Response to Comments

Essential Community Provider/Network Adequacy (ECP/NA) Data Collection to Support QHP Certification
(CMS-10803/0938-NEW)
60-Day Public Comment Response Summary (Ended 03/07/2022)
Comment Type
Burden

1

Comment Summary
Commenters submitted two remarks
regarding the burden estimates
associated with the addition of
telehealth data collection reporting for
SADPs. Commenters expressed concern
that the burden was underestimated for
SADPs and should be reassessed. The
commenters shared that they believe
the burden is underestimated because:
SADPs do not currently collect data on
telehealth; the estimate does not
include costs for a second reviewer; and
the hourly rate and total estimated
hours are too low.

Response
We appreciate the feedback received on the burden estimates for
SADPs. HHS is aware that the actual burden will vary for each QHP
based on a variety of factors. We acknowledge that telehealth data
collection may increase the burden for some QHPs, including SADPs.
We are also aware that some QHPs already have telehealth data
available, from sources like claims data or provider surveys. We have
reflected the telehealth data collection requirement in our burden
estimates and believe these estimates are reasonable. For issuers
that have not yet received responses from providers regarding
telehealth availability and do not have that information available
from other sources, like claims data, they can select the response on
the template that they are awaiting a response from that provider.
For QHP certification data collection and reporting, we use the mean
hourly wages for a compliance officer to estimate costs. This data was
retrieved from the Bureau of Labor Statistics web site. 1 HHS believes
that this job title and associated hourly wage provide a reasonable
basis for our estimates. We understand that multiple staff at different
levels may be involved and the total number of anticipated hours
reflects that. It is up to each issuer to determine their process for
collecting and reporting ECP/NA data and how many staff are
involved. We will collect user experience data regarding the
information collection requirements related to network adequacy
and will reassess burden estimates for future years as needed.

Occupational Employment and Wages, May 2021. (2022, March 31). Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes131041.htm

04/15/2022

1

ECP/NA PRA

CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be
privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.

Comment Type
Burden

Comment Summary
Two commenters expressed concern
that the burden estimate was too low.

General

One commenter stated that updates
made to ECP/NA data collection are
necessary and should be approved.
Some commenters recommended that
HHS defer to states that have similar
network adequacy standards as the
federal network adequacy standards,
and coordinate with states and NAIC
where possible.
A commenter encouraged HHS to
identify plans that use very narrow
networks as a discriminatory enrollment
selection process rather than to control
costs.
Some commenters recommended that
HHS align network adequacy standards
with NCQA and Utilization Review
Accreditation Commission (URAC)
standards.

State Deferral and
Coordination

Suggestion to
Strengthen Network
Adequacy Policy
Alignment with Existing
Standards

Network Tiering

04/15/2022

One commenter requested HHS allow
providers from multiple network tiers to
be considered when assessing network
adequacy.
2

Response
HHS believes the burden estimates accurately reflect the time it takes
for an issuer to complete the activities described in this package and
bases its estimates on extrapolation from experience in prior plan
years.
HHS agrees that the ECP/NA data collection is necessary to support
the ECP/NA portions of the QHP certification review process.
HHS will defer to states performing plan management that elect to
perform their own reviews during QHP certification, provided that the
state applies and enforces network adequacy standards that are at
least as stringent as the federal standards. HHS will continue to
coordinate with states and NAIC.
HHS appreciates this suggestion and will consider the possibility of
identifying plans that use narrow networks as a method to deter
consumers with greater health needs from enrollment.
HHS reviewed the NCQA and URAC standards regarding network
adequacy. We believe it is appropriate to align with NCQA in its use of
business days to measure appointment wait time standards, which
will be finalized in the final PY 2023 Letter to Issuers. We will also
finalize that the appointment wait time standard for the behavioral
health category will align with NCQA’s standards. NCQA and URAC do
not have quantitative parameters for the other categories we are
finalizing for appointment wait times nor do they have quantitative
standards for time and distance.
HHS is not finalizing the network tiering policy for network adequacy.

ECP/NA PRA

CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be
privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.

Comment Type
Review Timing

Review Timing,
Implementation Details

Review Timing

Justification

04/15/2022

Comment Summary
Some commenters requested that HHS
defer network adequacy standards until
PY 2024 and defer appointment wait
time standards until COVID-related
provider staffing issues are addressed.
Some commenters shared concerns that
plans will not have enough time to
implement changes required by the
proposed network adequacy policies
and that plans do not have sufficient
details on the implementation plans for
these policies. Some commenters
offered feedback on specific provider
types and requested more detail on how
provider types are defined. One
commenter requested clarification
about aspects of the ECP/NA template,
such as telehealth data collection,
provider specialty codes, and time and
distance parameters.
One commenter requested deferral of
telehealth data collection.
Two commenters recommended a clear
network adequacy justification process.

3

Response
HHS is finalizing appointment wait time standards and delaying
implementation until PY 2024.

HHS included details on the implementation of network adequacy
policies in the draft 2023 Letter to Issuers and believes issuers will
have sufficient time to comply with time and distance standards for
PY 2023 and appointment wait time standards beginning in PY 2024.
Further information, including detail on definitions of provider types
and clarification requested regarding aspects of the ECP/NA template,
will be included in the ECP/NA template, FAQs, QHP Application
Instructions, and other related documents.

HHS will collect data from issuers on which providers offer telehealth
as many issuers already have this information, can gather it during
the required timeframe, or can select that they have requested
information from the provider and are awaiting their response.
HHS has developed streamlined justification processes for network
adequacy and ECP that are described in the preamble of the 2023
Payment Notice final rule.

ECP/NA PRA

CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be
privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.

Comment Type
ECP Threshold

Comment Summary
Some commenters requested that HHS
use a phased-in approach to increasing
the ECP threshold or delay raising the
ECP threshold until PY 2024.

Reviews for Rural Areas

One commenter requested HHS
consider a different approach to assess
network adequacy in rural areas.

Appointment Wait Time
Standards

A commenter asked HHS to exclude
SADPs from appointment wait time
standards requirement.

Stakeholder Feedback

One commenter recommended that
HHS provide additional opportunities for
stakeholder feedback on
implementation of network adequacy
policies.
Support amending 45 CFR 147.104(e).

Out of scope

04/15/2022

4

Response
HHS is finalizing the ECP threshold for PY 2023 as proposed as it
anticipates the majority of issuers will be able to meet the standard
and the justification and ECP Write-in processes can be used by
issuers that are working to come into compliance with the ECP
standards.
HHS believes the time and distance standards for rural areas are
reasonable based on our review of industry standards. We will assess
time and distance standards at the county level. Rural counties and
counties with extreme access considerations will have time and
distance parameters that are longer than more metropolitan areas.
HHS does not agree that SADPs should be exempt from compliance
with appointment wait time standards. HHS believes it is important
that timely access to care is ensured, regardless of plan type. HHS will
evaluate all plans seeking QHP certification, including SADPs, for
compliance with appointment wait times beginning in PY 2024.
HHS will continue seeking stakeholder feedback on network adequacy
policies on an ongoing basis.

This comment is out of scope as 45 CFR 147.104(e) on nondiscrimination protections does not relate to ECP/NA data collection.

ECP/NA PRA

CLOSE HOLD – DO NOT SHARE INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be
privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.
Unauthorized disclosure may result in prosecution to the full extent of the law.