The Centers for Medicare & Medicaid Services (CMS) has released its final list of essential community providers (ECPs) for plan year 2019.
Health insurers use this annual list to identify providers that meet ECP requirements for inclusion in qualified health plan (QHP) networks for coverage offered on the Affordable Care Act marketplace. QHP issuers are required to:
- contract with at least 20 percent of ECPs in the plan’s service area to participate in its provider network;
- offer contracts in good faith to at least one ECP in each ECP category of each county in the service area, where available; and
- offer contracts in good faith to all available American Indian health care providers in the plan’s service area.
Qualifying hospitals should review the list and report any errors to their respective CMS regional offices. Hospitals that serve predominantly low-income or medically under-served patients have until Aug. 22 to petition CMS for inclusion on the list for the 2020 plan year.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.