Essential Community Providers a) ECP standard. Unless Covered California determines that Contractor has qualified under the alternate standard for essential community providers pursuant to the Affordable Care Act, Contractor shall maintain a network that includes a sufficient geographic distribution of care, including essential community providers (“ECP”), and other providers available to provide reasonable and timely access to Covered Services for low-income, vulnerable, or medically underserved populations in each geographic region where Contractor’s QHPs provide services to Covered California Enrollees. Contractor shall comply with other laws, rules and regulations relating to arrangements with ECPs, as applicable, including, those rules set forth at 45 C.F.R. § 156.235.
Essential Community Providers. Except if Contractor has qualified under the alternate standard for essential community providers provided by the Affordable Care Act as has been determined by the Exchange, Contractor shall maintain a network that includes a sufficient geographic distribution of essential community providers (“ECP”) that are available through Contractor to provide reasonable and timely access to Health Care Services to low- income populations in each geographic region where Contractor’s QHPs provide services to Enrollees.
Essential Community Providers. Article 3, Section 3.3.3 10% of total performance penalty at risk. Expectation: Contractor shall maintain a network that includes a sufficient geographic distribution of care, including essential community providers, and other providers, to provide reasonable and timely access to Covered Services for low income, vulnerable, or medically underserved populations in regions served by Contractor. Contractor to demonstrate provider agreements with at least 15% of 340B non-hospital providers in each applicable rating region. Contractor to demonstrate provider agreements that reflect a mix of essential community providers (hospital and non-hospital) reasonably distributed to serve the low-income, vulnerable, or medically underserved populations. Performance Level: 1. Sufficient ECP participation: 10% performance credit. 2. Developing ECP participation: no penalty or credit. 3. Insufficient ECP participation: 10% performance penalty. Alternate Standard Contractor Expectation: Contractor to produce access map to demonstrate low income, medically underserved enrollee access to health care services. Low income, vulnerable, or medically underserved individuals shall be defined as those Covered California enrollees who fall below 200 percent of the Federal Poverty Level (FPL). Maps shall demonstrate the extent to which provider sites are accessible to and have services that meet the needs of specific underserved populations, including: Individuals with HIV/AIDS American Indians and Alaska Natives Low income and underserved individuals seeking women’s health and reproductive health services Other specific populations served by Essential Community Providers in the service area such as STD Clinics, Tuberculosis Clinics, Hemophilia Treatment Centers, Black Lung Clinics and other entities that serve predominantly low income, medically underserved individuals. Performance level: Alternate Standard Contractors shall not be eligible for performance credits, nor shall they be subject to performance penalties. Submission of the above required mapping is a contract compliance requirement.
Essential Community Providers. Article 3, Section 3.3.3 10% of total performance penalty for Group 3 Expectation: Contractor shall maintain a network that includes a sufficient geographic distribution of care, including essential community providers, and other providers, to provide reasonable and timely access to Covered Services for low income, vulnerable, or medically underserved populations in regions served by Contractor. Contractor to demonstrate provider agreements with at least 15% of 340B non-hospital providers in each applicable rating region. Contractor to demonstrate provider agreements that reflect a mix of essential community providers (hospital and non-hospital) reasonably distributed to serve the low-income, vulnerable, or medically underserved populations. Performance Level: Does not meet ECP Standards: 10% penalty. Improvement in meeting ECP Standards: no penalty. Meets ECP Standards for timely access to network providers, 15% 340B non-hospital provider agreements, demonstrated ECP provider agreements: 10% credit.
Essential Community Providers. Contractor shall maintain a network compliant with all applicable Laws, that includes a sufficient geographic distribution of essential community providers (“ECP”.)
Essential Community Providers a) ECP standard. Unless the Exchange determines that Contractor has qualified under the alternate standard for essential community providers pursuant to the Affordable Care Act, Contractor shall maintain a network that includes a sufficient geographic distribution of care, including essential community providers (“ECP”), and other providers available to provide reasonable and timely access to Covered Services for low-income, vulnerable, or medically underserved populations in each geographic region where Contractor’s QHPs provide services to Enrollees. Contractor shall comply with other laws, rules and regulations relating to arrangements with ECPs, as applicable, including, those rules set forth at 45 C.F.R. §156.235.
Essential Community Providers. Contractor shall maintain a network compliant with all applicable Laws.
Essential Community Providers. The final budget accepts the Governor's proposal to set aside no less than $10 million (total Medicaid) in VAP funds for rural and essential community providers, including hospitals, nursing homes, diagnostic and treatment centers, ambulatory surgery centers, and clinics. This was a HANYS' advocacy priority as well. If federal financial participation (FFP) is not available, the non- federal share shall be made as state grants. Additionally, 30 days prior to distribution of funds, DOH must provide the Legislature with information about the methodology and its fiscal implications, as well as quarterly and other reports. Critical Access Hospitals (CAHs): The final budget accepts the Governor's proposal to increase the annual VAP set-aside for CAHs from $5 million to $7.5 million (total Medicaid) and to require an examination of permanent Medicaid rate methodology changes. HANYS has been pressing for additional support for CAHs for several years. Additionally, 30 days prior to distribution of funds, DOH must provide notice to the Legislature with specific information about the methodology and its fiscal implications, as well as quarterly and other reports.
Essential Community Providers. Covered California – Draft Health Plan Contract -- April 22, 2013April 298, 2013 Except if Contractor has qualified under the alternate standard for essential community providers provided by the Affordable Care Act as has been determined by the Exchange, Contractor shall maintain a network that includes a sufficient geographic distribution of essential community providers (“ECP”) that are available through Contractor to provide reasonable and timely access to Health Care Services to low- income populations in each geographic region where Contractor’s QHPs provide services to Enrollees.
