Overview
Many uninsured health center patients will reap the benefits of the Affordable Care Act by enrolling in health insurance in 2014. Health centers who hope to continue serving newly insured patients will need to negotiate contracts with managed care plans in both Medi-Cal and in the Exchange. CPCA has collected and created a variety of tools to help CCHCs in the managed care contracting process.
Exchange Contract Template
Negotiating Managed Care Contracts
- Negotiating Managed Care Contracts: How Not to Lose Your Shirt in the Process (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Farmworkers-Conference-Feldman-Tucker-presentation.pdf)- pdf presentation slides (presented by Adam J. Falcone, Esq., Feldman Tucker; at 2013 NACHC Farmworker Conference)(slides 14-32)
- Payment and Contracting in Exchanges (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-Payment-and-Contracting-in-Exchanges-Webinar-4-23-13.pdf)- pdf presentation slides (NACHC webinar)
- Exchange Contracting - Negotiating for Commercial Lives (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-01-29-HBEX-Contracting-Webinar.pdf)- pdf presentation slides (presented by CPCA, with Larry Garcia - January 29, 2013).
- Negotiating with Medi-Cal Managed Care Plans (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-02-28-CPCA-Presentation-Rurals-Webinar.pdf)- pdf presentation slides (presented by CPCA, with Larry Garcia and Nancy Oswald - February 8, 2013). Supporting documents:
- AMA Issue Brief: All Products Clause (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/AMA-Issue-Brief-All-Products-Clause.pdf)
- Essential Community Providers: Tips to Connect with Marketplace Plans (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-April-NASHP-tip-sheet-for-ECP-QHP-connectns.pdf)- pdf fact sheet (National Academy for State Health Policy, April 2013)
- Healthplan Network Development Strategies (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/HealthPlan-Network-Development-Strategies.pdf)
- NACHC Exchange Contracting Checklist (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-Exchange-Contracting-Checklist-3-26-13.pdf) (March 26, 2013)
- NACHC Exchange Contracting Checklist Overview Presentation (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-Exchange-Checklist-Overview-4-12-13-Presentation.pdf) pdf presentation slides (April 12, 2013)
- CMS Letter to NACHC on Rates for FQHCs Providing Services in Exchanges (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2012-06-08-CMS-Letter-to-NACHC-on-Rates.pdf) (June 8, 2012)
- Providers & Health Insurance Exchanges: Contracting and Other Implications for the New Marketplace (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/ECG-Webinar-Slides-Contracting-4-18-13.pdf) pdf presentation slides (ECG Management, April 18, 2013)
- Blue Sheild Letter to DMHC from Adovacates (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Active-Policy-Issues/Medi-Cal-ManagedCare/2015-07-08-BSLtr-toDMHC.pdf)
Building FQHC-Friendly Incentive Programs
General Information on the California Health Benefits Exchange (Covered California)
Exchange Basics
Supporting Materials