Managed Care Organization Subcontracts

In some cases, states limit the extent to which managed care organizations (MCOs) can assign duties or legal obligations to others.

Delegation of Responsibility; Subcontracts

  • Even when MCO subcontracts duties, MCO retains responsibility: Arizona a, Florida b
  • Entering into provider contract does not relieve MCO of legal obligations: Florida c, New York d
  • MCO must receive state approval before subcontracting or assigning contract responsibility to another party: Florida e
  • State must approve all subcontracts: New York f

MCO’s Relationship with Subcontractors and Providers

  • MCO is vicariously liable for outreach and marketing violations by employee, agent or subcontractor: Florida g
  • MCO must monitor subcontractors annually and provide state with monitoring schedule: Florida h
  • Providers may subcontract services; MCO must identify any aspect of services that provider can subcontract: Florida i
  1. Ariz. Contract, p. 67.  (back)
  2. Fla. Contract, Atch. II, p. 143.  (back)
  3. Fla. Contract, Atch. II, p. 72.  (back)
  4. N.Y. Medicaid Advantage Plus Contract, Sect. 22, p. 1.  (back)
  5. Fla. Contract, p. 3.  (back)
  6. N.Y. Medicaid Advantage Plus Contract, Sect. 22, pp. 1-2, App. R, p. 3.  (back)
  7. Fla. Contract, Atch. II, p. 58.    (back)
  8. Fla. Contract, Atch. II, p. 144.  (back)
  9. Fla. Contract, Atch. II, p. 144.  (back)

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