Revised New York State Department of Health Clauses for Managed Care Provider/IPA/ACO Contracts and Amendment

On April 1, 2017, the New York State Department of Health issued a revised version of the Provider Contract Guidelines for Article 44 MCOs, IPAs, and ACOs (“Provider Contract Guidelines”). According to the new Provider Contract Guidelines, managed care organizations must amend all existing participating provider agreements to include a new mandatory provision. Therefore, your existing agreement with Empire HealthChoice HMO, Inc. (d/b/a Empire BlueCross BlueShield HMO or Empire BlueCross HMO) and Empire HealthChoice Assurance, Inc. (d/b/a Empire Blue Cross BlueShield or Empire BlueCross) (collectively, “Empire”) is hereby unilaterally amended effective immediately to replace the “Regulatory Approval” provision of your Agreement with the following:

 

“Regulatory Approval. To the extent Provider participates in Networks under this Agreement, which are subject to review by the New York State Department of Health, this Agreement is subject to the approval of the New York State Department of Health as to form. If this Agreement is implemented prior to such approval, the parties agree to incorporate into this Agreement any and all modifications required by the Department of Health for approval or, alternatively, to terminate this Agreement if so directed by the Department of Health. The "New York State Department of Health Standard Clauses for Managed Care Provider/IPA/ACO Contracts", attached to the Agreement as Attachment A, are expressly incorporated into this Agreement and are binding upon the Article 44 plans and providers that contract with such plans, and who are a party to this Agreement. In the event of any inconsistent or contrary language between the Standard Clauses and any other part of the Agreement, including but not limited to appendices, amendments, exhibits, the parties agree that the provisions of the Standard Clauses shall prevail, except to the extent applicable law requires otherwise and/or to the extent a provision of the Agreement exceeds the minimum requirements of the Standard Clauses.”

 

To the extent that your Agreement contains Appendix A - New York State Department of Health Standard Clauses Appendix for Managed Care Provider/IPA Contracts , such Appendix A is deleted in its entirety and replaced with Attachment A - New York State Department of Health Standard Clauses for Managed Care Provider/IPA/ACO Contracts Revised April 1, 2017 attached .