Petition for the 2019 Plan Year

The ECP petition submission window for the final plan year 2018 ECP list closed at 11:59 p.m. ET on October 15, 2016. The final plan year 2018 ECP list can be viewed by clicking “Check to see if you are on the list” under question 6 of the petition. For ongoing provider updates, the ECP petition submission process will remain open year-round and additional updates will be reflected on the plan year 2019 ECP list that we anticipate releasing in the fall of 2017.

Background

In accordance with section 1311(c)(1)(C) of the Affordable Care Act (ACA), Qualified Health Plan (QHP), including Stand-alone Dental Plan (SADP) issuers are required to include within their network essential community providers (ECPs), where available, that serve predominantly low-income, medically-underserved individuals. Under this same section of the ACA, the Secretary of the Department of Health and Human Services (HHS) is charged with establishing criteria for certification of health plans as QHPs, including criteria for issuer satisfaction of the ECP inclusion requirement. Under 45 Code of Federal Regulations (CFR) 156.235, the Secretary of HHS has established criteria for inclusion of a sufficient number and geographic distribution of ECPs, where available, 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 satisfy this ECP requirement, QHP and SADP issuers must submit an ECP template as part of their QHP application, in which they must list the ECPs with whom they have contracted to provide health care services to low-income, medically-underserved individuals in their service areas.

The Department of Health and Human Services (HHS) has compiled a non-exhaustive list of available ECPs for plan year (PY) 2018. These providers submitted an ECP petition by October 15, 2016, to be added to the ECP list for plan year 2018 and were approved by CMS through the ECP petition review process. HHS updates this ECP list annually to assist issuers with identifying providers that qualify for inclusion in an issuer’s plan network toward satisfaction of the ECP standard under 45 CFR 156.235. Under that regulation, ECPs are defined as health care providers who serve predominantly low-income, medically-underserved individuals. They include health care providers defined in section 340B(a)(4) of the Public Health Service (PHS) Act; entities described in section 1927(c)(1)(D)(IV) of the Social Security Act, including State-owned family planning service sites, governmental family planning service sites, not-for-profit family planning service sites that do not receive Federal funding under special programs, including under Title X of the PHS Act or other 340B-qualifying funding; or Indian health care providers, unless any of the above providers has lost its status under either of these sections, 340(B) of the PHS Act or 1927 of the Social Security Act, as a result of violating Federal law.

Instructions

For clarifications regarding specific questions within the ECP petition, place your cursor over the information icon that follows each question and additional information will appear in a pop-up window. You may also access the FAQs available under the “Need Help?” button at the bottom of this petition. If you are experiencing issues with entering data into or submitting the form, try using one of the supported versions of the following browsers: IE 11, Microsoft Edge, Safari 9.0.2 or Chrome. If you need help beyond the tips provided here, you may reach us via email at essentialcommunityproviders@cms.hhs.gov.

Congratulations you have successfully submitted your petition!

Petition Form

About You

Qualified petitioners include providers petitioning to make a change to their own CMS ECP listing, providers petitioning to be added to or removed from the CMS ECP list, or individuals explicitly authorized by the provider to submit the petition on behalf of the provider. CMS is not accepting petitions from unauthorized third-party entities, including insurance companies (i.e. issuers), advocacy groups, state Departments of Health, state-based provider associations, and providers other than the provider for which the petition is applicable. However, if any of the above entities own or are the authorized legal representatives of an ECP, then they may submit a petition on behalf of a provider.

Requested Action

Select Add if you wish to be newly added to the CMS ECP List, including additional provider site locations. Affiliated practitioners located at same street location will appear only once on the ECP List, so please list the facility rather than individual practitioners located at same facility, indicating the number of qualified FTE practitioners available at the facility in questions 14 and 15. Solo practitioners may submit the petition under their individual provider location.

Select Change if you are a provider that already appears on the Final 2018 ECP List and you wish to change/update your facility information. If you are unsure of whether you appear on the Final 2018 ECP List, click the button labeled “Check to see if you are on the list” and enter your site name using the search functionality to identify your row number. Note that the row number for each facility on the ECP list appears in column A titled “PY 2018 Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel.

