Get Medicaid Advantage Plan (map) Model Contract. Medicaid Advantage Plan (map) Model Contract

This guide provides a comprehensive overview of how to effectively fill out the Medicaid Advantage Plan (MAP) Model Contract. It is designed to help users, regardless of their legal experience, understand the requirements and steps involved in the contract submission process.

Follow the steps to fill out the Medicaid Advantage Plan (MAP) Model Contract.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the name and address for the State Agency at the top of the form, ensuring accuracy to facilitate communication.
3. Fill in the Contractor's name and address, which identifies the organization supplying services under the contract.
4. Indicate the type of program by selecting 'Managed Long Term Care' from the options provided.
5. Complete the contract term section by filling in the start and end dates of the contract duration.
6. Confirm whether the Contractor has timely filed all required reports with the Attorney General's Charities Bureau and provide the Federal Tax Identification Number.
7. Specify the total funding amount for the contract term based on approved capitation rates.
8. Complete the disability and sectarian entity status sections by checking the appropriate boxes.
9. If applicable, mark the renewal option for two additional one-year periods subject to necessary approvals.
10. Enter additional required information regarding subcontractors, provider relations, and financial compliance.
11. Sign the contract in the designated areas for both the Contractor and State Agency representatives.
12. Attach any necessary appendices and certifications as specified in the contract before submission.
13. Finally, save changes and download, print, or share the completed form as needed.

Begin filling out your Medicaid Advantage Plan (MAP) Model Contract online today!