The Patient Protection and Affordable Care Act (ACA) requires Marketplace (or Exchange) plans to contract with some Essential Community Providers (ECP) providers with experience caring for medically underserved populations. ECPs are providers who are eligible to participate in the 340B drug purchase program. Many ECPs, including Ryan White providers, currently provide health care to individuals enrolled in the Marketplace plans. It is important for ECPs to be included in plan provider networks for their patients to be able to continue to receive care from them.
To learn more about the Marketplace in your state, visit the Kaiser Family Foundation’s Health Insurance Exchange web page.
What Providers Are Considered ECPs in Federally-Facilitated and Partnership Marketplaces?
In Federally-Facilitated Marketplaces, the following providers have been identified as ECPs: Federally Qualified Health Centers (FQHC) and FQHC “Look-Alikes”, Ryan White HIV/AIDS providers, Family Planning Providers (Title X Family Planning Clinics), Indian Providers and safety-net hospitals (hospitals that receive Disproportionate Share Hospital funding).
Other ECP providers are STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics, and other entities that serve predominantly low-income, medically underserved individuals.
Do I Need to Sign Up to Be an ECP?
New for contract year 2017, ECPs are required to complete an online petition to confirm their status as an ECP and update their provider data. ECPs are urged to complete the petition to ensure they remain on the ECP list and to ensure that their program information is accurate. Accurate program data is important to facilitate communication from health plans. The deadline to complete the ECP petition for the 2017 plan year is January 15, 2016. The ECP submission window will remain open year- round to build the ECP listing for future plan years. Starting in plan year 2018, ECPs will be dropped from the list if they have not fully completed the petition information. Complete the petition. Learn more.
What About State Run Marketplaces?
States administering their Marketplaces set the ECP requirement for their state. Information is available from the Kaiser Family Foundation on state ECP categories. Also check with your state Marketplace.
Are Plans Required to Contract With Ryan White Providers?
In Federally Facilitated Marketplace states for 2016, plans are required to contract with 30% of the ECPs in their service area. In addition, they are required to offer a contact to at least one of each type, including Ryan White provider.
How Do I Connect with the Health Plans Offering Marketplace Plans in My State?
- Contact the plans that you currently contract with and inquire if they are offering coverage in the Marketplace.
- Visit your state department of insurance website to see if they list the insurers currently offering coverage in your state.
When you contact plans, ask to speak with their Provider Relations department and let them know that you are an Essential Community Provider and can help them meet the ECP requirement. Plans should be aware of the ECP requirement, but if they are not direct them to the CCIIO web resources below.
- Click on the “Need Help?” button within the ECP petition.
- Submit queries by email to: EssentialCommunityProviders@cms.hhs.gov with the subject line “Comments on ECP Petition.”
- Email HIVMA
HIV/AIDS Bureau: http://hab.hrsa.gov/affordablecareact/ecp.html
Non-Exhaustive HHS List of Essential Community Providers: (scroll down under Other QHP Application Resources)
Essential Community Providers Tips to Connect with Marketplace Plans: http://www.nashp.org/sites/default/files/ecp.tips.connect.marketplace.plans.pdf
Ryan White and the ACA: http://hab.hrsa.gov/affordablecareact/
HIVMA – Health Care Reform Implementation:
HIV Healthcare Reform: www.hivhealthreform.org