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

• Individual/Exchange Network Addendum Participating Center Agreement (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Contract-Addendum-Template-Health-Benefit-Exchange.pdf)- Contract Template for Addendum to existing contract with Insurer who will now be participating in the Exchange
• Sample Letter of Intent to Participate in Health Net PPO Network (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-06-19-Sample-LOI-for-PPO-Network.pdf)
• Sample Participating Physician Group Agreement (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-06-19-Sample-Provider-Agmt-Anthem.pdf)- Anthem Blue Cross
• Letter of Intent to Participate in Provider Network Template (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-06-19-LOI-Network-template.doc)
• Independent Physician and Provider Agreement (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-06-19-Blue-Shield-IPPA.pdf) (Blue Shield)

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:
• Medi-Cal Rural Physician Agreement (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Medi-Cal-Rural-Physician-Agreement-25-County-Expansion.doc)
• Medi-Cal Rural Physician Agreement with modifications (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Medi-Cal-Blue-Cross-Rural-25-County-Addendum-w-track-changes.doc)
• Medi-Cal Rural Provider Incentives (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Medi-Cal-Rural-Provider-Incentives-for-25-County-Expansion.pdf)
• Medi-Cal Rural Document Checklist (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Medi-Cal-Rural-Document-Check-List.pdf)
• 2011-2012 Incentive Compensation (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2011-2012-Incentive-Compensation.pdf)
• DHCS - Portions of Sample Standard Agreement (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/DHCS-Portions-of-Sample-Standard-Agreement.pdf)
• 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)
• Webinar Follow-up Q & A (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/ECG-Webinar-Follow-up-QandA.pdf)

• 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

• Incentive Program for CHCs and Anthem: Background and CPCA Value Added (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Nancy-Oswald-CPCA-Anthem-Incentive-Presentation-04-2013.pdf)- pdf presentation slides (prepared by Nancy Oswald for CPCA – April, 2013)
• Marin and Mendocino Counties: 2012-2013 Primary Care Quality Improvement Program (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2012-2013-Summary-of-Measures-and-Thresholds-for-Marin-and-Mendocino-Counties.pdf) - (Partnership Healthplan – provided by Nancy Oswald, April 2013
• Yolo, Solano, Napa, and Sonoma Counties:  2012-2013 Summary of Measures and Thresholds (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2012-2013-Summary-of-Measures-and-Thresholds-Yolo-Solano-Napa-and-Sonoma-Counties.pdf)- (Partnership Healthplan)
• LA Care’s Physician Pay-for-Performance Program 2012 (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/LA-Care-PhysP4P-2012.pdf)
• Incentives and Protections in Managed Care Contracts (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/2013-Feb-CPCA-Incentives-and-Protections.pdf) (CPCA Presentation, February 2013)

General Information on the California Health Benefits Exchange (Covered California)

• CCHCs in Covered California (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/CPCA-CCHCs-in-Covered-California-presentation-2-2013.pdf)- pdf presentation slides (CPCA Presentation, February 2013)
• Covered California Assister Interest Form (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Covered-CA-Assister-Interest-Form.docx)
• Covered California Health Plans booklet (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/CC-Health-Plans-Booklet-FINAL-5-22-13.pdf) (May 23, 2013)
• Covered California – Frequently Asked Questions about Health Plans (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/Covered-CA-FAQs-on-Health-Plans-5-23-13.pdf) (May 23, 2013)

Exchange Basics

• NACHC 2013 Policy & Issues Forum Presentation (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-P-I-Forum-Exchange-Basics-3-20-13.pdf) pdf presentation slides (March 20, 2013)
• NACHC Essential Community Provider (ECP) White Paper (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-ECP-White-Paper-3-13-13.pdf) (March 13, 2013)
• NACHC Key Issues for Health Centers in Exchanges (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/NACHC-Fact-Sheet-Key-Issues-in-Exchanges-5-2013.pdf) (May, 2013)

Supporting Materials

• CPCA Community Clinics and Health Centers Fact Sheet (http://www.cpca.org/cpca2013/assets/File/Policy-and-Advocacy/Legislative/StateHCR/Managed-Care-Contracting/CPCA-CCHCs-Fact-Sheet.pdf) (May 2013)