NYS Contracted Health Plan Network Adequacy Standards

Medicaid Managed Care, HIV Special Needs Plan,
Health and Recovery Plan (HARP)

Network Adequacy contractual requirements for the Medicaid Managed Care, HIV Special Needs Plan, or Health and Recovery Plan (HARP) can be found in Section 21 of the Model Contract.

Guidelines for Managed Care Organization (MCO) Service Delivery Networks

New York State reviews the networks of all Medicaid Managed Care/HIV Special Needs Plan/Health and Recovery Plan contracted managed care organizations for availability, accessibility of services, and adequacy. Please see the below table.

Health Plan Offers an appropriate range of
preventive, primary care,
specialty services, and
Long Term Services and Supports
(LTSS) that is adequate for the
anticipated number of enrollees
for the services area.
Maintains a network of
providers that is sufficient in
number, mix, and geographic
distribution to meet the needs of
the anticipated number of
enrollees in the service area.
Affinity Health Plan
Amida Care
Blue Cross/Blue Shield of Western New York (HealthNow, Inc.)
Capital District Physicians’ Health Plan (CDPHP)
Crystal Run Health Plan
Emblem Health (Health Insurance Plan of Greater New York)
Excellus Health Plan
Fidelis Care (New York State Catholic Health Plan)
Empire Blue Cross/Blue Shield (HealthPlus, LLC)
Independent Health
MetroPlus Health Plan
MVP Health Plan
Molina Healthcare
VNS Choice Health Plan

To see if a specific provider participates with a specific managed care organization, please visit https://pndslookup.health.ny.gov/.

Last Updated: October 2018