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DOH Solicits Comments on Draft Revisions to Guidelines for Managed Care Contracts with Providers

The Department of Health (DOH) has posted a draft version of revised Provider Contract Guidelines (the Draft Guidelines) for Managed Care Organizations (MCOs). The Draft Guidelines modify the contract submission and review process to reflect Value Based Payment (VBP) arrangements pursuant to the NYS VBP Roadmap and the Regulatory Impact Subcommittee. In particular, the Draft Guidelines consolidate the existing five levels of DOH review into three levels for contracts that transfer risk from a MCO to a provider, Independent Practice Association (IPA), or Accountable Care Organization (ACO). This consolidation of the review tiers is intended to reduce the administrative burden of the reviews. This is in anticipation of a significant increase in such contracts as a result of the State’s efforts to encourage VBP arrangements. It is important to note that these Guidelines are not yet effective. DOH expects to finalize the Guidelines within the next few months.

A summary of changes that were made to the current Guidelines can be found here. Additional MCO/IPA provider contracting information can be found here. DOH is accepting comments on the Draft Guidelines until June 30, 2016. Comments can be submitted to bmccsmail@health.ny.gov.

LeadingAge New York’s preliminary comments are available here. LeadingAge NY members interested in submitting additional comments are encouraged to contact Karen Lipson.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.