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.
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.
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 email@example.com.