Ensuring Access to Essential Providers Act of 2025
Sponsored By: Senator Bill Cassidy
Introduced
Summary
Requires Medicare Advantage plans to include essential community providers in their networks. This bill would create an "Essential Community Provider" standard that makes plans offer contracts to local safety-net providers, ensure network access for low-income and rural enrollees, and require payment to Federally Qualified Health Centers consistent with current Medicare rules.
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- Families and low-income enrollees: Would get stronger access protections because plans must ensure a sufficient number and geographic distribution of essential community providers so people in rural areas and Health Professional Shortage Areas can get timely care.
- Federally Qualified Health Centers and safety-net clinics: Plans must offer to contract with these providers and pay FQHCs amounts consistent with section 1857(e)(3), helping preserve revenue streams for clinics that serve mainly low-income patients.
- Medicare Advantage organizations: Must include available essential community providers in each plan’s service area, explain in plan materials why any deficiency exists, and face potential plan denial if the Secretary finds the justification insufficient.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
More access to community providers for Medicare
If enacted, Medicare Advantage plans would have to include and offer to contract with "essential community providers" in each plan service area. The bill would define which providers count, such as Federally Qualified Health Centers, tribal and Indian Health Service facilities, certain hospitals, and mental health and substance use clinics. Where available, plans would need enough and well‑distributed such providers so low‑income, rural, and Health Professional Shortage Area residents have reasonable, timely access. Plans that do not meet the standard must explain why and how they will improve; the Secretary could deny plan approval if the explanation is insufficient. The bill would also require plans to pay FQHCs consistent with the Medicare rule cited. It would not require coverage of any specific medical procedure.
Sponsors & CoSponsors
Sponsor
Bill Cassidy
LA • R
Cosponsors
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 9/11/2025
Roll Call Votes
No roll call votes available for this bill.
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