Plan Management

Plan Management & Delivery Systems Reform

March 7th, 2019: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides
• Proposed 2020 Patient-Centered Benefit Plan Designs
• Proposed 2020 Patient-Centered Benefit Play Design – Side-by-Side Comparison
• Proposed Covered California 2020 Dental Benefit Plan Designs and Endnotes
• Proposed Covered California 2020 Dental Copay Schedule

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

• Agenda
• Presentation Slides
• Proposed Covered California 2020 Dental Copay Schedule
• Proposed Covered California 2020 Dental Benefit Plan Designs and Endnotes
• Proposed 2020 Patient-Centered Benefit Play Design – Side-by-Side Comparison
• Proposed 2020 Patient-Centered Benefit Plan Designs
  The proposed 2020 Patient-Centered Benefit Plan Designs presented during the February 14th meeting are final and there will be no further changes to the endnotes.

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January 10th, 2019: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides
• Plan Year 2020 QHP Certification Application Public Comment Summary

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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.

• Intent to Apply 2019 Quarterly QHP Covered California for Small Business
• Covered California Confidentiality Agreement
• Application
• Attachments & Appendices

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December 17th, 2018: 2020 Draft Qualified Health and Dental Plan Applications Have Been Posted

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October 11th, 2018: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides
• Merged Individual and Small Group Market Report - DRAFT
  • This is a draft report and public comments or questions can be submitted to allie.managiaracino@covered.ca.gov until COB October 26, 2018

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September 6th, 2018: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Plan Management Advisory Optional Survey on Topic Priorities and Forums:
  https://www.surveymonkey.com/r/WTZF39H
  Must be completed by Aug 31, 2018 at 12PM for results to be counted for Sept 6th meeting.
• Presentation Slides

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August 9th, 2018: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides

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March 8th, 2018: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides
• 2019 Patient Centered Benefit Plan Designs
• 2019 Proposed Plan Designs Side by Side Comparison
• 2019 Dental Benefit Plan Designs
• Covered California Silver Plan Compared to Short Term Insurance

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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.

• Qualified Health Plan Certification Application Plan Year 2019 Small Business Marketplace (Corrected 3-8-18)
• Qualified Health Plan Certification Application Plan Year 2019 Small Business Marketplace Red-Line (Corrected 3-8-18)
  • Attachments B C1 C2 D2 D3 – CCSB QHP
  • Attachment D1 Member Communication Calendar – CCSB QHP (word)
  • Attachment E QIS Run Charts
• Appendix A Definition of Good Standing
• Appendix G Covered California Brand Style Guide
• Appendix H 2017 QHP Issuer Contract Attachment 7
• Appendix I Provider Data Submission Guide v1.9
• Appendix J Issuer Payment Discrepancy Resolution
• Appendix K NOD 23 Report Glossary
• Appendix M 834 Companion Guide Design v2.2
• Appendix P CCSB Group XML Schema v2.1a
• Appendix Q CCSB EDI 820 Companion Guide V 2 0
• Appendix O GAO 15-593SP
• Appendix S1 CAUTI Rates
• Appendix S2 CLABSI Rates
• Appendix S3 C Diff Rates
• Appendix S4 MRSA Rates
• Appendix S5 SSI Colon Rates
• Appendix T Draft Summary of ACO Best Practice
• Appendix U IHA Commercial ACO Measure Set
• Application Legend (Corrected 3-8-18)
• Comment Template

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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.