Select Remove if you wish to be removed from the CMS ECP List. If you are requesting to be removed, please enter your row number in question 7 from the Final 2018 ECP List embedded within this petition by clicking the button labeled “Check to see if you are on the list” and enter your site name using the search functionality. Note that the row number for each facility on the ECP list appears in column A titled “PY 2018 Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel. If the Row Number field does not appear under question 7, you have selected Add in question 6, indicating that you do not appear on the Final 2018 ECP List and are petitioning to be newly added to the list, so the Row Number field would not be applicable.

Please note that if you return to this question to revise your selection, any data that you have entered for questions 7-45 will be deleted.Check to see if you are on the list
If you are a provider that already appears on the Final 2018 ECP List published with this petition, please identify the correct Row Number on which your facility is listed by clicking the button labeled “Check to see if you are on the list” (available in question 6) and enter your site name using the search functionality. Note that the Row Number for each facility on the ECP list appears in column A titled “PY 2018 Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel. Enter your Row Number and click elsewhere on the screen, and the petition will auto-populate many of the data fields that currently appear on the Final 2018 ECP List. Please do not include commas or spaces in your row number, only numbers. Check that the auto-populated data from the Final 2018 ECP List are correct, correct any errors, and provide missing data fields (e.g., NPI, ECP Category, Site County, etc.) by proceeding through the petition. Click here after entering Row Number
Select Yes to consent to be included on the CMS ECP List. Providers may be asked to renew their consent for CMS ECP listings beyond plan year 2019.

If you do not yet appear on the CMS ECP list and do not consent to be added to the list, then you should not submit this provider petition. If you currently appear on the Final 2018 ECP List, selecting No for this question means that you should return to question 6 and select Remove to ensure that your data are removed from the CMS ECP list for plan year 2019. If you are requesting to be removed, please enter your correct Row Number in question 7 from the Final 2018 ECP List embedded within this petition by clicking the button labeled “Check to see if you are on the list” and enter your site name using the search functionality. Note that the Row Number for each facility on the ECP list appears in column A titled “PY 2018 Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel.

Eligibility

Select Yes if you are eligible for or participating in the 340B program, or are a Rural Health Clinic, or are an Indian Health Care Provider. For a complete list of organizations that are eligible for the 340B program, see http://www.hrsa.gov/opa/eligibilityandregistration/index.html. Select No if you are not eligible for or participating in the 340B program, and are not a Rural Health Clinic and are not an Indian Health Care Provider.
Select Yes only if you are located in a low-income ZIP code or Health Professional Shortage Area (HPSA), based on the HHS “Low-Income and HPSA ZIP Code Listings” available at http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html (click on “Miscellaneous Qualified Health Plan Application Resources”). Selecting No to this question means that you do not qualify as an ECP for purposes of being added to the ECP list, unless you are a Rural Health Clinic; you are a State-owned family planning service site, governmental family planning service site, not-for-profit family planning service site that does not receive Federal funding under special programs, including under Title X of the PHS Act or other 340B-qualifying funding; or you are an Indian health care provider.
Select Yes only if you are willing to accept patients regardless of ability to pay and offer a sliding fee schedule.

Selecting No to this question means that you do not qualify as an ECP for purposes of being added to the ECP list, unless you are a Rural Health Clinic, or you are a not-for-profit or governmental family planning service site that does not receive Federal funding under Title X of the PHS Act or other 340B-qualifying funding (see 45 CFR 156.235(c)), or you are an Indian health care provider.
Select Yes only if you are willing to accept patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, private health insurance, etc.).

Selecting No to this question means that you do not qualify as an ECP for purposes of being added to the ECP list. If you already appear on the Final 2018 ECP List that was published with this petition, then you should return to question 6 and select Remove and then enter the correct Row Number in question 7 to ensure that your data are removed from the CMS ECP list. Your correct Row Number can be identified from the Final 2018 ECP List embedded within this petition by clicking the button labeled “Check to see if you are on the list” and enter your site name using the search functionality. Note that the Row Number for each facility on the ECP list appears in column A titled “Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel.
Select Yes only if you are willing to be listed in a consumer-facing directory of ECPs by an issuer with whom you have contracted to deliver health care services to their enrollees. CMS will continue to post the CMS ECP list on the CMS publicly available website as a resource for QHP issuers, providers, and consumers seeking providers who are willing to serve low-income and medically underserved populations.

