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Review of HHS ECP Lists for Coverage Years 2016, 2017, and 20181

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Review of HHS ECP Lists for Coverage Years 2016, 2017, and 20181 March 7, 2016 This brief seeks to provide Tribes with a summary of findings from a review, conducted by the Tribal Self- Governance Advisory Committee (TSGAC) to the Indian Health Service (IHS), of Indian health care providers (IHCPs) that appear on the federal Department of Health and Human Services Essential Community Provider Lists (HHS ECP Lists) for coverage years (CYs) 2016, 2017, and 2018. In addition, this brief includes an attached spreadsheet comparing the year-to-year listings of IHCPs on the HHS ECP List. This memorandum identifies steps IHCPs might need to take to remain on the HHS ECP List for CY 2018. Methodology TSGAC assessed whether IHCPs were listed on one or more of the HHS ECP Lists for 2016, 2017, and 2018. And TSGAC calculated the total number of entries on the various HHS ECP Lists for a given year against the totals listed for other years, in addition to calculating these numbers as percentages of each other. To conduct this review for CYs 2016 and 2017, TSGAC compiled a list of IHCPs by examining the list of health care facilities provided on the IHS Web site, as well as the IHCPs appearing on the CY 2016 and CY 2017 HHS ECP Lists, and determined whether the IHCPs appear on one or both of the HHS ECP lists for 2016 and 2017. To determine whether an IHCP is “on the HHS ECP List for 2018,” an assessment was made as to whether, for those entries on the HHS ECP List for 2017, all data fields were populated. (CCIIO has established a requirement—applicable to the HHS ECP List for 2018—that all data fields in an entry be populated. So, although an entry can be incomplete and remain on the 2016 and 2017 HHS ECP Lists, for a facility to be on the HHS ECP List for 2018, the facility must provide all the requested data.) Because a number of new data fields were added to the HHS ECP List for 2017 and subsequent years, an IHCP could populate the newly- added data fields by submitting a new entry or updating an existing entry on the HHS ECP List for 2017. For TSGAC assessment purposes, if an entry on the HHS ECP List for 2017 had one new data field in particular populated (the field for the national provider identifier (NPI)), the entry was considered “updated” or complete and assumed to be included on the HHS ECP List for 2018. Major Provisions of Final Rule A total of 677 IHCP entries are on the HHS ECP List for 2016. A total of 791 IHCP entries are on the HHS ECP List for 2017, an increase of 114 or 17%. A total of 426 IHCP entries are included on the HHS ECP List for 2018. This compares with a total of 791 IHCP entries on the HHS ECP List for 2017, a 46% reduction in entries from 2017 to 2018. • With regard to entries on the HHS ECP List for 2018 that are in Federally-facilitated Marketplace (FFM) states,2 there are 345 entries (a 43% reduction from 2017). 1 This brief is for informational purposes only and is not intended as legal advice. For questions on this brief, please contact Doneg McDonough, TSGAC Technical Advisor, at [email protected]. 2 In FFM states, qualified health plan (QHP) issuers are required to make good faith contract offers to all available IHCPs. • For non-FFM states, there are 81 entries (a 57% reduction from 2017). The inclusion of an IHCP on the HHS ECP List is important, as it serves as the way to maintain the right of an IHCP (in an FFM state) that is located in a QHP’s service area to receive a contract offer from the QHP. In non-FFM states, this requirement for QHPs to offer contracts to IHCPs currently does not apply, but Tribal representatives have requested that CCIIO extend the requirement to QHPs operating in non-FFM states as well. And, in fact, for CY 2017 CCIIO has extended the mandatory contract offer requirement from FFM states to QHP issuers operating in State-based Marketplace Federal Platform (SBM-FP) states.3 Analysis The number of IHCP entries on the HHS ECP List increased from 2016 to 2017. • This might be the result of HHS clarifying that, for the HHS ECP List for 2017, an organization’s providers located at the same street site should be included under a single entry. Rather than having the effect of reducing the number of entries on the HHS ECP List for 2017, IHCPs might have updated their facility entries from 2016 by submitting a new entry, rather than modifying their existing entries that are/were on the HHS ECP List for 2016. (In addition to the new entries, the “old” entries would be carried over to the HHS ECP List for 2017.) The number of IHCP entries on the HHS ECP List for 2018 is estimated to be significantly lower than the number of IHCP entries on the HHS ECP List for 2017. The drop in the number of IHCP entries estimated to be on the CY 2018 HHS ECP List in comparison with the number that are on the CY 2017 HHS ECP List might have resulted from: 1. The entries on the HHS ECP List for 2017 include those carried forward from the 2016 HHS ECP List, as well as any new entries submitted by January 15, 2016. 