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.

• 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
  • Integrated Primary Care (IPC)
  • Total Care for General Population (TCGP)
  • HARP
  • HIV/AIDS
  • Maternity
  • MLTC Partial Subpopulation
  • Total Cost for MLTC Population for Full Capitation
• VBP – Off–Menu Contracting Checklist
• Provider Contract Submission Requirements Webinar Presentation – May 3, 2017 (PDF)
• IPA Formation Requirements