2018 Essential Community Provider List & Petition

2018 Essential Community Provider List & Petition

Under the Affordable Care Act (ACA), Qualified Health Plans (QHPs), are required to include essential community providers (ECPs) that serve predominantly low-income, medically-underserved individuals in their networks

Rural Health Clinics are eligible for designation as ECPs

As part of the Plan Approval process, the Secretary Health and Human Services (HHS) has established criteria mandating inclusion of a sufficient number and geographic distribution of ECPs in an issuer’s network to ensure reasonable and timely access to a broad range of such providers for low-income, medically-underserved individuals in their service areas.

To demonstrate satisfaction of the ECP requirement, Qualified Health Plans must submit a list of ECP’s in the Plan’s network with whom the Plan has contracted to provide health care services to low-income, m edically-underserved individuals in their service areas. Failure to meet the ECP criteria would be grounds for rejection of the Plan’s application.

The Department of Health and Human Services (HHS) has compiled a draft non-exhaustive list of available ECPs for plan year 2018. These providers submitted an ECP petition by July 11, 2016, and were approved by CMS through the ECP petition review process. Nearly 1,000 federally certified RHCs have already been approved by HHS as ECPs.

You can see if you are on the approved ECP list by going to the searchable database and searching for your clinic by name. If you are NOT on the list, you can petition to be an ECP by going to the ECP petition webpage. If you are on the list and there is an error you would like to correct, you can do so on the ECP Petition webpage.

The Draft HHS ECP list for the 2018 benefit year is also embedded within ECP petition and can be viewed by clicking the button “Check to see if you are on the list” under question 6 of the ECP petition webpage.

CMS is accepting petitions from qualified providers until 11:59 p.m. ET on October 15, 2016, for data corrections and additions to be considered for the 2018 ECP List. RHCs who need technical assistance with the petition or may have general questions may receive assistance by emailing their question(s) to the following mailbox:

EssentialCommunityProviders@cms.hhs.gov

Providers should write “Comments on ECP Petition.” in the subject line of the email.