Database Questions: EssentialCommunityProviders@cms.hhs.gov
Under the health insurance law, also known as the Affordable Care Act, insurance plans offered through the Marketplace—known as Qualified Health Plans (QHPs)—are required to include some essential community providers (ECPs). ECPs are providers that serve predominately low-income medically underserved individuals. This definition includes Ryan White HIV/AIDS providers.
The Centers for Medicare and Medicaid Services Center for Consumer Information & Insurance Oversight maintain a Non-Exhaustive List of Essential Community Providers to assist health insurance issuers in locating ECP.
Insurers will be permitted to write in ECPs not on the list. If you are not on the list, when you contact insurers you should let them know you are an ECP and that they can write you in.
QHPs are finalizing their networks in the next few months, but are not required to include all safety net providers in their networks. It is strongly recommended that direct service providers reach out to health insurers now if you want to get into their networks for 2016.
HHS expects to monitor inclusion of ECPs in QHP provider network(s) over time, including providers that issuers write in, and will update this database in future years. Questions about the database may be directed to EssentialCommunityProviders@cms.hhs.gov.
For more information on the definition of ECP and health insurer requirements regarding ECPs, see CMS’ Affordable Exchanges Guidance: CMS Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF - 420 KB).
Education and Outreach Materials (ZIP - 8.3 MB)