[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: 48CFR1604.7201]

[Page 123]
 
            TITLE 48--FEDERAL ACQUISITION REGULATIONS SYSTEM
 
  CHAPTER 16--OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH 
                     BENEFITS ACQUISITION REGULATION
 
PART 1604_ADMINISTRATIVE MATTERS--Table of Contents
 
                Subpart 1604.72_Large Provider Agreements
 
Sec. 1604.7201  FEHB Program Large Provider Agreements.

    Source: 70 FR 31379, June 1, 2005, unless otherwise noted.

    Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.


    The following provisions apply to all experience-rated carriers 
participating in the FEHB Program:
    (a) Notification and information requirements. (1) All experience-
rated carriers must provide notice to the contracting officer of their 
intent to enter into or to make a significant modification to a Large 
Provider Agreement. Significant modification means a 20% increase or 
more in the amount of the Large Provider Agreement:
    (i) Not less than 60 days before entering into any Large Provider 
Agreement; and
    (ii) Not less than 60 days before exercising renewals or other 
options, or making a significant modification.
    (2) The carrier's notification to the contracting officer must be in 
writing and must, at a minimum:
    (i) Describe the supplies and/or services the proposed provider 
agreement will require;
    (ii) Identify the proposed basis for reimbursement;
    (iii) Identify the proposed provider agreement, explain why the 
carrier selected the proposed provider, and, where applicable, what 
contracting method it used, including the kind of competition obtained;
    (iv) Describe the methodology the carrier used to compute the 
provider's profit; and, (v) Describe the provider risk provisions.
    (3) The contracting officer may request from the carrier any 
additional information on a proposed provider agreement and its terms 
and conditions prior to a Large Provider award and during the 
performance of the agreement.
    (4) Within 30 days of receiving the carrier's notification, the 
contracting officer will either give the carrier written comments or 
written notice that there will be no comments. If the contracting 
officer comments, the carrier must respond in writing within 10 calendar 
days and explain how it intends to address any concerns.
    (5) When computing the carrier's annual service charge, the 
contracting officer will consider how well the carrier complies with the 
provisions of this section, including the advance notification 
requirements, as an aspect of the carrier's performance factor.
    (6) The contracting officer's review of any Large Provider 
agreement, option, renewal, or modification will not constitute a 
determination of the acceptability of terms or conditions of any 
provider agreement or the allowability of any costs under the carrier's 
contract, nor will it relieve the carrier of any responsibility for 
performing the contract.
    (b) Records and inspection. The carrier must insert in all Large 
Provider Agreements the requirement that the provider will retain and 
make available to the Government all records relating to the agreement 
as follows:
    (1) Records that support the annual statement of operations--Retain 
for 6 years after the agreement term ends.
    (2) Enrollee records, if applicable--Retain for 6 years after the 
agreement term ends.
    (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.