OMB Control Number 0938-1295 | Expiration Date: 07/31/2025

Essential Community Provider Petition

If you are a provider facility that wishes to receive contract offers from Marketplace Issuers to participate in their provider network, you have come to the right place to add your facility to the Essential Community Provider (ECP) List, modify your facility information that already appears on the list, or remove your facility from the list if you do not wish to receive such contract offers.

The deadline to submit a petition for inclusion on the Plan Year 2026 Final ECP List is August 14, 2024.
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About this program

What you will need to complete your petition:

  • National Provider Identifier (NPI) for your facility
  • Information about your facility's interest in contracting with Marketplace QHP issuers
  • Your 340B ID, if you are participating in HRSA's 340B program
  • Your HPSA ID, if you are located in a HPSA
  • Information about the services that you provide, including whether or not you offer telehealth services
  • Two points of contact (email and phone) for your organization

Things to consider before you begin:

  • We recommend searching for your facility to see if you’re already on the list in an effort to prevent duplicate submissions
  • Completing a petition, including gathering information and reviewing instructions, could take about 15-30 minutes
  • The petition cannot be saved and must be completed in one sitting
  • If you want to save a copy of your petition responses, do so before you hit "Submit"
  • You will receive a confirmation email after submitting your petition

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PRA Disclosure Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1295. The time required to complete this information collection is estimated to take up to 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. This estimate does not include time for training. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.