What is an essential community provider under the Affordable Care Act?
Asked by: Daphnee Kuhic III | Last update: August 28, 2025Score: 4.4/5 (45 votes)
What is an essential community provider?
The ACA defines ECPs as providers whose patients are predominantly low-income and medically underserved. Because of their geographic locations and the populations they are designed to serve, virtually all safety-net providers (SNPs) qualify as ECPs.
What is an essential care provider?
Under that regulation, ECPs are defined as providers who serve predominantly low-income, medically underserved individuals. They include health care providers defined in section 340B(a)(4) of the Public Health Service (PHS) Act and described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act (SSA).
What is an example of a community provider?
Community providers means treatment providers including but not limited to alcohol and other drug (AoD) treatment providers, primary care providers, medical specialists, hospitals, and service providers, including but not limited to housing entities, nutritionists, courts, or others involved in the clinical or non- ...
What is not considered an essential health benefit under the Affordable Care Act?
Pursuant to 45 CFR 156.115(d), the following benefits are excluded from EHB even though an EHB-benchmark plan may cover them: routine non-pediatric dental services (for plan years beginning on or before January 1, 2026), routine non-pediatric dental services, routine non-pediatric eye exam services, long-term/custodial ...
ACA 101: A Comprehensive Guide to the Affordable Care Act
What are 5 of the essential health benefits provided by the Affordable Care Act?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
Which of the following is not a form of minimum essential coverage?
So the list of plans that are not considered minimum essential coverage includes short-term health insurance, medical discount plans, limited-benefit plans, critical illness insurance, accident supplements, travel medical insurance, and dental/vision plans.
What is a community care provider?
Community providers can deliver care to Veterans on behalf of VA. VA's Community Care Network (CCN) is the preferred national network used to purchase care for eligible Veterans in their community.
Who is a community service provider?
Community service provider" means a provider of substance use disorder treatment or gambling addiction treatment, including, but not limited to, evaluation.
What is a community provide an example?
Examples of community.
For example, a community of interest refers to a community of people who share the same interests or passions, whereas a community of place refers to people who are brought together by proximity to each other, such as a retirement village, or a university campus.
Who is classified as an essential worker?
According to the U.S. Department of Homeland Security, essential workers are those who conduct a range of operations and services that are typically essential to continue critical infrastructure operations. Critical infrastructure is a large, umbrella term encompassing sectors from energy to defense to agriculture.
Who are considered care providers?
The term “health care provider” includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility, health care clinic, community mental health center (as defined in section 300x–2(b)(1) of this title), renal dialysis facility, blood center, ambulatory surgical center ...
What is the meaning of essential care?
The definition of essential health care is individual health care, family health care and community health care. Community health care includes the other 2, while family health care includes individual health care. Family health care activities include those which are best organized with the family unit as the target.
What is an example of an essential public health service?
Assess and monitor population health. Investigate, diagnose and address health hazards and root causes. Communicate effectively to inform and educate. Strengthen, support and mobilize communities and partnerships.
What is a community-based service provider?
Home- and Community-Based Services (HCBS) are types of person-centered care delivered in the home and community. A variety of health and human services can be provided. HCBS programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing.
What is ECP in insurance?
ECP: Electronic Claims Processing
A means to get your claims to a payer without submission of a paper claim.
What qualifies as community service?
Community service hours are hours spent during the year in work which directly benefits either (1) people experiencing poverty, discrimination, abuse, poor health, old age, youth, and/or physical-mental limitations or (2) the protection of animals or the environment for which an individual does not receive financial ...
What is a community provider in healthcare?
Community provider means a community–based agency or program funded by the Behavioral Health Administration or the Medical Care Programs Administration to serve individuals with mental disorders, substance–related disorders, or a combination of these disorders.
Who is considered a service provider?
A service provider (SP) is an organization that provides services, such as consulting, legal, real estate, communications, storage, and processing services, to other organizations. Although a service provider can be a sub-unit of the organization that it serves, it is usually a third-party or outsourced supplier.
What is an essential community provider as defined by CMS?
Under 45 CFR 156.235, ECPs are defined as health care providers who serve predominantly low-income, medically underserved individuals.
What is a community service provider?
A wide range of individuals and organisations who provide care and support to people in their local communities, including people with disability.
Is community care Medicaid or Medicare?
Community Care Partnership provides prescription drugs to members with Medicare. Partnership members who do not have Medicare receive prescription drugs through Medicaid.
Which of the following is required by the Affordable Care Act?
A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.
Can you have VA and Obamacare at the same time?
Yes. You can continue to use VA for all your health care needs, or complement your VA care with private health insurance or coverage by other federal health care programs, including Medicare, Medicaid, and TRICARE.