How to Use the Essential Community Provider (ECP) Tools
Did you know that CMS provides review tools that issuers and states can use to
prepare for the QHP Application process? These review tools allow you to check
for errors within your QHP Application that would result in corrections after submission.
Issuers are encouraged to use these tools to identify and correct data
errors prior to submitting application data
in order to reduce the number of required corrections identified during CMS’s reviews.
States are encouraged to use these tools during their reviews to identify potential
errors in their issuers’ application data that would require issuers to make corrections.
The Essential Community Provider Tools, or ECP Tools, help ensure that health plans meet the
ECP requirements for QHP and stand-alone dental plan (or SADP) certification.
The requirements and steps for using the review tools outlined in this video apply to both
the Medical QHP and SADP QHP ECP Tools. An essential community provider (or ECP)
is a medical or dental provider that serves predominantly low-income,
medically underserved individuals. To meet ECP requirements,
applicants must have contracts with 35% of available ECPs in each service area they cover.
Applicants will be asked to report provider data in each network associated with a health plan.
CMS has established two ECP standards: the general ECP standard and the alternate ECP standard.
To satisfy the general ECP standard, the applicant must:
1. Contract with at least 35% of available ECPs in each plan’s
service area to participate in the plan’s provider network;
2. Offer contracts in good faith to all available Indian health care providers in
the plan’s service area for each plan year; and 3. Offer contracts in good faith to at least one
ECP in each ECP category in each county in the plan’s service area for the plan year,
where available. (This is not applicable to SADP applicants).
To satisfy the alternate ECP standard, the applicant must:
1. Contract with at least 35% of available ECPs in each plan’s service area to
participate in the plan’s provider network; and 2. Offer all of the categories of services
provided by entities in each ECP category in each county in the plan’s service area as outlined in
the general ECP standard, or otherwise offer a contract to at least one ECP outside of
the issuer’s integrated delivery system per ECP category in each county in the plan’s service area
(This is not applicable to SADP applicants). For more information on the general and
alternate ECP standards, reference the ECP Standards tab within the tool.
To use the ECP Tools, you will need a populated Master Review Tool, with data from:
the Plans & Benefits Template, the Service Area Template,
the ECP/NA Template, In addition, if you are
relying on providers from the “Available ECP Write-in List” for the applicable plan year to
satisfy the ECP standard, you will also need a populated ECP Write-in Worksheet.
To download the Medical QHP and SADP QHP ECP Tools, visit the Review Tools webpage of the
QHP certification website and click on the Automated Review Tools link.
Inside the .zip file, you’ll see several review tools, including both the Medical QHP and SADP
QHP ECP tools. We will be reviewing the Medical QHP ECP Tool in detail,
but if you are reviewing dental plans in the SADP QHP ECP Tool, the steps will remain the same.
Open the appropriate tool in Excel and enable macros. Read the “Instructions”
tab carefully before beginning. Click on the “Import Data From
Master Review Tool” button, and select the Master Review Tool workbook you are using.
This will populate the “Plan Info Input,” “Service Area Input,” and “ECP Input” tabs.
After importing the Master Review Tool, click on the “Determine Type of ECP Review” button.
Based on the information included in the ECP/Network Adequacy Template,
the ECP Tool will determine whether you will be evaluated against the
General or Alternate ECP Standard. Click the “Run QHP ECP Tool” button.
Running the tool could take several minutes depending on how much data are processing.
If there are errors in your data, an “Errors” tab will display,
indicating the issues that may result in required corrections during CMS’s reviews.
The errors highlighted in red are considered major errors, and must be corrected for the
evaluation to be completed correctly. Review these carefully, and determine
how to correct the data in the templates. Then, review the rest of the identified
errors not highlighted in red. These may or may not impact the overall results of the review,
so please review each error carefully, and determine if corrections are necessary.
If errors prevent the tool from completing its evaluation of the ECP requirements,
make any necessary corrections in the appropriate templates, reimport the templates
into the Master Review Tool, and reimport the Master Review Tool into the ECP Tool.
Once the tool is able to complete evaluation of all plans, refer to either of the following tabs:
The “Output General Standard” – for General ECP Standard issuers –
or "Output Alternate Standard” – for Alternate ECP Standard issuers. On this tab, you will see the results for every
plan entered in the tool. This tab will convey: • If the 35% ECP threshold has been met,
• The number of ECPs a plan has in its network that overlap with the plan’s service area, and
• The number of ECPs available in the plan’s service area.
For any plans that did not meet the ECP standard, issuers need to determine the
appropriate corrections that need to be made, so that all plans meet the ECP standard.
Once the relevant corrections needed are determined,
the issuer should open the relevant template,
make the appropriate changes, validate and save it, and reimport it into the Master Review Tool.
Then, reimport the Master Review Tool into the ECP Tool, run the tool, and repeat the
review process until all plans meet the ECP requirements, outlined in the output tab.
For dental plans, you will follow these same guidelines using the SADP QHP ECP Tool.
The SADP QHP ECP Tool will evaluate your data using the same General or Alternate ECP standards
described previously, and will generate review results similar to the Medical QHP ECP Tool.
Some common errors that applicants can avoid include:
• An applicant lists an ECP that is not part of the issuer’s service area.
• An applicant lists a dental provider within its Medical QHP ECP Tool,
rather than the SADP QHP ECP Tool. • An applicant imports inconsistent
issuer data into the Medical QHP ECP Tool or SADP QHP ECP Tool from the Master Review Tool.
Please note that for issuers requiring ECP corrections, CMS generates an issuer’s partially
prepopulated ECP Justification Form and uploads it to the Plan Management (PM) Community for issuer retrieval.
Good faith ECP contract offers reported on the ECP Justification Form are ingested within
the embedded ECP Tool logic and counted toward satisfaction of the ECP standard, as applicable.
If you have questions regarding the QHP Application Review Tools,
please contact the Marketplace Service Desk at CMS_FEPS@cms.hhs.gov, or 855-CMS-1515.
For more information about the QHP Application Process, visit www.qhpcertification.cms.gov.