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CMS enumerates facility status codes for Essential Community Providers and required documentation
Summary
CMS listed 13 facility status options for ECPs — from 'contract executed' to 'facility relocated' or 'not licensed' — and explained when issuers must provide extra documentation such as contract dates and contact names.
An agency official walked through the Status and Action options issuers must select for each ECP and explained which statuses require additional explanatory notes or supporting data.
"The Status and Action column in the Select ECPs section shows a status of complete or incomplete for each facility," the official said, noting that an incomplete status indicates more details are required. The presenter then enumerated per-facility statuses including 'contract executed'; 'contract offer made awaiting response'; 'pre-contract negotiations in progress'; 'offer rejected'; 'contract not offered due to no response following issuer outreach'; 'facility closed'; 'facility has no interest in contracting with commercial insurance'; 'not licensed or certified by the state'; 'facility relocated outside the service area'; and that category mismatches can be flagged for CMS review.
The guidance explained that certain statuses require additional fields such as contract offer date, contracting point of contact name and email, and how the issuer learned of the status change. Optional notes can provide CMS with justifications or context when a status allows supplemental explanation.
Issuers were told to edit facility contract details via the Status and Action column and to ensure status values are accurate before running ECP calculations.