Selecting No to this question means that you do not qualify as an ECP for purposes of being added to the ECP list. If you already appear on the Final 2018 ECP List that was published with this petition, then you should return to question 6 and select Remove and then enter the correct Row Number in question 7 to ensure that your data are removed from the CMS ECP list. Your correct Row Number can be identified from the Final 2018 ECP List embedded within this petition by clicking the button labeled “Check to see if you are on the list” and enter your site name using the search functionality. Note that the Row Number for each facility on the ECP list appears in column A titled “PY 2018 Row Number” of the Excel spreadsheet and begins with the numbers 2018xxxxx, rather than referring to the electronic row number assigned by Excel.
For inpatient hospitals, including children’s hospitals, please indicate the number of staffed hospital beds rather than FTE practitioners. For all other ECP categories, please enter number of FTEs representing MDs, DOs, PAs and NPs authorized by the state to independently treat and prescribe medication within the listed facility at this street location, as of the date of your petition submission. Two part-time practitioners can be counted as one FTE and fractional FTEs up to two decimal places can be reported (e.g., 0.75). Multiple affiliated MDs, DOs, PAs and NPs practicing within the same provider facility located at the same street location (regardless of different suite/floor number) will appear on one row on the CMS ECP List, so please list the facility and indicate number of affiliated FTE practitioners located at the facility rather than submitting a petition for each individual practitioner. Also, practitioners who practice within a multi-practitioner facility should not submit a petition under their individual practitioner NPI independent of the facility in which they practice; rather, only individuals authorized by the facility should submit the petition using the facility-level NPI and indicate the number of affiliated FTE practitioners practicing within the facility. Multi-practitioner facilities with multiple locations should submit a petition for each site location, entering the NPI associated with each of its facility-specific site locations, and indicating the number of affiliated FTE practitioners practicing only within the facility-specific site location. In contrast, solo practitioners may submit the petition under their individual practitioner NPI. If you have only dentists (DMDs and DDSs) at this facility, please enter zero in this field.
For inpatient hospitals, including children’s hospitals, please enter 0. For all other ECP categories, please enter number of FTEs representing DMDs and DDSs practicing at your facility at this street location, as of the date of your petition submission. Two part-time practitioners can be counted as one FTE and fractional FTEs up to two decimal places can be reported (e.g., 0.75). Multiple affiliated dentists practicing within the same provider facility located at the same street location (regardless of different suite number) will appear on one row on the CMS ECP List, so please list the facility and indicate number of affiliated FTE dentists located at the facility rather than submitting a petition for each individual dentist. Also, dentists who practice within a multi-practitioner facility should not submit a petition under their individual practitioner NPI independent of the facility in which they practice; rather, only individuals authorized by the facility should submit the petition using the facility-level NPI and indicate the number of affiliated FTE dentists practicing within the facility. Multi-practitioner facilities with multiple locations should submit a petition for each site location, entering the NPI associated with each of its facility-specific site locations, and indicating the number of affiliated FTE dentists practicing only within the facility-specific site location. In contrast, solo practitioners may submit the petition under their individual practitioner NPI. If you have only medical practitioners (MDs, DOs, PAs and NPs) at this facility, please enter zero in this field.
Enter the number of contracts that you have executed with QHP insurance companies (i.e., issuers) for the 2018 plan year, as of the date of your petition submission.
Enter the number of contract offers that you have received from QHP issuers and were offered in good faith that you have rejected for the 2018 plan year, as of the date of your petition submission. As stated in the Final 2017 Letter to Issuers in the Federally-facilitated Marketplaces, a good faith contract should offer terms comparable to terms that it offers to a similarly-situated non-ECP provider, except for terms that would not be applicable to an ECP, such as by virtue of the type of services that an ECP provides. Collecting this information will assist CMS in better determining issuer compliance with the ECP requirements pertaining to the offering of contracts in good faith to qualified ECPs.