• Qualified Health Plan Certification Application Plan Year 2019 Individual Marketplace (Corrected 3-13-18)
• Qualified Health Plan Certification Application Plan Year 2019 Individual Marketplace Red-Line (Corrected 3-13-18)
  • Attachments B C1 C2 D2 D3 – Individual QHP
  • Attachment D1 Member Communication Calendar – Individual QHP (word)
  • Attachment E QIS Run Charts – Individual QHP
• Appendix A Definition of Good Standing
• Appendix C PMPM_Member_Level_Detail_Response SAMPLE
• Appendix D Covered California Reconciliation Process Guide v3
• Appendix E Covered California Delegation Policy
• Appendix G Covered California Brand Style Guide
• Appendix H 2017 QHP Issuer Contract Attachment 7
• Appendix I Provider Data Submission Guide v1.9
• Appendix L 834 Companion Guide v17.9.20
• Appendix O GAO 15-593SP
• Appendix S1 CAUTI Rates
• Appendix S2 CLABSI Rates
• Appendix S3 C Diff Rates
• Appendix S4 MRSA Rates
• Appendix S5 SSI Colon Rates
• Appendix T Draft Summary of ACO Best Practice
• Appendix U IHA Commercial ACO Measure Set
• Application Legend (Corrected 3-8-18)
• Comment Template

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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.

• Qualified Dental Plan Certification Application Plan Year 2019 Small Business Marketplace (Corrected 3-13-18)
• Qualified Dental Plan Certification Application Plan Year 2019 Small Business Marketplace Red-Line (Corrected 3-13-18)
  • Attachments C1 C2 D2 D3 – CCSB QDP
  • Attachment D1 Member Communication Calendar – CCSB QDP (word)
• Appendix A Definition of Good Standing
• Appendix G Covered California Brand Style Guide
• Appendix I Provider Data Submission Guide v1.9
• Appendix J Issuer Payment Discrepancy Resolution
• Appendix K NOD 23 Report Glossary
• Appendix M 834 Companion Guide Design v17.9.20
• Appendix O GAO 15-593SP
• Appendix P CCSB Group XML Schema v2.1a
• Appendix Q CCSB EDI 820 Companion Guide V 2 0
• Application Legend (Corrected 3-8-18)

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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.

• Qualified Dental Plan Certification Application Plan Year 2019 Individual Marketplace (Corrected 3-13-18)
• Qualified Dental Plan Certification Application Plan Year 2019 Individual Marketplace Red-Line (Corrected 3-13-18)
  • Attachments C1 C2 D2 D3 – Individual QDP
  • Attachment D1 Member Communication Calendar – Individual QDP (word)
• Appendix A Definition of Good Standing
• Appendix C PMPM_Member_Level_Detail_Response SAMPLE
• Appendix D Covered California Reconciliation Process Guide v3
• Appendix E Covered California Delegation Policy
• Appendix G Covered California Brand Style Guide
• Appendix I Provider Data Submission Guide v1.9
• Appendix L 834 Companion Guide v17.9.20
• Appendix O GAO 15-593SP
• Application Legend (Corrected 3-8-18)
• Public Comment & Responses

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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.

• Draft Qualified Health Plan Certification Application Plan Year 2019 Covered California for Small Business
  • Attachments B C1 C2 D2 D3 – CCSB QHP
  • Attachment D1 Member Communication Calendar – CCSB QHP (word)
  • Attachment E QIS Run Charts – CCSB QHP
• Appendix A Definition of Good Standing
• Appendix G Covered California Brand Style Guide
• Appendix H 2017 QHP Issuer Contract Attachment 7
• Appendix I Provider Data Submission Guide v1.9
• Appendix J Issuer Payment Discrepancy Resolution
• Appendix K NOD 23 Report Glossary
• Appendix M 834 Companion Guide Design v2.2
• Appendix O GAO 15-593SP
• Appendix P CCSB Group XML Schema v2.1a
• Appendix Q CCSB EDI 820 Companion Guide V 2 0
• Appendix R Attachment 7_Meaurement Specifications
• Appendix S1 CAUTI Rates
• Appendix S2 CLABSI Rates
• Appendix S3 C Diff Rates
• Appendix S4 MRSA Rates
• Appendix S5 SSI Colon Rates
• Appendix T Draft Summary of ACO Best Practice
• Application Legend
• Comment Template



