Essential Community Providers

An Essential Community Provider (ECP) is a health care provider that serves high-risk, special needs, and underserved individuals.

The Minnesota Department of Health designates ECPs pursuant to the requirements in Minnesota Statutes §62Q.19 and Minnesota Rules Part 4688.

Those regulations require that ECPs:

• Provide or coordinate supportive and stabilizing services, such as transportation, child care, linguistic services, and culturally sensitive and competent services to its clients.
• Have processes for identifying a need for supportive and stabilizing services and for enabling clients to access these services; and
• Qualify as one of six statutorily specified types of health care providers.

A health care provider that seeks to qualify as an ECP based on nonprofit, tax-exempt status must also:

• Charge for services on a sliding fee schedule based on income; and
• Provide unrestricted access to its services regardless of a client's financial limitations.

Health plan companies must offer provider contracts to all designated ECPs in their service areas.

Contracting with Health Plans

The Essential Community Provider (ECP) law requires health plan companies to offer a provider contract to any designated ECP located in the area served by the health plan company. The ECP must request a contract from the health plan company. Contracted rates must be at least as much per unit of service as are paid to other providers for the same or similar services. The health plan company may require ECPs to meet the same data requirements, utilization review, and quality assurance requirements that other contracted providers must meet. While the health plan company should not unduly delay the start date of a contract, it may choose a start date that will place the ECP on the same contracting schedule as other contracted providers.

Please note that ECP contracting requirements do not apply to companies with fewer than 50,000 enrollees, all of whom are on medical assistance.

If a health plan company does not respond to a request for a contract, or offers a contract that is not on par with other contracted providers, remind the health plan company of its obligations under Minnesota Statutes, Section 62Q.19, subdivisions 3 and 5. If the health plan company still does not offer an appropriate contract, you may contact the Managed Care System for assistance. Call 651-201-5100, or 800-657-3916, toll free.

The Minnesota Department of Health is authorized to impose monetary penalties against Health Maintenance Organizations that violate ECP law.

Health Plan Companies

By law, a health plan company must offer a provider contract to any designated Essential Community Provider located in the area served by the health plan company. Contracting with more health plan gives a provider access to more patients with a source of reimbursement for care.

Federally Designated ECPs

The Centers for Medicare and Medicaid Services (CMS) designates ECPs according to federal requirements specified in Qualified Health Plan Certification (cms.gov). Under that regulation, ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. They include health care providers defined in section 340B(a)(4) of the Public Health Service (PHS) Act and described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act (SSA).

• Qualified Health Plan Certification - Designated ECPs | CMS

For more information, email health.ecp@state.mn.us