Group Certification Accept* I hereby certify all staff have completed cultural competency training for this year or in the last 12 months. I understand this certification is required annually by the New York State Department of Health. I confirm new providers/staff who join our group will complete the Medicaid Cultural Competency Training and the group will submit an updated provider list and certification upon request by the Plan. I declare that the above statement is true and accurate to the best of my knowledge. Additionally, this will confirm that I hold the authority to make this certification. Name of Authorized Person* First Name* Last Name Email Address* Title of Authorized Person* Delegate Name* Organizational TIN*Number of Providers* CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