• Draft Qualified Dental Plan Certification Application Plan Year 2019 Covered California for Small Business
  • Attachments B C1 C2 D2 D3 – CCSB QDP
  • Attachment D1 Member Communication Calendar – CCSB QDP (word)
• Appendix A Definition of Good Standing
• Appendix G Covered California Brand Style Guide
• Appendix I Provider Data Submission Guide v1.9
• Appendix J Issuer Payment Discrepancy Resolution
• Appendix K NOD 23 Report Glossary
• Appendix M 834 Companion Guide Design v2.2
• Appendix O GAO 15-593SP
• Appendix P CCSB Group XML Schema v2.1a
• Appendix Q CCSB EDI 820 Companion Guide V 2 0
• Application Legend
• Comment Template

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January 19, 2018: Draft 2019 Qualified Dental Plan Certification Application

Covered California is accepting comments on the draft QDP Certification Application until close of business Wednesday January 31. 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 QDP 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 QDP Issuers.

• Draft Qualified Dental Plan Certification Application Plan Year 2019 Individual Marketplace
  • Attachments B C1 C2 D2 D3 – Individual QDP
  • Attachment D1 Member Communication Calendar – Individual QDP (word)
• Appendix A Definition of Good Standing
• Appendix C PMPM_Member_Level_Detail_Response SAMPLE
• Appendix D Covered California Reconciliation Process Guide v3
• Appendix E Covered California Delegation Policy
• Appendix G Covered California Brand Style Guide
• Appendix I Provider Data Submission Guide v1.9
• Appendix L 834 Companion Guide v17.9.20
• Appendix O GAO 15-593SP
• Application Legend
• Comment Template

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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.

• Draft Qualified Health Plan Certification Application Plan Year 2019 Individual Marketplace
  • Attachments B C1 C2 D2 D3 – Individual QHP
  • Attachment D1 Member Communication Calendar – Individual QHP (word)
  • Attachment E QIS Run Charts – Individual QHP
• Appendix A Definition of Good Standing
• Appendix C PMPM_Member_Level_Detail_Response SAMPLE
• Appendix D Covered California Reconciliation Process Guide v3
• Appendix E Covered California Delegation Policy
• Appendix G Covered California Brand Style Guide
• Appendix H 2017 QHP Issuer Contract Attachment 7
• Appendix I Provider Data Submission Guide v1.9
• Appendix L 834 Companion Guide v17.9.20
• Appendix O GAO 15-593SP
• Appendix R Attachment 7_Meaurement Specifications
• Appendix S1 CAUTI Rates
• Appendix S2 CLABSI Rates
• Appendix S3 C Diff Rates
• Appendix S4 MRSA Rates
• Appendix S5 SSI Colon Rates
• Appendix T Draft Summary of ACO Best Practice
• Application Legend
• Comment Template

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January 11th, 2018: Plan Management Advisory Group Meeting and Webinar

• Presentation Slides
• Agenda
• 2019 Proposed Plan Designs
• 2019 Patient-Centered Benefit Plan Designs
• 2019 Dental Benefit Design
• Plan Management Advisory Group January 11th, 2018 (Video)

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November 30, 2017: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides

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October 10, 2017: Dental Technical Workgroup Meeting and Webinar

• Agenda
• Presentation Slides

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October 2, 2017: Plan Management Advisory Group Meeting and Webinar

• Agenda
• Presentation Slides

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August 23, 2017: Dental Technical Workgroup Meeting and Webinar

• Agenda
• Presentation Slides

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August 10, 2017: Plan Management Advisory Meeting

• Agenda
• Presentation slides

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July 20, 2017: Plan Management Advisory Meeting

• Agenda
• Presentation slides

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June 8, 2017: Plan Management Advisory Meeting

• Agenda
• Presentation slides
• CSR Supplemental Rate Filing Instructions

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May 11, 2017: Plan Management Advisory Meeting

• Agenda
• Presentation slides

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March 2, 2017: Plan Management Advisory Meeting

• Agenda
• Presentation slides
• Join by Webinar
• Please note that comments on the draft 2018 Essential Community Provider (ECP) list can be submitted to ProviderDirectory@Covered.CA.gov between 3/1 and 3/16.

