WAC 284-170-300. 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 284-170-130 (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 websites; and (13) Federal qualified health centers (FQHC) or FQHC look-alikes.