Essential Community Provider Designation

Essential Community Provider Designation

Are you an Essential Community Provider (ECP)? Most Rural Health Clinics will answer that question with a resounding YES! But for many Health Plans sold on the Affordable Care Act (ACA) Exchanges, the answer is often a resounding “maybe”. Why, because many RHCs have failed to petition for ECP designation.

Under the ACA, RHCs are eligible for designation as Essential Community Providers which would enhance or strengthen the likelihood that Health Plans would be required to include your clinic in their provider networks under the “Network Adequacy” standards. But ECP designation is not automatic. Here is a link to the DRAFT ECP list released recently by the Centers for Medicare and Medicaid Services (CMS).

RHCs are one of the largest groups of provider types on the DRAFT ECP list but we know that many RHCs are not on this list. Please take a few minutes to see if your RHC is on this list (you can search by clinic name. If you are not on the list, go to the CMS website and complete the petition to be added to the list. It only takes a few minutes to get your clinic listed and the benefits of this could be significant when Health Plans begin putting together their provider networks in 2019.

NOTE: The deadline for submitting an ECP petition is December 22, 2017

If you have any questions or need additional information, you can submit those to: EssentialCommunityProviders@cms.hhs.gov
Some facilities qualify in multiple categories. For example, a facility might choose as their primary “Black Lung Clinic” but also qualify as an “RHC” as a secondary designation.