Covenant

The Delegation Governance Standard · DGS v1.0

A free published standard. Nothing to buy.

Every delegation is a promise on paper. Prove you're keeping it.

Executive Briefing · June 2026

Health plans delegate clinical and administrative functions to third parties. Between annual reviews, almost nobody is watching.

The industry answer has been the same for twenty years: annual oversight. Once a year, collect reports, review SLAs, file the results. A delegate that begins underperforming in February will not be assessed until January. Eleven months of degraded performance with nobody watching.

The annual cycle catches problems months after they start. It was designed to file results, not to catch failures in time.

The Window Is Closing

550 MA contracts now audited annually
(up from 60)
$2.9M CMPs in 2024 cycle
14 sponsors, 18 violations
$200M Kaiser behavioral health settlement
DMHC, 2023
Feb '26 OIG's first MA compliance guidance
in 27 years

The 2026 HPMS audit updates shifted from form-based validation to evaluating whether compliance programs actually govern delegated work. Ceremonial oversight will be flagged. The November 2025 HPMS memo requires oversight models to define risk ownership, monitoring expectations, escalation thresholds, and enforcement authority. CMP totals through 2025 already exceed the combined total for 2021 through 2024.

The Delegation Governance Standard

DGS v1.0 defines the minimum requirements for structured, continuous delegation oversight. It specifies what to monitor, how often, at what thresholds, with what response protocols, and with what documentation.

It is a free published standard. The full text and the self-assessment tools are open to every health plan, delegate, and regulator at covenantdgs.com. There is no subscription, no platform fee, and nothing to buy. Covenant is a tool, not a product.

The legal floor is already set. Under 42 CFR 422.504(i), the plan remains accountable for every entity in the delegation chain: first tier, downstream, and related. CMS audits the plan, not the delegate. The standard exists because the floor is not a program.

CMS audits all 550 MA contracts now. Delegation oversight is a top finding. Your spreadsheet is a liability.

The Seven Non-Negotiables
  1. 01 Continuous beats annual.
  2. 02 The plan cannot delegate accountability.
  3. 03 Sub-delegation must be visible to the bottom.
  4. 04 The trigger fires whether you are watching or not.
  5. 05 Documentation is the governance.
  6. 06 Escalation has teeth.
  7. 07 The governance program governs itself.

The Trigger Model

Eight governance triggers, threshold-based rather than judgment-based. Each one specifies the required response, the responsible party, and the documentation generated. A trigger that fires without a documented response is a governance failure.

SLABREACH
SLA Threshold Breach
NEWDEL
Pre-Delegation Assessment
SUBDEL
Sub-Delegation Discovery
REGAUDIT
Regulatory Audit Notification
LEADCHANGE
Leadership Change
CAPMISS
CAP Milestone Missed
REGCHANGE
Regulatory Requirement Change
DATAINT
Data Integrity Anomaly
Green85-100Standard monitoring. No intervention.
Yellow70-84Monthly reporting. Quarterly face-to-face.
Red50-69CAP required. Weekly reporting. On-site audit.
Critical< 5048-hour exec notification. Termination planning.

Delegation Health Score

The standard scores every delegated entity on a 0-100 composite, weighted by function criticality and updated as monitoring data arrives. The sample certificate shows the score in use.

DGS specifies three monitoring tiers running simultaneously:

Tier 1 · Continuous

Automated data feeds. Claims turnaround, UM decisions, call center metrics, credentialing processing. Exceptions surface as they occur, not at year-end.

Tier 2 · Periodic

Monthly or quarterly structured assessments. Claims accuracy audits, UM appropriateness reviews, quality measure validation. Defined sampling methodology.

Tier 3 · Event-Driven

Triggered by governance events. Regulatory actions, leadership changes, data failures. May override the periodic schedule temporarily.

The Standard and the Tools

Everything below is published at covenantdgs.com, free. No login required to read the standard. Sign in only if you want to save your work.

  • StandardDGS v1.0 in full. Seven non-negotiables, eight triggers, escalation tiers, monitoring tiers, documentation requirements.
  • AssessDelegation Risk Self-Assessment. Eight questions scored against the standard, an A-F grade, and a gap analysis you can hand to compliance leadership.
  • CalculatePenalty Exposure Calculator. What the current enforcement environment costs a plan your size.
  • CrosswalkRegulatory Crosswalk. CMS, NCQA, OIG, and state requirements mapped to your delegation model. Federal base plus the six largest MA states: CA, TX, NY, FL, OH, PA.
  • CertifyThe Delegation Governance Certificate is the output artifact: per-delegate status, SLA compliance, a composite health score an auditor can read without asking the person who built it. A sample is published.

What Covenant Is Not

Not a product

There is no subscription, no platform fee, and no sales motion behind this deck. The standard is free and stays free. The work happens in your shop, with your people, against a published bar.

Not an audit firm

Audit firms show up once a year, find problems, and leave. The standard requires continuous monitoring, with the response protocol attached to the trigger before the breach ever happens.

Not a spreadsheet upgrade

Spreadsheets store data. They do not trigger responses. A plan with 10 delegates, 5 functions each, 6 metrics per function, monitored monthly generates 3,600 data points per year. Nobody governs that in Excel.

Not compliance theater

A plan running DGS produces the documentation trail regulators actually want to see. Not a binder assembled the week before an audit. A living record that shows continuous governance as it happened.

Adopting the Standard

There is no implementation and no vendor. A plan adopts DGS v1.0 in its own shop, with its own people, on the data it already produces. Your delegates, your contracts, and your compliance staff all stay exactly where they are.

Self-Assess

Read the standard and run the free self-assessment against your current oversight program. It takes an afternoon. The gaps it finds are the work plan.

Crosswalk

Map your federal and state requirements to your delegation model, and map the chain to the bottom tier. Accountability does not stop at the first contract, and neither can your visibility.

Stand Up the Triggers

Set the eight triggers with thresholds in your own monitoring. Run the escalation tiers with teeth. Document every trigger and every response. Then self-assess the program annually, because the standard requires it of itself.

Who Wrote the Standard

DGS v1.0 was written by one operator, not a committee.

Joe Nalley built and sold a 13-location health system (200,000+ patients) and ClearBill ($9.2M returned to payers in its first six months), then built the governance methodology applied across 65,234 specialty patients that Covenant extends to delegation oversight. Today he is Staff VP, Carelon Growth (Elevance Health), owning six specialty risk books (MSK, Oncology, CHF, Maternity, Autoimmune, Dementia) across $50B+ in spend.

Part of the Corridor family: Cadence (specialty governance), Curated (episode-based care), Caliber (claims verification), Waybright (maternity navigation).

The Ask

Adopt the standard. It is free, it is published, and the self-assessment takes an afternoon. The sample certificate shows what conformance looks like when it is written down.

If you want a second set of eyes on your delegation model, book 30 minutes. I'll bring the crosswalk for your states and we can walk your chain together.

joe.nalley@showyourwork.health

cal.com/joe-nalley/30min

covenantdgs.com