Information for Health Plans

Health Plan Certification in New York State

Health plans 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 complete the NYS MCO Certification Application - Medicare Only (PDF)

Important dates for the Medicare Advantage “only” line of business
(Please note, this guidance does not pertain to the Medicaid Advantage Plus (MAP) line of business or the Integrated Benefit-Dual (IB-D) program)

Application Type DOH Due Date CMS Due Date Medicare
Coverage
Year
New Medicare Advantage only line of business
(Existing MCO)
October 1, 2021 Mid-February 2022 2023
New Medicare Advantage only line of business
(New MCO Applicant)
October 1, 2021 Mid-February 2022 2023
Service Area Expansion
(SAE)
November 1, 2021 Mid-February 2022 2023
New Medicare Advantage only line of business
(New MCO Applicant)
February 1, 2022 Mid-February 2023 2024
New Medicare Advantage only line of business
(Existing MCO)
July 1, 2022 Mid-February 2023 2024
Service Area Expansion (SAE) November 1, 2022 Mid-February 2023 2024

All completed applications must be submitted to the DOH via email at bmccsmail@health.ny.gov with the subject line containing the "Applicant/MCO Legal Name-Medicare Advantage Application".

For MCOs offering Medicare Advantage to participate in the New York State Medicaid Advantage program for dual eligible populations plans must meet programmatic guidelines and standards as described in the Application for Participation in Medicaid Advantage (PDF)

To certify as a preferred provider organization (PPO) delivering workers´ compensation medical care, see the Workers´ Compensation PPO Application.

Health Plan Guidelines

Character and Competency Forms

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.

Quality Review Reports

References