Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs
Note: Effective April 1, 2017, all contracts, contract templates, and material amendments between plans and IPA/ACO; plans and providers; IPA/ACO and provider and IPA/ACO and IPA/ACO must be submitted to the Department of Health for review and approval in accordance with the revised Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs (dated April 1, 2017). The Standard Clauses for Managed Care Provider/IPA/ACO Contracts and the Provider Contract Statement and Certification have also been revised. The Standard Clauses for Indian Tribal Providers has been updated March 1, 2019.
The contract and required documentation should be submitted to:
- For managed long term care plans: MLTCcontract@health.ny.gov
- For all other MCOs: contract@health.ny.gov
Incomplete submissions will not be accepted for review.
Note: All contracts, including File and Use, are not considered received by DOH unless submitted through one of the email addresses above. Contract submission solely to the plan manager is NOT acceptable.
Questions regarding the contract review process may be sent:
- For managed long term care plans: MLTCcontract@health.ny.gov or call the NYS DOH Division of Managed Care, Bureau of Managed Long Term Care at (518) 474–6965
- For all other MCOs: contract@health.ny.gov or call the NYS DOH Division of Managed Care, Bureau of Managed Care Certification and Surveillance at (518) 474–5515
- Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs
- Standard Clauses for Managed Care Provider/IPA/ACO Contracts
- Standard Clauses for Indian Tribal Providers (updated 3.1.19)
- Provider Contract Statement and Certification (PDF)
- Disclosure of Lobbying Activities (PDF)
- Certification Regarding Lobbying (PDF)
References
- Provider Contract FAQs – October 31, 2017
- Standard Clauses for Indian Tribal Providers FAQs – March 1, 2019
- New Requirements for TCGP Quality Measure Reports – October 4, 2019
- VBP – On Menu Checklists
- VBP – Off–Menu Contracting Checklist
- Provider Contract Submission Requirements Webinar Presentation – May 3, 2017 (PDF)
- IPA Formation Requirements