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January 19th 2017: Plan Management Advisory Meeting

• Agenda
• Plan Management Advisory Group Slides
• Draft Covered California 2018 Patient Centered Benefit Plan Designs 10.0
• Draft Covered California 2018 Patient Centered Benefit Plan Designs 9.5
• Proposed Plan Designs 2017
• Draft Endnotes for 2018 PCBPD 2017
• Join by Webinar
• Plan Management Advisory Group January 19, 2017 (Video)

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January 12, 2017: Dental Technical Workgroup Meeting and Webinar

• Agenda
• Presentation Slides
• Draft 2018 Dental Benefit Designs
• Draft 2018 Copay Schedule

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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.

• Draft QHP Certification Application for Plan Year 2018 Individual Marketplace
• • Attachments B C1 C2 D2 D3 – Individual QHP
  • Attachment D1 Member Communication Calendar – Individual QHP (word)
  • Attachment E QIS Run Charts – Individual QHP (excel)
• Draft QDP Certification Application for Plan Year 2018 Individual Marketplace
• • Attachments C1 C2 D2 D3 – Individual QDP
  • Attachment D1 Member Communication Calendar – Individual QDP (word)
• Draft QHP Certification Application for Plan Year 2018 Covered California for Small Business
• • Attachments B C1 C2 D2 D3 G – CCSB QHP
  • Attachment D1 Member Communication Calendar – CCSB QHP (word)
  • Attachment E QIS Run Charts – Individual QHP (excel)
• Draft QDP Certification Application for Plan Year 2018 Covered California for Small Business
• • Attachments C1 C2 D2 D3
  • Attachment D1 Member Communication Calendar – CCSB QDP (word)
• Appendix A Definition of Good Standing
• Appendix B Issuer Participation Fee Billing Discrepancy Resolution
• Appendix C PMPM_Member_Level_Detail_Response SAMPLE
• Appendix D Covered California Reconciliation Process Guide v2
• Appendix E Covered California Agent of Record (AOR) Policy
• Appendix G Covered California Brand Style Guide
• Appendix H 2017 QHP Issuer Contract Attachment 7
• Appendix I Provider Data Submission Guide 2018
• Appendix K NOD 23 Report Glossary
• Appendix L 834 Companion Guide v16.9.40
• Appendix M 834 Companion Guide Design v2.2
• Appendix N CCSB Agent of Record Policy
• Appendix O GAO 15-593SP
• Appendix P CCSB Group XML Schema v2.1a
• Appendix Q CCSB EDI 820 Companion Guide v2.0
• Appendix R Attachment 7_Meaurement Specifications
• Comment Template

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December 8, 2016: Plan Management Advisory Group Meeting and Webinar

Please send additional comments on the 2018 Benefit Design topic to Allie.Mangiaracino@covered.ca.gov by December 31, 2016.

• Agenda
• Slides
• 2018 Benefit Design Workgroup Proposals for Policy Discussion Item
• DRAFT Covered CA 2018 Standard Benefit Plan Designs 10.0 EHB 2016-12-08
• DRAFT Endnotes for 2018 PCBPD 2016-12-08

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December 1, 2016: Dental Technical Workgroup Meeting and Webinar

• Agenda
• Slides

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November 14, 2016: Dental Technical Workgroup Meeting and Webinar

• Agenda
• Final Slides
Please note, changes were made to Slide 20 only.

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November 10, 2016: Plan Management Advisory Group

• Agenda
• Slides
California Hospital C-Section Honor Roll Announcement:
http://www.iha.org/our-work/insights/smart-care-california

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October 20, 2016: Plan Management Advisory Group Meeting and Webinar

• Recording
• Agenda
• Slides

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September 8, 2016: Plan Management Advisory Group Meeting and Webinar

• Recording
• Agenda
• Slides
• Enrollment System Updates Slides

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August 30, 2016: Covered California's Consolidated Essential Community Provider List

Please refer  any questions to ahmed.al-dulaimi@covered.ca.gov noting “ECP 2016” in the subject line.

• Covered California Consolidated ECP List (AUG 2016)

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August 11th, 2016 Plan Management Advisory Group Meeting

• Agenda
• Register for Webinar
• Appendix 2 to Attachment 7: Measurement Specifications, 8/5/16
• Meeting Slides

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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.

