CHA News Article

Covered California Releases Draft Consolidated Essential Community Provider List
Requests stakeholder feedback no later than July 10

Covered California has released a draft consolidated list of essential community providers (ECPs) that serve the low-income and medically underserved communities in the provider networks offered by Covered California qualified health plans (QHPs). Covered California notes that the federal 340B list of ECPs is a critical but not an exclusive category of ECPs, because some providers serve low-income and medically underserved populations but are not 340Bs, including some that qualify as 1204a entities under California law. According to Covered California, the draft consolidated ECP list is an attempt to create a single, unduplicated list of ECPs that potentially could serve Covered California enrollees. Covered California also notes that the draft list is non-exhaustive, subject to change and will be updated or re-issued at a future date; its purpose is to make it easier for QHPs to identify ECPs for contracting purposes.

Covered California has requested that organizations that believe they should be considered an ECP but are not listed should contact Covered California and indicate they are a potential addition to the consolidated ECP list. Conversely, if an organization is included on the list and believes their organization does not qualify as an ECP, they should also contact Covered California. Please submit any comments to qhp@covered.ca.gov no later than July 10, noting “ECP 2014″ in the subject line.

The definition of ECP as adopted Aug. 23, 2012, by Covered California has not changed. Current ECP categories, included in the draft list, are:

  • 340B entities (clinics, hospitals and other entities). Covered California notes there is substantial overlap between the 340B, DSH, FQHC, Tribal/UI and 1204a community clinic lists.
  • California Disproportionate Share Hospitals (DSH), defined by the California Department of Health Care Services (DHCS);
  • Federally Qualified Health Centers (FQHCs);
  • Federally designated 638 Tribal Health Programs and Title V Urban Indian Health Organizations (Tribal/UI);
  • Providers licensed as “community clinic” or “free clinic” under California Health and Safety Code 1204(a), or community or free clinics exempt from licensure under 1206 (1204(a) clinics); and
  • Providers that qualified for HI-TECH Medi-Cal Electronic Health Record (Medi-Cal EHR) Incentive Program funding. These are eligible providers who completed the application process for this federal program, administered by DHCS, to distribute financial resources to encourage providers to establish electronic medical records.

Covered California Draft Consolidated ECP List
Previously, Covered California posted five separate files with the contact information for the ECP entities listed above. In collaboration with ECPs and stakeholders, Covered California has worked to develop a single draft consolidated list of California ECPs.

The draft consolidated ECP list contains two tabs:

  • Hospital ECPs
    • 340B hospitals
    • DSH hospitals
    • Children’s hospitals
    • County hospitals
  • Non-hospital ECPs
    • 340Bs
    • FQHCs
    • Community clinics
    • Free clinics
    • Tribal and urban Indian clinics

Covered California reports that due to the quantity and lack of reliable address information for the Medi-Cal HI-TECH doctors, they are not included in this draft consolidated ECP list. However, Medi-Cal HI-TECH doctors are considered qualified as ECPs. The most current DHCS list of Medi-Cal HI-TECH doctors can be found at http://medi-cal.ehr.ca.gov.

Covered California notes that the following reference lists were used:

  • Federal 340B list was downloaded from HRSA’s website on April 9.
  • DSH list obtained from DHCS for financial year 2011-12 on April 1.
  • The 1204a list was downloaded from the California Department of Public Health on April 11.
  • The most current Indian Health Services list was obtained June 5, 2014.
  • FQHC lists obtained from the California Primary Care Association and dated Feb. 19.
  • Public hospital affiliated community clinics obtained from the California Association of Pubic Hospitals and dated April 9.

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