FORHP is pleased to note that CMS recently agreed to include RHCs on the 2016 list of Essential Community Providers (ECPs), which Marketplace/Exchange plans use when setting up their provider networks. However, not all RHCs are on the list because of the qualification requirements. To determine whether your RHC is on the list and learn how to get on the list, please read the following:
For the 2016 Marketplace benefit year, CMS has released a draft updated list of ECPs to assist Qualified Health Plan (QHP) issuers in complying with the requirements of the Affordable Care Act. ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. Visit http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html and scroll down to the section titled “Other QHP Application Resources” to view the draft list and a description of the list (3rd and 4th bullets).
A Medicare-certified RHC is included on the 2016 ECP list if it meets the following two requirements:
- Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
- Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. In addition, any RHC that is not currently on the list is eligible to be added to a future version of the list by completing an attestation form (the same form used for automatic HPSA designation) available at: http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf. More info about the RHC auto HPSA designation process is available at: http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html.
In addition, CMS is providing an opportunity to make corrections to the draft list. Public comments will be accepted until 5 p.m. EST on January 9 to improve the accuracy of the list. CMS considers the following to be within the scope of request for comments:
- Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
- Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.
Corrections or additions should be sent to the ECP electronic mailbox at: EssentialCommunityProviders@cms.hhs.gov. Commenters should write in the subject line of the email the following: “Comments on draft ECP list.”