• Appendix 2 to Attachment 7 – Measurement Specifications, 6/1 – CLEAN
• Appendix 2 to Attachment 7: Measurement Specifications, 6/1  – REDLINE

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.

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June 13th, 2016: Plan Management Advisory Group Meeting

• Agenda
• Register for Webinar
• Meeting Slides
• 2017 Standard Benefit Plan Designs

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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.

• Appendix 2 to Attachment 7: Measurement Specifications, 5/3 VERSION – CLEAN
• Appendix 2 to Attachment 7: Measurement Specifications, 5/3 VERSION – REDLINE

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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

• Agenda
• Dr. Kevin Grumbach – Identifying Advanced (or at least Advancing) Primary Care Practices – May 10, 2016
• Dr. Robert Berenson – Perspectives on Primary Care Transformation: Measurement, MACRA, Medical Homes, and Payment Reform – May 10, 2016
• Leah Newkirk, JD – Overview of Comprehensive Primary Care PLUS – May 10, 2016

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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.

• Agenda
• Appendix 2 to Attachment 7: Measurement Specifications, 4/28 VERSION – REDLINE
• Appendix 2 to Attachment 7: Measurement Specifications, 4/28 VERSION – CLEAN
• CMS RFP Announcement – Hospital Improvement Innovation Networks (HIINs)

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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.

• Agenda
• Appendix 2 to Attachment 7: Measurement Specifications, 4/14 VERSION – REDLINE
• Appendix 2 to Attachment 7: Measurement Specifications, 4/14 VERSION – CLEAN

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March 29th, 2016: Plan Management Advisory Group Meeting

• Agenda
• Slides
• Register for Webinar

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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.

• 1:00 PM – 3:00 PM
• Agenda
• Proposed Timeline for Reporting Baseline Measures – 2017 Certification Application
• Percentages of Self-Reported Race and Ethnicity Information by Issuer – Covered California Post-Enrollment for Plan Year 2016
• Appendix 2 to Attachment 7: Measurement Specifications – REDLINE VERSION
• Appendix 2 to Attachment 7: Measurement Specifications – CLEAN VERSION
• Appendix 2 to Attachment 7: Measures 9 and 10 – Cerebrovascular and Cardiovascular Dx Codes

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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.

• Intent to Apply 2017 QHP Covered California for Small Business

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March 17, 2016: Attachments to 2017-2019 Draft QDP Issuer Contract

Please submit comments for all Attachments to Val Shipman at Valerie.shipman@covered.ca.gov by Monday, March 28, 2016.

• Attachment 5: Dental Carrier Evaluation
• Attachment 7: Quality, Network Management and Delivery Systems Standards
• Attachment 13: List of Required Reports
• Attachment 14: Performance Standards

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March 15, 2016:  2017-2019 Draft QDP Issuer Model Contract

Please submit comments to Val Shipman at Valerie.shipman@covered.ca.gov by Thursday, March 24, 2016.

• 2017-2019 Draft QDP Issuer Model Contract
• Comment Template for the 2017 QDP Contract

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Attachment 7: Quality, Network Management and Delivery System Standards – Final Draft Recommendation 3-4-2016

Attachment 7: Quality, Network Management and Delivery System Standards – Final Draft Recommendation 3-4-2016_ Redline from 2-18-2016

The versions of Attachment 7 above will be discussed at the March 29th Plan Management Advisory Meeting from 1- 3 PM.”

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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.

• Attachment 7: Quality, Network Management and Delivery System Standards
  • Attachment 7: Quality, Network Management and Delivery System Standards (Redline)
• Attachment 14: Performance Standards
  • Attachment 14: Performance Standards (Redline)

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February 11th, 2016: Plan Management Advisory Group Meeting

• Agenda
• Slides
• Recording of Webinar
• Proposed 2017 Standard Benefit Plan Designs
• Covered CA 2017 Standard Benefit Plan Designs 9.5 EHB
• Covered CA 2017 Standard Benefit Plan Designs 10.0 EHB
• Endnotes to 2017 Standard Benefit Plan Designs (Draft)
• Proposed 2017 Dental Plan Design – Children- Family Copay
• Proposed 2017 Dental Plan Design – Children- Family Employer Coinsurance

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 Tuesday, February 16th at 9am.

