Information for Health Plans

Managed Care Organizations (MCO) are required to establish a mental health and substance use disorder parity compliance program pursuant to 10 NYCRR Subpart 98-4. This regulation sets forth the requirements of such programs. The regulation further requires MCOs to submit a written certification to the Commissioner, certifying that the MCO satisfactorily meets the requirements of the regulation. The certification is required to be submitted by December 31, 2021 and annually thereafter.

The Parity Compliance Program Certification form was jointly developed by the Department of Financial Services and the Department of Health requires all MCOs subject to the regulation to use this form to certify that all requirements of the regulation have been met.

The completed certification form, and any questions are to be sent to the mailbox at BHParity@health.ny.gov

Entities seeking certification as a New York State Managed Care Organization (MCO) for the sole purpose of providing health care coverage as a federal Medicare Advantage plan, will need to complete the NYS MCO Certification Application - Medicare Only (PDF).

Important New York State Department of Health application due dates that must be submitted to the Division of Health Plan Contracting and Oversight related to Medicare Advantage as a requirement for participation.

Application Type (As Defined in Narrative Below the Chart) Complete DOH Application Due Date Letter of Intent Due to CMS with copy to DOH CMS Application Due Date (Including DOH State Certificate Form) Executed Model Contract *Applied to MAP and IB-Dual SMAC Due Date (As Defined in Narrative Below the Chart) Medicare Coverage Year
Medicare Coverage Year 2027 for IB-Duals, MAP, and Medicare Advantage
New Article 44 MCO Applicant for:
   MAP
   Medicare Advantage (all other types below)		 February 3, 2025 November 3, 2025 Mid-February 2026 May 2026
*Applies to MAP and IB-Dual		 July 6, 2026 2027
New Line of Business Application for an Existing Article 44 MCO:
  • IB-Dual
  • MAP
  • Medicare Advantage (all other types below)
 July 1, 2025 November 3, 2025 Mid-February 2026 May 1, 2026 July 6, 2026 2027
Service Area Expansion (SAE) for an Existing Article 44 MCO for a new county or new Medicare type:
  • IB-Dual
  • MAP
  • Medicare Advantage (all other types below)
 November 3, 2025 November 3, 2025 Mid-February 2026 May 1, 2026 July 6, 2026 2027
Medicare Coverage Year 2028 for IB-Duals, MAP, and Medicare Advantage
New Article 44 MCO Applicant for:
  • MAP
  • Medicare Advantage (all other types below)
 February 2, 2026 November 2, 2026 Mid-February 2027 May 1, 2027 July 5, 2027 2028
New Line of Business Application for an Existing Article 44 MCO:
  • IB-Dual
  • MAP
  • Medicare Advantage (all other types below)
 July 1, 2026 November 2, 2026 Mid-February 2027 May 1, 2027 July 5, 2027 2028
Service Area Expansion (SAE) for an Existing Article 44 MCO for a new county or new Medicare type:
  • IB-Dual
  • MAP
  • Medicare Advantage (all other types below)
 November 2, 2026 November 2, 2026 Mid-February 2027 May 1, 2027 July 5, 2027 2028

Below is additional information from the New York State Department of Health regarding the types of Medicare Advantage applications that must be submitted by the due dates in the above chart.

For additional Medicare Advantage resources and information on the Medicare Advantage program types, please contact the New York State Department of Health and visit the Centers for Medicare & Medicaid Services (CMS).

The New York State Department of Health due dates apply to the following applications:

  1. Integrated Benefit-Dual (IB-Dual) "Mini Application" - This application is required to certify the IB-Dual program for the Medicaid Managed Care and HARP lines of business that includes Medicare Advantage D-SNP for dual eligibles.
  2. Medicaid Advantage Plus (MAP) Application - This application is required to certify the MAP line of business that includes Medicare Advantage D-SNP that is exclusively aligned with the New York State Department of Health MAP benefits.
  3. Medicare Advantage Application - These applications are required to certify a new Medicare Advantage type in a county. To be clear, the MCO may already operate Medicare Advantage in that county, however, an application is required to add a new Medicare Advantage type in that county. Below are the Medicare Advantage types:
    1. Medicare Advantage D-SNP Coordination Only - This application is required to certify the Medicare Advantage line of business for the Medicare Advantage D-SNP type where members are dually eligible. The MCO covers the Medicare Advantage services only and is responsible for coordination of benefits with New York State Medicaid Fee-for-Service (FFS) for Medicaid services.
      • *As per the State Medicaid Agency Contract (SMAC) - agreement requirements, the New York State Department of Health will not accept new Medicare Advantage D-SNP Coordination Only Line of Business applications.
      • MCO's that currently offer a Medicare Advantage D-SNP Coordination Only may continue to operate in existing service areas, however, the MCO may not submit a Service Area Expansion (SAE) to further expand into new counties for Medicare Advantage D-SNP Coordination Only.
    2. Medicare Advantage C-SNP Application - The application is required to certify the Medicare Advantage line of business for the Medicare Advantage C-SNP type where members have specific severe or disabling chronic conditions as required per CMS. The MCO covers Medicare Advantage services only.
    3. Medicare Advantage I-SNP/IE-SNP Application - The application is required to certify the Medicare Advantage line of business for the Medicare Advantage I-SNP and IE-SNP types where members require placement in an Institution (I-SNP) or Institutional Equivalent (IE-SNP) facility. The MCO covers Medicare Advantage services only.
    4. Medicare Advantage MAPD Application - The application is required to certify the Medicare Advantage line of business for the Medicare Advantage MAPD type where members receive Medicare Advantage and prescription drug (MAPD) coverage. The MCO covers Medicare Advantage services only.
    5. Medicare Advantage Application - The application is required to certify the Medicare Advantage line of business for the Medicare Advantage where members receive Medicare Advantage, without prescription drug coverage. The MCO covers Medicare Advantage services only.

The following character and competency review forms are provided for the use and convenience of certified managed care plans in order to facilitate change of control, mergers, expansions, acquisitions etc. Contact DMC for assistance or for the character and competency forms for management contractors.