Get Model Subcontract Between The Hcias And Their Networks Of Waiver ... - Ocfs Ny

Filling out the Model Subcontract between Health Care Integration Agencies (HCIAs) and their Networks of Waiver services is essential for ensuring compliance with the New York State Health Care Integration program. This guide provides clear, step-by-step instructions to help you complete the document efficiently while adhering to required standards.

Follow the steps to complete the subcontract form online.

1. Press the ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by filling in the date of execution in the designated blank space at the top of the document.
3. Enter the name of the Health Care Integration Agency (HCIA) in the first blank provided, ensuring that the name reflects the entity as recognized by the New York State Office of Children and Family Services (OCFS).
4. In the following blanks, input the HCIA's address, city, state, and zip code accurately.
5. Proceed to fill in the full name of the Agency, which is the Waiver services provider, in the appropriate blank.
6. Fill in the address of the Agency, including street address, city, state, and zip code.
7. Review the 'WHEREAS' clauses to ensure all applicable conditions and definitions relevant to the agreement are represented. No input is needed here unless specific details apply.
8. Carefully read through the sections detailing the terms of the agreement, scope of services, standards of operation, and additional responsibilities of both parties.
9. Ensure that sections identifying the term of the agreement are filled out appropriately, including any required dates of commencement.
10. Conclude by signing the document where indicated, including the printed name, title, and date of signature for both the HCIA and the Agency.
11. After completing the form, you may save changes, download, print, or share the subcontract as needed.

Complete the Model Subcontract online today to ensure your compliance with the B2H Waiver services agreement.