• Attachment 7 – Quality, Network Management, Delivery System Standard and Improvement Strategy – VERSION 2/11/2016, REDLINED
• Attachment 7 – Quality, Network Management, Delivery System Standard and Improvement Strategy – VERSION 2/11/2016, CLEAN
• Attachment 14 – Performance Standards – VERSION 2/11/2016, REDLINED
• Attachment 14 – Performance Standards – VERSION 2/11/2016, CLEAN

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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.

• Comment Template
• Qualified Dental Plan (QDP) Certification Application for Plan Year 2017 Covered California for Small Business
• Appendix A
• Appendix E
• Appendix F
• Appendix G
• Appendix I
• Appendix J
• Appendix K
• Appendix M
• Attachments (excel)
• Attachment D1 (word)

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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.

• Comment Template
• Qualified Dental Plan (QDP) Certification Application for Plan Year 2017
• Appendix A
• Appendix B
• Appendix C
• Appendix D
• Appendix E
• Appendix F
• Appendix G
• Appendix I
• Appendix M
• Attachments (excel)
• Attachment D1 (word)

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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.

• Comment Template
• Qualified Health Plan (QHP) Certification Application for Plan Year 2017 (word)
• Appendix A
• Appendix E
• Appendix F
• Appendix G
• Appendix H
• Appendix I
• Appendix J
• Appendix K
• Attachments (excel)
• Attachment D1 (word)

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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.

• 2017-2019 Draft QHP Issuer Model Contract
• Attachment 5 - Plan Management Carrier Evaluation
• Attachment 7 - Quality, Network Management, Delivery System Standards and Improvement Strategy
• Appendix 2 to Attachment 7 - Measurement Specifications
• Attachment 13 – List of Required Reports
• Attachment 14 – Performance Standards
• 2017 QHP Issuer Contract Attachment 7 Appendix 1 EAS Vendor_General Layouts
• 2017-2019 Comment Template

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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).

• Comment Template
• Covered California Qualified Health Plan Certification Application for Plan Year 2017
• Appendix A
• Appendix B
• Appendix C
• Appendix D
• Appendix E
• Appendix F
• Appendix G
• Appendix H
• Appendix I
• Attachment D1 Member Communications Calendar
• 2017 Draft QHP Certification Application Attachments

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January 14, 2016: Plan Management Advisory Meeting

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Joint Letter on C Section Safety
• Proposed 2017 Standard Benefit Plan Designs
• Covered CA 2017 Standard Benefit Plan Designs 9.5 EHB
• Covered CA 2017 Standard Benefit Plan Designs 10.0 EHB
• Endnotes to 2017 Standard Benefit Plan Designs (Draft)
• Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid
• 2016 and 2017 Standard Benefit Plan Designs Comparision
• Register for Webinar

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January 7, 2016: Dental Technical Workgroup

• 10:00 am to 12:00 pm
• Agenda
• Covered California Draft Dental Copay Schedule All Procedures
• BSC Proposed 2017 Pediatric and Adult Standardized Full Copay Schedule
• Presentation Slides
• Register for Webinar

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December 8, 2015: Dental Technical Workgroup

• 1:00 to 3:00 pm
• Agenda
• Presentation Slides
• Covered California 2017 Dental Copays (Draft)
• Register for Webinar

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November 12, 2015: Plan Management Advisory Meeting

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar
• CPEHN Letter on Covered CA Quality Strategy
• Covered CA 2017 Benefit and Networks Workgroup Advocates Comments

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November 5, 2015: Dental Technical Workgroup

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Common ADA DEntal Procedure Codes
• Register for Webinar

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October 29, 2015: Dental Technical Workgroup

• This meeting has been cancelled

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October 15, 2015: Plan Management Advisory Meeting

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar

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September 23, 2015: Dental Technical Workgroup

