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CMS guidance: issuers must submit Essential Community Providers data in MPMS for QHP certification
Summary
CMS staff walked issuers through using the MPMS/HIOS module to complete the Essential Community Providers section of the QHP Plan Attributes group, including navigation, import options, and the requirement to document provider networks so enrollees have timely access.
An agency official from the Centers for Medicare & Medicaid Services said issuers seeking to offer Qualified Health Plans, including standalone dental plans, must submit a complete QHP application per CMS guidelines and complete the Essential Community Providers section to show adequate provider access.
"Issuers must submit ECP facility data in each network associated with an issuer's plans," the agency official said. The presentation explained the ECP section lives inside the Plan Attributes group of the Marketplace Plan Management System (MPMS) module in the Health Insurance Oversight System (HIOS) and that issuers must either select ECPs from the state list or add write-ins as applicable.
The guidance covered navigation steps: from the QHP Applications page select Edit for the application, open Plan Attributes, and Edit the Essential Community Providers section to reach the ECP Introduction and Setup page. Issuers must indicate whether they meet the alternate ECP standard and then proceed to add or import ECP facilities for each network.
CMS provided links and resources for more information and directed issuers to the QHP certification website for full technical guidance and supporting documentation.
