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Essential Community Providers
An Essential Community Provider (ECP) is a health care provider that serves high-risk, special needs, and underserved individuals.
Those regulations require that ECPs:
- Provide or coordinate supportive and stabilizing services, such as transportation, child care, linguistic services, and culturally sensitive and competent services to its clients.
- Have processes for identifying a need for supportive and stabilizing services and for enabling clients to access these services; and
- Qualify as one of six statutorily specified types of health care providers.
A health care provider that seeks to qualify as an ECP based on nonprofit, tax-exempt status must also:
- Charge for services on a sliding fee schedule based on income; and
- Provide unrestricted access to its services regardless of a client's financial limitations.
Health plan companies must offer provider contracts to all designated ECPs in their service areas.
Federally Designated ECPs
The Centers for Medicare and Medicaid Services (CMS) designates ECPs according to federal requirements specified in QHP. Under that regulation, ECPs are defined as 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 and described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act (SSA).
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