Plan Management & Delivery Systems Reform

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    February 14th, 2019: Plan Management Advisory Group Meeting and Webinar

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    Qualified Health Plan Quarterly Certification Application for Plan Year 2019 Covered California Small Business Marketplace

    Interested applicants must use template provided. Letters of Intent (LOI) are nonbinding, but are required to obtain access to the electronic application submission portal. Covered California for Small Business Applicants must submit an LOI and a Plan Year 2019 CCSB QHP Quarterly Certification Application by the date designated in the Application for the appropriate quarter. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

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    March 1, 2018: 2019 Qualified Health Plan Application Covered California for Small Business

    The Small Business Marketplace Health Plan Application has been posted. The application is available electronically to Applicants who submitted a Letter of Intent between February 1 and 15, 2018. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

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    March 1, 2018: 2019 Qualified Health Plan Application Individual Marketplace

    The Individual Marketplace Health Plan Application has been posted. The application is available electronically to Applicants who submitted a Letter of Intent between February 1 and 15, 2018. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

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    March 1, 2018: 2019 Qualified Dental Plan Application Covered California for Small Business

    The Covered California for Small Business Qualified Dental Plan Application has been posted. The application is available electronically to Applicants who submitted a Letter of Intent between February 1 and 15, 2018. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

    Details & Downloads:

    March 1, 2018: 2019 Qualified Dental Plan Application

    The Qualified Dental Plan Application has been posted. The application is available electronically to Applicants who submitted a Letter of Intent between February 1 and 15, 2018. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

    Details & Downloads:

    January 26, 2018: Draft 2019 Qualified Health Plan and Qualified Dental Plan Applications Covered California for Small Business

    Covered California is accepting comments on the draft QHP and QDP CCSB Certification Applications until close of business Friday February 9. Please use the comment template and submit to QHPCertification@covered.ca.gov. Please note, Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents. The Application Legends provide detailed information summarizing the changes made to requirements for currently contracted QHP and QDP Issuers.

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    January 16, 2018: Draft 2019 Qualified Health Plan Certification Application

    Covered California is accepting comments on the draft QHP Certification Application until close of business Friday January 26. Please use the comment template and submit to QHPCertification@covered.ca.gov. Please note, Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents. The Application Legend provides detailed information summarizing the changes made to requirements for currently contracted QHP Issuers.

    December 22: Draft 2018 QHP/QDP Certification Applications

    Please note, Covered California has extended the comment deadline to close of business Friday January 13, 2017. Please use the comment template and submit to Taylor Priestley at taylor.priestley@covered.ca.gov. Please note, Applicants will ultimately complete applications electronically and questions will populate dynamically based on Applicant type (current QHP/QDP Issuer or New Entrant Applicant) as indicated in application documents.

    Details & Downloads:

    Appendix 2 to Attachment 7 – Measurement Specifications

    Covered California has finalized Appendix 2 to Attachment 7 and will convene a technical workgroup to discuss implementation.

    Details & Downloads:

    UPDATE 7/15/16: Covered California will be revising this document to reflect changes to the reporting timeline and will release an updated version in the coming weeks.

    Appendix 2 to Attachment 7 – Measurement Specifications: Comment period open through May 18th at 5 p.m.

    Covered California is accepting comments on the near-final draft of Appendix 2 to Attachment 7 – Measurement Specifications. Please submit all final questions and comments to Allie Mangiaracino at allie.mangiaracino@covered.ca.gov and Lindsay Petersen at lindsay.petersen@covered.ca.gov by Wednesday, May 18th at 5 p.m.

    Details & Downloads:

    May 10, 2016, 9 a.m. – 10:15a.m. Promoting Effective Care Models: Covered California’s Initiative to Advance Primary Care

    Covered California is convening this stakeholder meeting to discuss the approach for defining advanced primary care and identifying payment strategies to support accessible, data-driven, team-based care with accountability for meeting the goals of the triple aim

    April 28, 2016, 10 a.m. – 12 noon: Covered California 2017 Quality Initiatives Metrics and Specifications Workgroup

    Please submit action items, measurement specifications suggestions, and proposed agenda items to Allie Mangiaracino at allie.mangiaracino@covered.ca.gov and Lindsay Petersen at lindsay.petersen@covered.ca.gov by Monday, April 25th at 9 a.m.

