Essential Community Provider Petition
This petition will allow Medical Providers who wish to be listed on our Essential Community Providers (ECPs) list to provide all the necessary information to request that they be added. Please note that receipt of this petition does not guarantee that the provider will be added to our ECP List; we will review the petition and add it to our list if and only if it meets the standards for inclusion. The ECP List is updated each spring and the most recent list was published April 28, 2021, to the MHBE website: https://www.marylandhbe.com/wp-content/uploads/2021/04/2022-MHBE-Essential-Community-Provider-List.xlsx
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Background Information
Section 1311(c)(1)(C) of the ACA requires that all Qualified Health Plan, including Stand Alone Dental Plan, issuers include in their network Essential Community Providers (ECPs) which are healthcare providers that predominantly serve low-income, medically-underserved populations.

- Health and Human Services (HHS) has determined the criteria for certification of QHPs, including what criteria are required to meet the ECP inclusion requirement.

- To meet this criteria, issuers must submit an ECP Template as part of their QHP application that lists the ECPs that they contract with to provide health care to low-income, medically-underserved individuals in their service areas.
HHS has a list compiled from a petition that providers submitted and CMS approved through their ECP review process, which is updated annually.

- The ECP Categories used by the federal government are: Black Lung Clinics, Community Mental Health Centers, Dental Providers, Family Planning Providers, Federally Qualified Health Centers, Inpatient Hospitals (other than children’s hospitals), Outpatient Hospital Clinics, Programs operated by the Indian Health Service, Programs operated by a Tribe or Tribal organization under the authority of the Indian Self-Determination and Education Assistance Act, Programs operated by an urban Indian organization under the authority of Title V of the Indian Health Care Improvement Act, Rural Health Clinics, Ryan White Providers, Sexually Transmitted Disease Clinics, Tuberculosis Clinics, and Other ECP Providers.

- We use the same categories plus an “Expanded ECP category” as defined by 45 CFR § 156.235(c), which can be; a local health department, an outpatient mental health center or substance use disorder treatment provider (as described at COMAR 10.09.80.03.B(1) & B(3)) that is licensed or approved by DH as a program or facility, or a school-based health center.

- We require that issuers contract with at least 30% of the ECPs in each plan’s service area and we provide an alternative standard to help issuers meet this requirement, allowing them to provide us with a list of the providers that they were unable to contract with and the denominator used to calculate the 30% requirement is reduced by the number of “Uncontracted ECPs” listed on their ECP Template.

- The ECP list is a database we create with all the contact info and ECP type data for ECPs that contract with insurance carriers in MD. The list is utilized in the MD ECP Template, where the carriers identify which ECPs they contract with and what network the ECP is covered under.
Instructions
Please fill in the questions to the best of your ability. If you experience issues or have trouble using this form, please contact the MHBE Policy and Plan Management Department at: mhbe.policy@maryland.gov
Site name where medical services are provided: *
Organization Name *
National Provider Identifier (if available, otherwise blank):
Select your ECP Type: *
Required
Site Street Address: *
Site City: *
Site Zip Code: *
Site County: *
Organization Street Address: *
Organization City: *
Organization Zip Code: *
Organization County: *
Primary Contact Name: *
Primary Contact Title: *
Primary Contact Phone Number: *
Primary Contact Phone Extension (if applicable):
Primary Contact Email Address: *
URL:
Secondary Contact Name:
Secondary Contact Title:
Secondary Contact Phone Number:
Secondary Contact Phone Extension (if applicable):
Secondary Contact Email:
Secondary URL:
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