The Center for Consumer Information and Insurance Oversight (CCIIO) released a draft letter Feb. 4 to issuers that plan to offer qualified health plans (QHPs) through the federally facilitated health insurance marketplace in 2015. Responding to input from America’s Essential Hospitals to strengthen the essential community provider (ECP) requirements, CCIIO notes an enhanced ECP standard. For 2015, each QHP network must include at least 30 percent of all available ECPs in its service areas, which is an increase from 20 percent in 2014.
In addition, each QHP must offer contracts to at least one ECP in each ECP category in each county in the service area and to all available Indian health providers in the service area. These contracts must offer terms that would be acceptable to a similarly situated non-ECP provider. CCIIO also eliminated the minimum expectation standard as an option for QHPs to meet network adequacy requirements.
America’s Essential Hospitals is pleased CCIIO recognizes that more protection is needed for ECP patients’ access to care but believes that the requirements should be strengthened further. America’s Essential Hospitals will submit comments to CCIIO by Feb. 25.
Please contact Xiaoyi Huang, assistant vice president for policy, at firstname.lastname@example.org or 202-585-0127 with questions.