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CMS has recently published a final list that contains more than 19,000 essential community providers (ECPs). These providers care for predominately low-income and underserved populations. CMS also published guidelines that describe how the list should be used.
According to the letter that will be going out to insurers, they must contract with 30% of available ECPs within their service areas while offering contracts in good faith to Indian health providers. Additionally, they will need to offer contracts in good faith to a minimum of one ECP within each of six categories, including hospitals, Ryan White providers, federally qualified health centers, family planning providers, Indian health care providers, and those listed as “other” ECPs.
These findings were published in the Health Affairs Blog on February 17, 2016.