Site Information

Enter the Site Name at which you provide health care services to patients.
Enter the Organization Name that the insurance companies (i.e. issuers) would contact for purposes of contract negotiations.
Enter NPI in a 10-digit format (no hyphens). Affiliated practitioners who practice within a multi-practitioner facility should not submit a petition under their individual practitioner NPI; rather, only individuals authorized by the facility should submit the petition using the facility-level NPI, site name, and indicate the number of FTE practitioners practicing within the facility. In contrast, solo practitioners may submit the petition under their individual practitioner NPI.
21. ECP Category
(Select All that Apply) Select all categories that describe the health care services that you provide. For example, if the contracted provider is a Federally Qualified Health Center (FQHC) that is also a Ryan White HIV/AIDS provider, select both the FQHC and Ryan White Provider categories. However, if you are a dental provider and provide no non-dental medical services at your facility, please select only the “Dental Providers” ECP category (i.e., all of the non-dental ECP categories require the petitioner to enter the FTE counts in question 14 for medical practitioners at the respective facility and the MD, DO, NP, and PA counts, which would not be applicable to a dental provider). If HHS is unable to verify your provision of these services with our Federal partners, we may default your listing to the “Other ECP Providers” category until such verification can be made.
Enter the street address at which you provide health care services to patients. If an individual provider practices in the same group or company at the same street location with other affiliated providers, the facility should submit only one petition, indicating the number of qualified FTE practitioners available at the facility in questions 14 and 15.
Enter the suite number, floor number, or other secondary address information (associated with the same street location in Site Street Address Line 1) at which you provide health care services to patients. [Please do not enter a separate street location in this field if your facility offers multiple locations; instead, submit a separate petition for any additional practice sites.] If an individual provider practices in the same group or company at the same street location with other affiliated providers, the facility should submit only one petition, indicating the number of qualified FTE practitioners available at the facility in questions 14 and 15.
Enter the Site City in which you provide health care services to patients.
Enter the Site State in which you provide health care services to patients.
Enter the Site ZIP code in which you provide health care services to patients. Your ZIP code must be located within a low-income ZIP code or Health Professional Shortage Area (HPSA), based on the HHS “Low-Income and HPSA ZIP Code Listings” available at http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html (click on “Miscellaneous Qualified Health Plan Application Resources”). You are exempt from this requirement if you are a Rural Health Clinic; you are a State-owned family planning service site, governmental family planning service site, not-for-profit family planning service site that does not receive Federal funding under special programs, including under Title X of the PHS Act or other 340B-qualifying funding; or you are an Indian health care provider.
Enter the Site County in which you provide health care services to patients. Site county information is used for purposes of insurance companies (i.e. issuers) meeting the requirement in the Federally-facilitated Marketplace to offer a contract in good faith to at least one ECP in each ECP category in each county in the service area.

Organization Information

Enter the Organization Street Address that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the secondary Organization Street Address (associated with the same street location in Org Street Address Line 1) that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Organization City that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Organization State that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Organization ZIP code that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Organization County that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations. Organization county information is not used for purposes of issuers meeting the requirement in the Federally-facilitated Marketplace to offer a contract in good faith to at least one ECP in each ECP category in each county in the service area. Instead, the Site County in question 27 is used for purposes of that ECP requirement.

Point of Contact (POC) 1 Information

Enter the Primary Point of Contact Name that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Primary Point of Contact Title that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Primary Point of Contact Phone # that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Primary Point of Contact Phone Ext that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Primary Point of Contact Email that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Primary URL that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.

Point of Contact (POC) 2 Information

Enter the Alternate Point of Contact Name that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Alternate Point of Contact Title that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Alternate Point of Contact Phone # that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Alternate Point of Contact Phone Extension that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Alternate Point of Contact Email that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.
Enter the Alternate URL that the insurance companies (i.e. issuers) would use to contact you for purposes of contract negotiations.