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Stephanie Pellitt

Policy and Advocacy Associate

CMS Releases Draft List of Essential Community Providers for 2018 Plan Year

September 15, 2016 | Medicaid | Comments
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Health care providers have until October 15th to be added to the Essential Community Provider list for the 2018 benefit year. The list is used by Qualified Health Plans in the Affordable Care Act’s insurance marketplaces to meet ACA contracting requirements. QHPs operating in the health care marketplace must contract with at least 30 percent of the available “essential community providers” in their service area to ensure network adequacy for consumers.

Essential Community Providers are safety net providers who serve predominantly low-income, medically underserved individuals. While community-based mental health and addiction treatment providers are not currently included in the definition of ECP’s, health plans may count community behavioral health providers towards the 30 percent requirement. Additionally, community behavioral health providers may meet the definition of ECP under another eligible provider type, such as Federally Qualified Health Centers (FQHCs) or Ryan White providers.

Provider organizations that want to be added to the Essential Community Provider list must submit this petition by October 15th. Not sure if your organization is on the list?  Click here for the draft list. For additional information, please click here.  Any questions should be directed to essentialcommunityproviders@cms.hhs.gov.