Committee Leaders Raise Questions About Recent Update to Health Law’s Essential Community Provider List

June 28, 2013

WASHINGTON, DC – House Energy and Commerce Committee leaders today continued their oversight of the implementation of the president’s health care law, writing to Health and Human Services (HHS) Secretary Kathleen Sebelius regarding a recent update to the “Essential Community Provider” (ECP) list maintained by the department. The Patient Protection and Affordable Care Act (PPACA) requires that insurers offering plans on the Health Insurance Marketplaces, or exchanges, include a “sufficient number and geographic distribution” of providers that serve predominantly “low-income, medically underserved individuals.” These providers are referred to as Essential Community Providers.

The inclusion of 639 Planned Parenthood clinics on a recently updated list of ECPs concerns the leaders as some Planned Parenthood affiliates plan to become official government-funded “Navigators” under the president’s health care law, so that they may directly advise individuals on enrollment.

In writing to Secretary Sebelius, Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA), Health Subcommittee Chairman Joe Pitts (R-PA), full committee Vice Chairman Marsha Blackburn (R-TN), and full committee Chairman Emeritus Joe Barton (R-TX) requested information relating to PPACA’s requirements relating to Essential Community Providers. A deadline of July 12, 2013, was set for HHS to respond to the following questions:

  1. The criteria that CMS uses when evaluating whether a health care facility will be listed as an essential community provider;
  2. All documents provided to either HHS or the Center for Consumer Information and Insurance Oversight (CCIIO) by Planned Parenthood concerning their identification as an Essential Community Provider. This would include, but is not limited to, communications between administration representatives and Planned Parenthood, including e-mails.
  3. All documents submitted to either HHS or CCIIO by insurers or their representatives concerning the approval of Planned Parenthood as an Essential Community Provider. This would include, but is not limited to, communications between administration representatives and the insurance industry (and their representatives), including e-mails.
  4. Explain whether the PPACA or its regulations permit an Essential Community Provider to also serve as a Navigator or Assister.

To read the letter to HHS, click here.

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