Section 284-43-0221 - Essential community providers for exchange plans-Definition "Essential community provider" means providers listed on the Centers for Medicare and Medicaid Services Non-Exhaustive List of Essential Community Providers. This list includes providers and facilities that have demonstrated service to medicaid, low-income, and medically underserved populations in addition to those that meet the federal minimum standard, which includes:
(1) Hospitals and providers who participate in the federal 340B Drug Pricing Program;(2) Disproportionate share hospitals, as designated annually;(3) Those eligible for Section 1927 Nominal Drug Pricing;(4) Those whose patient mix is at least thirty percent medicaid or medicaid expansion patients who have approved applications for the Electronic Medical Record Incentive Program;(5) State licensed community clinics or health centers or community clinics exempt from licensure;(6) Indian health care providers as defined in WAC 284-43-130(16);(7) Long-term care facilities in which the average residency rate is fifty percent or more eligible for medicaid during the preceding calendar year;(8) School-based health centers as referenced for funding in Sec. 4101 of Title IV of ACA;(9) Providers identified as essential community providers by the U.S. Department of Health and Human Services through subregulatory guidance or bulletins;(10) Facilities or providers who waive charges or charge for services on a sliding scale based on income and that do not restrict access or services because of a client's financial limitations;(11) Title X Family Planning Clinics and Title X look-alike Family Planning Clinics;(12) Rural based or free health centers as identified on the Rural Health Clinic and the Washington Free Clinic Association web sites; and(13) Federal qualified health centers (FQHC) or FQHC look-alikes.Wash. Admin. Code § 284-43-0221
Adopted by WSR 14-10-017, filed 4/25/14, effective 5/26/2014Amended by WSR 14-22-007, Filed 10/23/2014, effective 11/23/2014