Common use of Essential Community Providers Clause in Contracts

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. i. Reporting requirements for the ECP standard are contained within the required monthly provider data submission pursuant to Section 4.4.4. The Contractor must provide a provider data file to Covered California upon request for the purpose of determining compliance with the ECP standard. This file is separate and distinct from the files provided to the Integrated Health Care Association’s Symphony Provider Directory as described in Section 4.4.5. Reporting requirements for the ECP standard are as follows: 1. Contractor to demonstrate provider agreements with at least fifteen percent (15%) of 340B non-hospital providers in each applicable rating region. 2. 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.

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. i. Reporting requirements for the ECP standard are contained within the required monthly provider data submission pursuant to Section 4.4.4. The Contractor must provide a provider data file to Covered California upon request for the purpose of determining compliance with the ECP standard. This file is separate and distinct from the files provided to the Integrated Health Care Association’s Symphony Provider Directory as described in Section 4.4.5. Reporting requirements for the ECP standard are as follows: 1. Contractor to demonstrate provider agreements with at least fifteen percent (15%) % of 340B non-hospital providers in each applicable rating region. 2. 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.

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. i. Reporting requirements for the ECP standard are contained within the required monthly provider data submission pursuant to Section 4.4.4. The Contractor must provide a provider data file to Covered California upon request for the purpose of determining compliance with the ECP standard. This file is separate and distinct from the files provided to the Integrated Health Care Association’s Symphony Provider Directory as described in Section 4.4.5. Reporting requirements for the ECP standard are as follows: 1. Contractor to demonstrate provider agreements with at least fifteen percent (15%) of 340B non-hospital providers in each applicable rating region. 2. 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.