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

Essential Community Provider Petition for the 2024 plan year

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 ECP List, or remove your facility from the list if you do not wish to receive such contract offers.
 
What is the ECP List?
The Department of Health and Human Services (HHS) has compiled and maintains a non-exhaustive list of available ECPs that serve primarily low-income and medically underserved populations. These providers initiated their inclusion on the ECP List by submitting an ECP petition to be added to the HHS ECP List and were approved by the Centers for Medicare and Medicaid Services (CMS) through the ECP petition review process.

Types of providers that are eligible for possible inclusion on the HHS ECP List include the following:
  • Federally Qualified Health Centers (FQHCs) and FQHC look-alikes
  • Dental clinics providing dental services to low-income consumers in low-income ZIP codes or Health Professional Shortage Areas
  • Specific types of Inpatient Hospitals: Critical Access Hospitals, Rural Referral Centers, Disproportionate Share Hospitals Children’s Hospitals, Sole Community Hospitals, Free-standing Cancer Centers
  • Indian health care providers, which include providers participating in programs operated by 1) the Indian Health Service; 2) a Tribe or Tribal organization under the authority of the Indian Self-Determination and Education Assistance Act; and 3) an urban Indian organization under the authority of Title V of the Indian Health Care Improvement Act
  • Ryan White HIV/AIDS Program providers
  • Family planning providers receiving Federal funding under Title X of the PHS Act and not-for-profit or governmental family planning service sites that do not receive Federal funding under Title X of the PHS Act or other 340B-qualifying funding
  • Other providers that serve predominantly low-income, medically underserved individuals, including Black Lung Clinics, Community Mental Health Centers, Hemophilia Treatment Centers, Rural Health Clinics, Sexually Transmitted Disease Clinics, Substance Use Disorder Treatment Centers, and Tuberculosis Clinics
The ECP List currently displayed on this website is the Rolling Draft ECP List, updated monthly to include recently approved provider petitions. This ECP List can be viewed by clicking “Check to see if your facility is on the ECP List” within the petition form.
Why does the ECP List exist and what does it mean to be an ECP?
HHS updates this ECP List monthly to assist Marketplace issuers with identifying providers that qualify as ECPs for inclusion in a Marketplace issuer’s plan network toward satisfaction of the ECP standard under 45 CFR 156.235.

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, Marketplace issuers must submit provider data as part of their Qualified Health Plan (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.

If your facility is on the HHS ECP List, Marketplace issuers can contract with you to help them meet the ECP requirements to submit a successful application for QHP certification.
When is the timeline for submitting my ECP petition and how will I know if my petition was approved?
The ECP petition submission process remains open year-round so providers can submit and update their provider data at any time. Your petition will be reviewed for inclusion on the Rolling Draft ECP List within approximately one month of submission. This means that if your provider petition is approved, your facility will appear on the Rolling Draft ECP List within approximately one month, allowing a Marketplace issuer to receive credit toward satisfying QHP certification requirements by offering a contract to your facility for the upcoming plan year.
Where does the authority for the ECP List come from?
In accordance with section 1311(c)(1)(C) of the Affordable Care Act (ACA), Qualified Health Plan (QHP) issuers, including Stand-alone Dental Plan (SADP) issuers, are required to include within their networks essential community providers (ECPs), where available. ECPs are providers 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. One of these criteria is the inclusion of ECPs in QHP and SADP issuers’ networks.

Under 45 CFR 156.235, 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 (SSA), 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, 340B of the PHS Act or 1927 of the SSA, as a result of violating Federal law.
 

Need help with your petition?

Email us at EssentialCommunityProviders@cms.hhs.gov

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