Health Center Federal Policy

Exchange Plans are Live! What’s the Status of Contract Negotiations…?

As Outreach & Enrollment efforts continue after the first week of the new Health Insurance Exchanges being live, participating Qualified Health Plans are ramping up their networks in order to finalize their coverage and providers for the beginning of 2014 when the newly enrolled will be able to access their covered benefits.  Accordingly, this means finalizing contracts with Essential Community Providers, including FQHCs.  To date we have heard that this is a mixed bag—with some health centers being offered very poor “take it or leave it” contracts, others not receiving any offers from plans, and still others being offered reasonable rates in line with the PPS requirement as advocated for in the “Menendez Amendment.”

Given how varied the response has been nationwide, we are looking for feedback from health centers as to how things are going.  Specifically, we are interested in knowing from individual centers whether plans have agreed to pay their health center PPS rate or if they are negotiating a different rate with the center…and if plans are negotiating a different rate, is it reasonable in the eyes of the health center?  This feedback will enable NACHC policy staff to continue the dialogue with CMS and Capitol Hill and encourage CMS to strengthen the ECP minimum contracting requirements for 2015 and beyond.  Please send any feedback, questions, or challenges to Heather Foster ( and Susan Sumrell (