Covered California delays contract vote following CMA request for physician involvement

February 15, 2016
Area(s) of Interest: Advocacy Health Care Reform 

Covered California, the state’s health insurance exchange, has postponed a vote on a major health plan contract after hearing concerns from the California Medical Association (CMA) that the deal’s development lacked sufficient physician participation.

Specifically, CMA has issue with a provision – Attachment 7 – of the agreement involving measures to rate a provider’s quality of care. Representing more than 41,000 physicians and medical students in California, CMA wants to ensure that its members are not overburdened by costly and unwieldy administrative requirements and that any quality rating measures developed by Covered California are both meaningful and accurate.

CMA submitted comments expressing its concerns on the 2017-19 health plan contract and co-authored a letter – with the California Hospital Association (CHA) and the California Association of Health Plans (CAHP) – that was sent to Covered California on Feb. 17.

“The technical aspects of the contract and its attachments would have benefited from technical expertise to which CAHP, CHA, and CMA have access,” the joint letter read. “However, the current process did not provide opportunity for our members – Covered California’s infrastructure – to engage in that dialogue with both the larger stakeholder community and Covered California staff.”

Covered California responded by postponing a vote on the contract until April.

Until then, CMA will continue to work with the insurance exchange to ensure physicians are involved as quality measures are developed.


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