[Code of Federal Regulations]
[Title 48, Volume 6]
[Revised as of October 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 48CFR1602.170-15]

[Page 120-121]
 
            TITLE 48--FEDERAL ACQUISITION REGULATIONS SYSTEM
 
  CHAPTER 16--OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH 
                     BENEFITS ACQUISITION REGULATION
 
PART 1602_DEFINITIONS OF WORDS AND TERMS--Table of Contents
 
                Subpart 1602.1_Definitions of FEHBP Terms
 
Sec. 1602.170-15  Large Provider Agreement.

    (a) Large Provider Agreement means an agreement between--
    (1) An FEHB carrier, at least 25 percent of which total contracts 
are FEHB enrollee contracts, and
    (2) A vendor of services or supplies such as mail order pharmacy 
services, pharmacy benefit management services, mental health and/or 
substance abuse management services, preferred provider organization 
services, utilization review services, and/or large case or disease 
management services. This representative list includes organizations 
that own or contract with direct providers of healthcare or supplies, or 
organizations that process claims or manage patient care. A hospital is 
not

[[Page 121]]

considered to be a vendor for purposes of this chapter.
    (i) Where the total costs charged to the FEHB carrier for a contract 
term for FEHB members, including benefits and services, are reasonably 
expected to exceed 5 percent of the carrier's total FEHB benefits costs, 
or
    (ii) Where the total administrative costs charged to the FEHB 
carrier for the contract term for FEHB members are reasonably expected 
to exceed 5 percent of the carrier's total FEHB administrative costs 
(applicable to agreements where the provider is not responsible for FEHB 
benefits costs).
    (3) As used in this section, the term ``carrier'' does not include 
local health plans that serve under an umbrella arrangement with an FEHB 
carrier.
    (b) The FEHB Program Annual Accounting Statement for the FEHB Plan 
for the prior contract year will be used to determine the 5 percent 
threshold under Large Provider Agreements.
    (c) Large Provider Agreements based on cost analysis are subject to 
the provisions of FAR 52.215-2, ``Audit and Records-Negotiation.''
    (d) Large Provider Agreements based on price analysis are subject to 
the provisions of 48 CFR 1646.301 and 1652.246-70.

[70 FR 31379, June 1, 2005]