2. The consolidation of shared location entries under a single IHCP entry (as CCIIO requested the listing of providers at a single location be included under one entry) would have reduced the total number of entries for 2018, after the non-updated entries were dropped for 2018. 3. Some of the entries on the CY 2017 HHS ECP List were tribal health organizations which do not provide direct medical care; these entries will correctly not be carried forward to the CY 2018 list. 4. The entries on the HHS ECP List for 2018 (as determined by the TSGAC analysis) are only those entries that were updated or newly submitted between December 8, 2015, and January 15, 2016; 3 As of January 2016, the SBM-FPs subject to the new requirements beginning in 2017 are NV, HI, NM, and OR. SBM-FPs are Marketplaces operated by states that use the FFM (healthcare.gov) technology platform. March 7, 2016 Page 2 of 3 the entries determined to be “on the HHS ECP List for 2018” are only those entries with the new NPI data field populated. 5. The limited time frame (December 8, 2015, to January 15, 2016) for updating and adding entries for the CY 2018 HHS ECP List, in particular being over a holiday period, might have restricted the number of IHCPs that were able to update their entries. 6. The potential difficulty of IHCPs navigating the “petition” process on the CMS Web site during the 5- week period that was allowed for updating and adding entries on the CY 2018 HHS ECP List might have reduced the number of IHCPs that successfully updated their entries. 7. Some IHCPs might have been unaware of the need to update existing entries on the HHS ECP List in order to remain on the CY 2018 HHS ECP List. 8. A number of IHCPs located in non-FFM states might have concluded that it is not useful to remain on the HHS ECP List (as Marketplace rules in non-FFM states generally do not require QHPs issuers to make good faith contract offers to all available ICHPs on the HHS ECP List.) Next Steps—Action Needed by Tribes 1. As indicated in the attached document from CCIIO, the petition process remains open to add an IHCP to the HHS ECP List for 2018. The document reads: “For providers who remain on the 2017 HHS ECP list with missing data (such as a missing NPI or FTE practitioner count), these providers represent those who have not yet submitted an ECP petition to correct and update their provider data. Although the provider submission window for corrections and updates to be reflected on the final ECP list for the benefit year 2017 closed on January 15, 2016, the ECP petition process remains open throughout the year for providers to correct and update their data for future plan year ECP list releases.” (Emphasis added.) The HHS ECP List petition can be accessed at https://data.healthcare.gov/cciio/ecp_petition. 2. Although the “petition” process is not generally available to add new entries to the HHS ECP List for 2017, IHCPs are able to engage QHP issuers directly to secure an in-network provider contract. The QHP issuer would then “write-in” the IHCP as one of the facilities, enabling the QHP issuer to meet Marketplace-imposed provider network requirements, as long as the IHCP submits a petition to CCIIO through the process identified above by no later than August 22, 2016. 3. IHCPs should update their entries on the HHS ECP List on an ongoing basis. For example, it is important to maintain the contact information in an IHCP entry on the HHS ECP List in order for QHP issuers to contact an IHCP and provide network contract offers. To update an entry on the HHS ECP List, use the Web link identified above and described in the attached CCIIO document. Attachment: - CCIIO, “Description and Purpose of Non-Exhaustive HHS List of Essential Community Providers” - TSGAC, “Matrix of CMS Policies on Select Health Insurance Marketplace Issues, 2017 – 2018” - TSGAC, “Table of TSGAC Analysis of IHCPs in HHS ECP Lists – 2016-2018” March 7, 2016 Page 3 of 3 Center for Consumer Information and Insurance Oversight Description and Purpose of Non-Exhaustive HHS List of Essential Community Providers DESCRIPTION OF THE NON-EXHAUSTIVE HHS LIST OF ECPs: For the 2017 benefit year, the Centers for Medicare & Medicaid Services (CMS) is releasing an updated list of Essential Community Providers (ECPs) to assist issuers with identifying providers that qualify for inclusion in an issuer’s plan network toward satisfaction of the ECP standard under 45 CFR 156.235 for the 2017 benefit year.
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