Access to essential community providers

(a) Essential community providers Section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— (1) by inserting (i) after (C); and (2) by adding at the end the following new clauses: (ii) not later than January 1, 2027, increase the percentage of essential community providers as described in clause (i) included in its network by 10 percent annually (based on the level in the plan for 2023) until 90 percent of all federally qualified health centers and 75 percent of all other such essential community providers in the contract service area are in-network; and (iii) include at least one essential community provider in each of the essential community provider categories described in section 156.235(a)(2)(ii)(B) of title 45, Code of Federal Regulations (as in effect on the date of enactment of the Health Equity and Accountability Act of 2026), in each county in the service area, where available;. (b) Reporting requirements Section 1311(e)(3) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended by adding at the end the following new subparagraph: (E) Data on essential community providers The Secretary shall require qualified health plans to submit annually to the Secretary data on the percentage of essential community providers as described in clause (ii) of subsection (c)(1)(C), by county, that contract with each qualified health plan offered in that county and the percentage of such essential community providers, by category as described in clause (iii) of such subsection, that contract with each qualified health plan offered in that county. Such data shall be made available to the general public.. (c) Essential Community Provider provisions applied under Medicare and Medicaid (1) Medicare Section 1852(d)(1) of the Social Security Act (42 U.S.C. 1395w–22(d)(1)) is amended— (A) by striking and at the end of subparagraph (D); (B) by striking the period at the end of subparagraph (E) and inserting; and; and (C) by adding at the end the following new subparagraph: (F) the plan meets the requirements of clauses (ii) and (iii) of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers).. (2) Medicaid Section 1932(b)(5) of the Social Security Act (42 U.S.C. 1396u–2(b)(5)) is amended— (A) by striking, and at the end of subparagraph (A) and inserting a semicolon; (B) by striking the period at the end of subparagraph (B) and inserting; and; and (C) by adding at the end the following new subparagraph: (C) meets the requirements of clauses (ii) and (iii) of section 1311(c)(1)(C) of the Patient Protection and Affordable Care Act (relating to inclusion in networks of essential community providers) with respect to services offered in the service area involved..