    April 14, 2016: Covered California 2017 Quality Initiatives Metrics and Specifications Workgroup

    Please submit action items, measurement specifications suggestions, and proposed agenda items to Allie Mangiaracino at allie.mangiaracino@covered.ca.gov and Lindsay Petersen at lindsay.petersen@covered.ca.gov by Thursday, April 7th at 9 a.m.

    March 22, 2016: Covered California 2017 Quality Initiatives Metrics and Specifications Workgroup

    Please submit comments using the “2017-2019 Comment Template” on the revised Appendix 2 to Attachment 7: Measurement Specifications to Allie Mangiaracino at allie.mangiaracino@covered.ca.gov and Lindsay Petersen at lindsay.petersen@covered.ca.gov by Wednesday, March 16th at 9 a.m. We will use these comments to set the agenda of discussion items for the workgroup meeting on March 22, 2016.

    Qualified Health Plan Certification Application For Plan Year 2017 Covered California for Small Business

    Covered California will accept Letters of Intent to Apply until 4:59pm PST April 15, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.

    Please submit comments using the “2017-2019 Comment Template” on the revised Attachment 7 and Attachment 14 to Allison Mangiaracino at allie.mangiaracino@covered.ca.gov and Lindsay Petersen at lindsay.petersen@covered.ca.gov by Monday, February 29th at 9am.

    February 11th, 2016: Plan Management Advisory Group Meeting

    Qualified Dental Plan Certification Application for Plan Year 2017 Covered California for Small Business

    Please submit comments on draft application and materials to Taylor Priestley at taylor.priestley@covered.ca.gov by Tuesday February 16, 2016.

    Qualified Dental Plan Certification Application for Plan Year 2017 Individual Marketplace

    Please submit comments on draft application and materials to Taylor Priestley at taylor.priestley@covered.ca.gov by Friday February 12, 2016.

    Qualified Health Plan Certification Application for Plan Year 2017 Covered California for Small Business

    Please submit comments on draft application and materials to Taylor Priestley at taylor.priestley@covered.ca.gov by Wednesday February 10, 2016.

    Details & Downloads:

    January 26, 2016: 2017-2019 Draft QHP Issuer Model Contract

    Please submit comments to Elise Dickenson at Elise.Dickenson@covered.ca.gov by Thursday, February 4th.

    Please submit comments on Appendix 2 to Attachment 7: Measurement Specifications to Allison Mangiaracino at allie.mangiaracino@covered.ca.gov by Tuesday, February 16th.

    January 21, 2016: Covered California Draft Qualified Health Plan Certification Application For Plan Year 2017

    Please submit comments on draft application and materials to Taylor Priestley at taylor.priestley@covered.ca.gov by Thursday February 4, 2016 (please note new date).

    January 14, 2016: Plan Management Advisory Meeting

    October 29, 2015: Dental Technical Workgroup

    Details & Downloads:

    • This meeting has been cancelled

    February 4, 2014: Plan Management Advisory Group Meeting

    July 22, 2013: Plan Management and Delivery System Reform Advisory Group Webinar

    We will be discussing and asking for feedback on the Quality Rating System methodology, pediatric dental policy, and plan based enrollers. You may attend in-person or via webinar.

    Monday, July 22, 2013, from 1:00 pm to 3:00 pm

    The meeting will be held at Covered California, 560 J Street, Suite 290 in the Yosemite and Lassen conference rooms.

    February 19th Plan Management and Delivery System Reform Advisory Group Webinar

    This will be the second Plan Management and Delivery System Reform meeting of the year.

    Tuesday, February 19, 2013, from 12:00 pm to 3:00 pm PST

    Details & Downloads:

    Webinar Recording

    Agenda

    Presentation

    January 9th Plan Management and Delivery System Reform Advisory Group Webinar

    The purpose of this group is to provide input and feedback on the QHP process. In this webinar, we will discuss the model contract focusing on quality improvement and delivery system reforms, fee structure for plans, and plan partnerships and marketing.

    Wednesday, January 9, 2013, from 1:00 pm to 4:00 pm PST

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    Resources

    2023-25 Contract Refresh

    Quality Transformation Initiative 

    2022 Contract Amendment 

    Health Equity & Quality Transformation Refresh Resources

    Benefit Plan Designs

    Final QHP Issuer Model Contracts

    Additional Stakeholder Links

    Provider Data Submission Support Documents

    Essential Community Providers

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