• 11:00 am to 12:30 pm
• Agenda
• Presentation Slides
• Register for Webinar

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September 17, 2015: Plan Management Advisory Meeting

• 10:00 am to 11:00 AM
• Agenda
• Presentation Slides
• Register for Webinar

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August 13, 2015: Plan Management Advisory Meeting

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar

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July 23, 2015: Plan Management Advisory Group Meeting and Webinar

• 10:00 am to 12:00 pm
• Agenda
• Register for Webinar
• Presentation Slides
• CMS Summary Report in Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2015 Benefit Year
• 2016 QHP Draft Contract and Attachments

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June 29, 2015: Dental Technical Workgroup

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar

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May 14, 2015: Plan Management and Delivery System Reform Advisory Group

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar

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April 28, 2015: Dental Technical Workgroup

• 10:00 am to 12:00 pm
• Agenda
• DQA Measures Overview
• Presentation Slides
• Register for Webinar

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April 9, 2015: Plan Management and Delivery System Reform Advisory Group

• 10:00 am to 12:00 pm
• Agenda
• Presentation Slides
• Register for Webinar

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February 26, 2015: Plan Management and Delivery System Reform Advisory Group

• 10:00 am to 12:15 pm
• Agenda
• Presentation Slides
• Register for Webinar

January 13, 2015: Plan Management and Delivery System Reform Advisory Group

• 10:00 am to 12:15 pm
• Register for Webinar
• Agenda
• Presentation Slides
• 2016 Standard Benefit Design (Revised 1-14-15)

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December 22, 2014: Review of 2016 QHP New Entrant Certification Application

• 1:30 pm to 3:00 pm
• Recording of Webinar
• Presentation Slides
• QHP New Entrant Application for PY 2016 (DRAFT)
• QHP New Entrant Application - Appendix A (DRAFT)
• QHP New Entrant Application - Appendix B (DRAFT)
• QHP New Entrant Application - Attachments A - G (DRAFT)
• QHP New Entrant Application - Section 8 eValue8 (DRAFT)

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December 16, 2014: Review of 2016 QHP & QDP Recertification Draft Application

• 10:00 am to 12:00 pm
• Recording of Webinar
• Draft 2016 QDP Recertification Application (with proposed changes)

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December 9, 2014 : Plan Management Advisory Committee

• 10:00 am to 12:00 pm
• Register for Webinar
• Agenda
• Presentation Slides
• QRS Reporting - Fall 2015

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November 6, 2014 : Plan Management Advisory Committee

• 10:00 am to 1:00 pm
• Register for Webinar
• Agenda
• Nomination Letter (DRAFT)
• New Member Nomination/Application Form 2014 (for 2015-16 term)
• Presentation Slides

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October 16, 2014 : Dental Ad Hoc Advisory Group Meeting

• 12:00 pm to 3:00 pm
• Register for Webinar
• Agenda
• Ad Hoc Dental Slides

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September 12, 2014 : Plan Management Advisory Group Meeting

• 12:00 pm to 2:30 pm
• Recording of Webinar
• Agenda
• September 12, 2014 Plan Management
• PUBLIC CAHPS Rating Methods Fall 2014
• Summary

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August 15, 2014 : Plan Management Committee Advisory Meeting

• 12:00 pm to 3:00 pm
• Recording of Webinar
• Agenda
• PowerPoint Presentation
• APTC Letter

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August 14, 2014 : Dental Ad Hoc Advisory Group Meeting

• 12:00 pm to 3:00 pm
• Recording of Webinar
• Agenda
• PowerPoint Presentation
• Adult Dental Benefits Chart

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June 6, 2014 : Dental Ad Hoc Advisory Group Meeting

• 12:00 pm to 2:00 pm
• Register for the Webinar   
• Agenda
• PowerPoint Presentation

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June 5, 2014 : Plan Management Advisory Group Meeting

• 12:00 pm to 2:30 pm
• Register for the Webinar
• Agenda
• PowerPoint
• Road Map

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April 15, 2014 : Special Enrollment Ad Hoc Work Group Meeting

