First Essential Provider List Released

Some purchasers of healthcare insurance via Covered California may have had issues with the provider networks of the health plans they selected, but the exchange itself is putting the finishing touches on a list of essential providers available to a large number of enrollees.

Known as essential community providers, or ECPs, the list was mandated under the Affordable Care Act as a way to address disparities in care based on income, geography and other demographics. It is intended to ensure that people who have become newly insured under the ACA are able to remain with the community providers after they obtain coverage. 

The draft list, which Covered California officials spent several months compiling, includes 227 hospitals and more than 2,000 community clinics and various county-operated health centers.

“Covered California's draft consolidated ECP list is an attempt to create a single, de-duplicated list of ECPs that potentially could serve Covered California enrollees,” Covered California said on its website.

In August 2012, Covered California officials decided that the list of ECPs includes federally qualified health centers, disproportionate share hospitals, community clinics and free clinics, tribal health programs, and hospitals that are participating in the 340B drug discount program, among others.

Although Covered California also noted that the intention of the list is to ensure that health plans participating in the exchange have a list of essential community providers to contract with, exchange spokesperson Anne Gonzales said that the provider list is open to all enrollees.

The list could also provide a greater sense of stability for health plan enrollees in search of providers. 

Covered California had initially experienced delays in posting available providers on its website when it became available for enrollment last year, although those issues were eventually resolved. 

Many of the participating health plans also relied on narrow networks in order to keep premiums down. That led to some consumers complaining that Anthem Blue Cross of California and Blue Shield of California listed many providers that were not actually part of their networks. 

The Department of Managed Health Care is currently investigating the complaints about Anthem and Blue Shield. Altogether, about 1,800 complaints about Covered California have been lodged with regulators to date.

The provider list was posted on the Covered California website last month, and is subject to a public comment period that is to end on July 10.

Although a final list will be issued shortly, it is subject to change and updates.