[Federal Register: September 2, 2008 (Volume 73, Number 170)]
[Proposed Rules]
[Page 51260-51261]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02se08-21]
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OFFICE OF PERSONNEL MANAGEMENT
48 CFR Part 1652
RIN 3206-AL66
Federal Employees Health Benefits Program Acquisition Regulation:
Miscellaneous Clarifications and Corrections
AGENCY: Office of Personnel Management.
ACTION: Proposed rule.
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SUMMARY: The Office of Personnel Management (OPM) is issuing a proposed
rule to amend the Federal Employees Health Benefits Acquisition
Regulations (FEHBAR). The rule clarifies the rate setting process for
community rated carriers with respect to Similarly Sized Subscriber
Groups (SSSG) and removes the ban on adjustments based on rate
reconciliation for the final year of Federal Employees Health Benefits
Program (FEHBP) contracts.
DATES: Comments must be received on or before: October 2, 2008.
FOR FURTHER INFORMATION CONTACT: Edward M. DeHarde, Senior Policy
Analyst at 202-606-0004, or e-mail Edward.DeHarde@opm.gov.
ADDRESSES: You may submit comments, identified by docket number and/or
RIN
[[Page 51261]]
number by any of the following methods:
Federal eRulemaking Portal: http://www.regulations.gov.
Follow the instructions for submitting comments.
Mail: Edward M. DeHarde, Senior Policy Analyst, Insurance
Policy Group, Office of Personnel Management, 1900 E Street, NW., Room
3415, Washington, DC 20415.
SUPPLEMENTARY INFORMATION: The purpose of this proposed regulation is
to clarify requirements with respect to the rate setting process for
community rated carriers and to require rate reconciliation for the
final contract term for community rated carriers that leave the FEHBP.
In prior years, carriers were not subjected to rate reconciliation
in the final year of their contracts. Information technology and
electronic transmission and storage of data now make it possible to
efficiently perform rate reconciliation for the final contract year.
Therefore, OPM will begin conducting such rate reconciliation on
community rated contracts that terminate after January 1, 2009.
Regulatory Flexibility Act
I certify that this regulation will not have a significant economic
impact on a substantial number of small entities because all the small
plan FEHBP contracts fall below the threshold for submitting cost or
pricing data.
Executive Order 12866, Regulatory Review
This rule has been reviewed by the Office of Management and Budget
in accordance with Executive Order 12866.
Lists of Subjects in 48 CFR Parts 1652
Government employees, Government procurement, Health insurance,
Reporting and recordkeeping requirements.
Office of Personnel Management.
Michael W. Hager,
Acting Director.
Accordingly, OPM proposes to amend chapter 16 of title 48, CFR as
follows:
PART 1652--CONTRACT CLAUSES
1. The authority citation for part 1652 continues to read as
follows:
Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.
Subpart 1652.2--Texts of FEHBP Clauses
2. Amend Sec. 1652.216-70 by revising paragraphs (b)(2) through
(b)(4) and (b)(6), and adding paragraphs (b)(7) and (b)(8) to read as
follows:
1652.216-70 Accounting and price adjustment.
* * * * *
(b) * * *
(2) The subscription rates agreed to in this contract shall be
equivalent to the subscription rates given to the carrier's similarly
sized subscriber groups (SSSGs) as defined in FEHBAR 1602.170-13. The
subscription rates shall be determined according to the carrier's
established policy which must be applied consistently to the FEHBP and
to the carrier's similarly sized subscriber groups (SSSGs). If an SSSG
receives a rate lower than that determined according to the carrier's
methodology, it is considered a discount. The FEHBP must receive a
discount equal to or greater than the carrier's largest SSSG discount.
(3) If, at the time of the rate reconciliation, the subscription
rates are found to be lower than the equivalent rates for the lower of
the two SSSGs, the carrier may include an adjustment to the Federal
group's rates for the next contract period, except as noted in
paragraph (b)(7) of this clause.
(4) If, at the time of the rate reconciliation, the subscription
rates are found to be higher than the equivalent rates for the lower of
the two SSSGs, the Carrier shall reimburse the Fund, for example, by
reducing the FEHB rates for the next contract term to reflect the
difference between the estimated rates and the rates which are derived
using the methodology of the lower rated SSSG, except as noted in
paragraph (b)(7) of this clause.
* * * * *
(6) For contract years beginning on or after January 1, 2009, in
the event this contract is not renewed, the final rate reconciliation
will be performed. The carrier must promptly pay any amount owed to
OPM. Any amount recoverable by the carrier is limited to the amount in
the contingency reserve for the terminating plan as of December 31 of
the terminating year.
(7) Carriers may provide additional guaranteed discounts to the
FEHBP that are not given to SSSGs. Any such guaranteed discounts must
be clearly identified as guaranteed discounts. After the beginning of
the contract year for which the rates are set, these guaranteed FEHBP
discounts may not be adjusted.
(8) Carriers may not impose surcharges (loadings not defined based
on an established rating method) on the FEHBP subscription rates or use
surcharges in the rate reconciliation process irrespective of whether
surcharges are applied to the SSSGs.
[FR Doc. E8-20269 Filed 8-29-08; 8:45 am]
BILLING CODE 6325-39-P