Get Nys Article 44 Application Form

Filling out the Nys Article 44 application form is an essential step for health plans seeking to participate in Medicaid Advantage Plus and Managed Long Term Care programs. This guide provides clear, step-by-step instructions to help users navigate the online application process effectively.

Follow the steps to complete the Nys Article 44 Application Form.

1. Click ‘Get Form’ button to obtain the Nys Article 44 application form and open it in your online document management tool.
2. Complete the applicant information section, providing details such as the date received, applicant name, street address, city, state, and zip code. Ensure accuracy to avoid delays.
3. Fill in the contact information for the executive director, chairman of the board, and any individual executing the application. Include names, addresses, and phone numbers for each person.
4. Select the application type by checking the appropriate box for Managed Long Term Care Plan, Medicaid Advantage Plus, or MLTC Partial Capitation.
5. For financial requirements, prepare revenue and expense statements and ensure they meet the guidelines provided by the Department of Health. Include projections for the first 36 months of operation.
6. Draft a transmittal letter that must be signed by the CEO or COO. The letter should attest to the accuracy of the information provided in the application.
7. Review the additional sections of the application regarding provider networks and subcontractors. Gather necessary documentation to submit with your application.
8. Complete the pre-operational requirements section, ensuring all marketing and operational plans are approved by the relevant department.
9. Finally, after thoroughly reviewing all sections for completeness and accuracy, save your changes, download a copy, print, or share the filled application as required.

Submit the Nys Article 44 application online to ensure your application is reviewed efficiently.