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Physician Resources for Contracting With Exchange Plans

The following information and resources will help prepare practices for contracting with health plans that are participating in Covered California, the state’s health benefit exchange.

Current CMA Resources

1. CMA’s Got You Covered: A Physician’s Guide to Covered California, the State’s Health Benefit Exchange. This resource is free for members and includes the following:

  • Background and overview of the ACA and the exchange.
  • A discussion of the exchange participation eligibility, essential health plan benefits, and timeline for implementation.
  • Clarification of physician’s rights and responsibilities regarding existing health plan contract amendments.
  • Links to CMA resources related to health plan contract analysis and negotiating contracts.

2. CMA Reform Essentials. This regular publication, which members can download and/or subscribe to receive, includes timely information related to California’s implementation of federal healthcare reform, including discussions on network adequacy, model contract development, and reporting requirements.

3. California Health Benefits Exchange Fact Sheet. This document provides a summary of the exchange and how it may impact physician practices. NOTE: CMA staff is in the process of updating this resource.

4. CMA Practice Resources (CPR). Member can subscribe or download this monthly publication. Current and past issues include tips and tools for contracting with health plans in the exchange.

5. Live and on-demand CMA webinars. SDCMS-CMA members have access to the on-demand webinar titled, California’s Health Benefit Exchange: How it Will Impact Your Practice and Change Commercial Insurance (recorded April 24, 2013).

CMA is hosting a live webinar titled California’s Health Benefit Exchange: The Positives and Perils of Contracting on September 11, 2013. The webinar is free for SDCMS-CMA member physicians and their office staff.

6. Live Educational Forums. CMA staff is available to provide onsite, live informational sessions on the exchange and what physicians and their staff can do to prepare for contracting with exchange plans.

7. Essential Health Benefits Fact Sheet. This fact sheet was developed to help physicians understand the basic facts around the “essential health benefits” component of federal healthcare reform and how California’s health benefits exchange may be affected. Click here to download it.

8. CMA ON CALL Document #7450, Health Benefits Exchange. This medical-legal document includes a discussion on network adequacy, administrative burden associated with exchange plans, the grace-period issue, concerns that physicians may be contracted with exchange plans without knowing it, what to look for in the mail on exchange plan contracting, and examples of termination provisions in current exchange contracts.

9. CMA's Payor Contracting Resources. Links to CMA’s contracting resources, which includes a dedicated discussion on contracting with exchange plans.

Additional Resources

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