Information for Health Care Providers
Joining an MCO Network
Providers wishing to join a managed care organization's network can contact the plan directly and request application procedures and the minimum qualification requirements a provider must meet in order to be considered by the plan. There is no requirement in New York State law that plans accept any provider who wishes to join their network. However, plans must maintain a network that is sufficient to deliver comprehensive services to their enrolled population. The Division of Health Plan Contracting and Oversight (DHPCO) reviews provider networks routinely to ensure enrollee access to health care. Contact DHPCO for problems encountered in obtaining application procedures.
Contracting with an MCO
The Division of Health Plan Contracting and Oversight (DHPCO) reviews HMO and IPA provider contracts to ensure that applicable laws and regulations are adhered to. However, the specific terms, services, compensation, risk arrangements, claims procedures, quality assurance requirements, etc. of the contracts are the purview of the contracting parties. Assistance with general contracting issues may be found by contacting professional associations or provider trade organizations.
Independent Practitioner Associations
Independent Practitioner Associations (IPAs) are created to arrange for the provision of health care services by licensed or certified health care providers through contracted agreements with one or more certified MCOs. The Division of Legal Affairs, Bureau of Health Insurance Programs, reviews requests for Commissioner of Health consent to form an IPA, which must meet the IPA Formation Requirements. Consent must be obtained prior to filing a certificate of incorporation, (or, in the case of a limited liability company, articles of organization) with the Secretary of State.
Medicaid Managed Care Program
Medicaid managed care provides comprehensive health care services to enrollees. More specific information on enrollee eligibility and conditions of Medicaid coverage should be obtained by contacting the health plan and/or eMEDNY.
- New York State's Operational Protocol for the Partnership Plan
- The Partnership Plan — New York's 1115 Medicaid Managed Care Demonstration. A copy of the original 1115 application is available by writing to firstname.lastname@example.org
- Medicaid Managed Care Model Member Handbook (PDF, 183KB, 36pg.)
- Family Health Plus Model Member Handbook (PDF, 202KB, 36pg.)
- Information on HIV Special Needs Plans
Managed Care Model Contracts
- Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan Model Contract (PDF, 4,455KB, 365pg.)
- Medicaid Advantage Model Contract (PDF, 1.57MB, 223pg.)
To obtain a copy of a managed care model contract please send a request, identifying the contract needed, to email@example.com or write to:NYSDOH Division of Health Plan Contracting and Oversight (DHPCO)
Corning Tower Room 2001
Empire State Plaza
Albany, New York 12237-0094