Sec. 429. Access to essential community providers
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Section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(c)(1)(C) ) is amended— by inserting
(i)after
(C); and by adding at the end the following new clauses: not later than January 1, 2020, increase the percentage of essential community providers as described in clause
(i)included in its network by 10 percent annually (based on the level in the plan for 2016) until 90 percent of all federally-qualified health centers and 75 percent of all other such essential community providers in the contract service area are in-network; and include at least one essential community provider in each of the essential community provider categories described in section 156.235(a)(2)(ii)(B) of title 45, Code of Federal Regulations (as in effect on the date of enactment of the Health Equity and Accountability Act of 2018 ) in each county in the service area, where available; . Section 1311(e)(3) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(e)(3) ) is amended by adding at the end the following new subparagraph: The Secretary shall require qualified health plans to submit annually to the Secretary data on the percentage of essential community providers as described in clause
(ii)of subsection (c)(1)(C), by county, that contract with each qualified health plan offered in that county and the percentage of such essential community providers, by category as described in clause
(iii)of such subsection, that contract with each qualified health plan offered in that county. Such data shall be made available to the general public. . Section 1852(d)(1) of the Social Security Act ( 42 U.S.C. 1395w–22(d)(1) ) is amended— by striking and at the end of subparagraph (D); by striking the period at the end of subparagraph
(E)and inserting ; and ; and by adding at the end the following new subparagraph: the plan meets the requirements of clauses
(ii)and
(iii)of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers). . Section 1932(b)(5) of the Social Security Act ( 42 U.S.C. 1396u–2(b)(5) ) is amended— by striking and at the end of subparagraph (A); by striking the period at the end of subparagraph
(B)and inserting ; and ; and by adding at the end the following new subparagraph: meets the requirements of clauses
(ii)and
(iii)of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers) with respect to services offered in the service area involved. .
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- 42 USC 1395w–22(d)(1)
- 42 USC 1396u–2(b)(5)
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Sec. 429
Access to essential community providers
Cite42 USC 1395w–22(d)(1)
Cite42 USC 1396u–2(b)(5)
Cites 3Cited by 0 across 0 sources