asthma home-based self-management program 313.D.III Evidence based medicine guidelines for asthma management 31

3.E.I Comprehensive Strategy to decrease HIV/AIDS transmission to reduce avoidable hospitalizations – development of a Center of Excellence for management of HIV/AIDS 283.F.I Increase support programs for maternal & child health (including high risk pregnancies) (Example: Nurse-Family Partnership) 293.G.I IHI “Conversation Ready” model 29

3.G.II Integration of palliative care into medical homes 223.G.III Integration of palliative care into nursing homes 25

3.H.I Specialized Medical Home from Chronic Renal Failure 29

Domain 4 Population-Wide Projects4A. Promote Mental Health and Prevent Substance Abuse (MHSA)4B. Prevent Chronic Diseases4C. Prevent HIV and STD's4D. Promote Healthy Women, Infants and Children

Select One4.A.I Promote mental, emotional and behavioral (MEB) well-being in communities 23

4.A.II Prevent Substance Abuse and other Mental Emotional Behavioral Disorders 204.A.III Strengthen Mental Health and Substance Abuse Infrastructure across Systems 20

4.B.I Promote tobacco use cessation, especially among low SES populations and those with poor mental health 234.B.II Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings (Note: This project targets chronic diseases that are not included in domain 3.b., such as cancer) 174.C.I Decrease HIV morbidity 19

4.C.II Increase early access to, and retention in, HIV care 194.C.III Decrease STD morbidity 154.C.IV Decrease HIV and STD disparities 18

4.D.I Reduce premature births 24

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