Information for Health Plans

Health Plan Certification in New York State

To apply for certification under Public Health Law Article 44 as a Health Maintenance Organization or Prepaid Health Services Plan, contact:

Division of Managed Care and Program Evaluation
Bureau of Managed Care Certification and Surveillance
Corning Tower Room 1911
Empire State Plaza
Albany, New York 12237
(518) 474-5515

For full-risk MCOs to qualify to participate in the New York State Medicaid managed care program in counties with mandatory or voluntary enrollment, including qualification requirements for serving dual eligible populations, plans must meet programmatic guidelines and standards as described in the Managed Care Organization Medicaid Qualification Guidelines (PDF, 565KB, 55pg.)

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

Health Plan Guidelines

Utilization Review Agent Registration

Article 49 of the NYS Public Health Law requires that independent utilization review agents register with the Department of Health every two years, prior to conducting utilization review services for MCOs in New York State. Contact DMCPE for assistance.

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 DMCPE for assistance or for the character and competency forms for management contractors.

Quality Review Reports

References