• Agenda
• Webinar Recording
• Plan Management Road Map 2014-2016

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April 9, 2014 : Dental Ad Hoc Advisory Group Meeting

• 1:30 pm to 4:00 pm
• Webinar Recording
• Agenda
• PowerPoint Presentation

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April 1, 2014 : Plan Management Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda
• PowerPoint Presentation

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March 12, 2014 : Dental Ad Hoc Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda
• PowerPoint Presentation

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March 4, 2014 : Plan Management Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Agenda
• 2015 Dental Standard Benefit Plan Designs SADP and Family Dental
• PowerPoint Presentation
• Webinar Recording

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February 7, 2014 : Dental Ad Hoc Advisory Group Meeting

• 11am to 2 pm
• Webinar Recording
• Agenda
• PowerPoint Presentation
• Pediatric Dental Insurance FAQs

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February 4, 2014: Plan Management Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda

  QHP New Entrant Application Draft
  QHP Renewal Application Draft
  SADP Renewal Application Draft
  Dental New Entrant Application for 2015 Draft
  Dental New Entrant Attachment 11 - Technical Specifications
  Dental New Entrant Attachment 12 - Performance Measures
  Dental New Entrant Attachment 14 - Additional Questions and Requirements
  Draft 2015 Dental New Entrant Regulations
  Draft 2015 Recertification Regulations
  Draft 2015 QHP New Entrant Regulations
  Draft 2015 QHP Recertification Regulations

• Power Point Presentation

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January 15, 2014: Dental Ad Hoc Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda
• Power Point Presentation
• Draft Brief

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January 7, 2014: Plan Management Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda
• Power Point Presentation

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December 10, 2013: Dental Ad Hoc Advisory Group Meeting

• 1:30 pm to 4:30 pm
• Webinar Recording
• Agenda

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November 15, 2013: Plan Management and Delivery System Reform Advisory Group Webinar

• 1:30 pm to 3:30 pm
• Webinar Recording
• Agenda
• Power Point Presentation

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November 13, 2013: Dental Ad Hoc Advisory Group Meeting

• 12:00pm-2:00pm
• Webinar Recording
• Power Point Presentation

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October 29, 2013: Plan Management and Delivery System Reform Advisory Group Webinar

• Tuesday, October 29, 2013, from 12:00 pm to 3:00 pm
• Webinar Recording
• Agenda
• Power Point Presentation

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September 11, 2013: Plan Management and Delivery System Reform Advisory Group Webinar

• 10:00 am to 1:30 pm.
• Webinar Recording
• Agenda
• Power Point Presentation
• Grace Period Memorandum

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August 20, 2013: Plan Management Advisory Group Webinar on Pediatric Dental

• Webinar Recording
• Agenda
• Slide Deck for Webinar

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August 6, 2013: Plan Management and Delivery System Reform Advisory Group Webinar

Tuesday, August 6, 2013, from 1:00 pm to 2:30 pm.

Webinar Recording

Slide deck for Webinar

Slide deck for Pediatric Dental Update

Agenda

Memo: Covered California's Quality Rating System

Certified Plan-Based Enrollment Guidelines (Draft)

Presentation - Plan-Based Enrollment

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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.

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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.

Webinar Recording

Agenda

Pediatric Dental Benefit Comment Letter

Request for Information

Pediatric Dental Knowns

Pediatric Dental Advocate Letter

Policy Paper on Pediatric Dental Issues

Pediatric Dental Essential Health Benefits FAQ developed by Deborah Kelch of the Health Insurance Alignment Project

          Draft Bridge Plan Demonstration Project Brief

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April 11th Plan Management and Delivery System Reform Advisory Group Webinar

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

Thursday, April 11, 2013, from 10:00 am to 1:30 pm PST

Webinar Recording

Agenda

Presentation (Leesa Tori)

Presentation (Jeff Rideout)

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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

Webinar Recording

Agenda

Presentation

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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

Agenda

First Plan Management and Delivery System Reform Advisory Group Meeting Presentation

Bridge Plan: A Strategy to Promote Safety Net Continuity and Affordability Presentation

Webinar Recording