Essential Community Provider

The Academy supports the concept of Essential Community Provider (ECP) as a means of protecting access to essential services, delivered by qualified providers, to achieve measurable outcomes for vulnerable populations.

It is appropriate for state governments to promote the availability and accessibility of essential health care services to medically underserved populations by requiring payers (public and private) to contract with qualified, local providers of such services whenever possible. Furthermore, to the extent that such contracts cover essential services, states should require that they contain terms and conditions at least as favorable as those applicable to the payor's other providers of such services with respect to:

  1. The scope of services for which payment is made to the provider;
  2. The rate of payment for covered care and services;
  3. The availability of financial incentives to participating providers;
  4. Limitations on financial risk provided to other participating providers;
  5. Assignment of enrollees;
  6. Reasonable access to specialty and inpatient care providers.

(1995) (2007)