Chapter 37: Required Provisions to Network Provider Agreements

In this chapter, you will find mandatory contract language required by the State of New York and the Centers for Medicare & Medicaid Services, including the Managed Care Law of 2009, the New York State Department of Health (NYSDOH) Standard Clauses, the Special Provisions Related to Medicaid Members, and the Medicare Advantage Addendum..

Effective Dec. 27, 2020, the Consolidated Appropriations Act, 2021 includes provisions designed to expand transparency in cost and quality information for health care consumers and employer groups.

As a result, our provider network contracts no longer restrict EmblemHealth from:

  1. Disclosing provider-specific cost or quality-of-care information or data, through a consumer engagement tool or any other means, to referring providers, employer groups, members, or individuals eligible to become members; and
  2. Electronically accessing and sharing, in accordance with applicable privacy regulations, de-identified claims and encounter information or data with a business associate for plan administration and quality improvement purposes.