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Essential community providers for exchange plans—Definition.
"Essential community provider" means providers listed on the Centers for Medicare and Medicaid Services Non-Exhaustive List of Essential Community Providers. This list includes providers and facilities that have demonstrated service to medicaid, low-income, and medically underserved populations in addition to those that meet the federal minimum standard, which includes:
(1) Hospitals and providers who participate in the federal 340B Drug Pricing Program;
(2) Disproportionate share hospitals, as designated annually;
(3) Those eligible for Section 1927 Nominal Drug Pricing;
(4) Those whose patient mix is at least thirty percent medicaid or medicaid expansion patients who have approved applications for the Electronic Medical Record Incentive Program;
(5) State licensed community clinics or health centers or community clinics exempt from licensure;
(6) Indian health care providers as defined in WAC 284-43-130
(7) Long-term care facilities in which the average residency rate is fifty percent or more eligible for medicaid during the preceding calendar year;
(8) School-based health centers as referenced for funding in Sec. 4101 of Title IV of ACA;
(9) Providers identified as essential community providers by the U.S. Department of Health and Human Services through subregulatory guidance or bulletins;
(10) Facilities or providers who waive charges or charge for services on a sliding scale based on income and that do not restrict access or services because of a client's financial limitations;
(11) Title X Family Planning Clinics and Title X look-alike Family Planning Clinics;
(12) Rural based or free health centers as identified on the Rural Health Clinic and the Washington Free Clinic Association web sites; and
(13) Federal qualified health centers (FQHC) or FQHC look-alikes.
[Statutory Authority: RCW 48.02.060
, 45 C.F.R. 156.230, 156.235, and 156.245. WSR 14-22-007, § 284-43-221, filed 10/23/14, effective 11/23/14. Statutory Authority: RCW 48.02.060
, 45 C.F.R. §§ 156.230, 156.235, and 156.245. WSR 14-10-017 (Matter No. R 2013-22), § 284-43-221, filed 4/25/14, effective 5/26/14.]