Procedure for Contracting with Saratoga County to provide CPSE Services

  1. Contact Saratoga County Public Health Services regarding interest to contract at 518-584-7460
  2. Complete and submit State Central Registry Clearance forms to Saratoga County Public Health Services
  3. Once cleared, Saratoga County Public Health Services will send and require documentation below:
    1. 3 original signed copies of the contract
    2. Provider agreement
    3.  Appendix A – Description of services and locations
    4. Appendix B – Statement of Medicaid Reassignment
    5. Providers Insurance must include:
      • Name of provider, NYS authorized insurance company, policy number
      • Professional liability insurance with coverage at a minimum of $1 million per incident and $2 million in the aggregate
      • Workplace liability with coverage at a minimum of $1 million per incident and $2 million in the aggregate OR – General liability/Off-premise liability with coverage at a minimum of $1 million per incident and $2 million in the aggregate (additional insured must be added to the General/Off-premise liability only!)  An endorsement naming County of Saratoga, 40 McMaster St., Ballston Spa, NY 12020 must be provided to prove this additional insured on the General/Off Premise liability only.
      • Abuse and molestation coverage.  Endorsement not necessary from Savers, CNA/HPSO, and American Home insurance providers (included in policy)
      • Proof of payment on memorandum or a receipt
    6. Current resume
    7. A copy of your license/diploma, current registration, teaching certification and evidence of ASHA membership (if speech pathologist)
    8. Documentation of your National Provider Identifier number
    9. School Supportive Health Services Program (SSHSP)-Medicaid number-(if speech pathologist)

Executed contract is sent back to Saratoga County Public Health Services.  Provider is notified and sent a packet of information explaining billing, vouchers, claims, etc.

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