97-23883. Federal Employees Health Benefits Program Acquisition Regulation; Truth in Negotiations Act and Related Changes  

  • [Federal Register Volume 62, Number 175 (Wednesday, September 10, 1997)]
    [Rules and Regulations]
    [Pages 47569-47583]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 97-23883]
    
    
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    OFFICE OF PERSONNEL MANAGEMENT
    
    48 CFR Parts 1602, 1603, 1604, 1615, 1616, 1629, 1631, 1643, 1644, 
    1645, 1649, 1652, and 1653
    
    RIN 3206-AH45
    
    
    Federal Employees Health Benefits Program Acquisition Regulation; 
    Truth in Negotiations Act and Related Changes
    
    AGENCY: Office of Personnel Management.
    
    ACTION: Final rulemaking.
    
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    SUMMARY: The Office of Personnel Management (OPM) is issuing a final 
    regulation amending the Federal Employees Health Benefits Acquisition 
    Regulation (FEHBAR) to implement those portions of the Federal 
    Acquisition Streamlining Act of 1994 (FASA) that impact on the FEHB 
    Program.
    
    EFFECTIVE DATE: October 10, 1997.
    
    FOR FURTHER INFORMATION CONTACT: Mary Ann Mercer, (202) 606-0004.
    
    SUPPLEMENTARY INFORMATION: On June 24, 1996, OPM issued a proposed 
    regulation in the Federal Register [61 FR 32401] to inform Federal 
    Employees Health Benefits (FEHB) Program carriers, Federal agencies, 
    and the public how it intends to implement those portions of the 
    Federal Acquisition Streamlining Act of 1994 (FASA), Public Law 103-
    355, effective October 13, 1994, affecting the FEHB Program. The 
    changes proposed also reflect how OPM intends to implement sections 
    4201 through 4204 of the Federal Acquisition Reform Act of 1996 (FARA), 
    Public Law 104-106, enacted on February 10, 1996.
        OPM received comments from one private citizen and five 
    organizations: Two FEHBP carriers, a trade association representing 
    health maintenance organizations (HMOs), preferred provider 
    organizations (PPOs), and other network plans, an association that 
    represents FEHB Program fee-for-service carriers, and a contract law 
    group. We appreciate the observations and suggestions offered and have 
    taken them into consideration in these regulations.
        The majority of the comments were favorable toward OPM's efforts to
    
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    implement the provisions of the Truth in Negotiations Act (TINA) as 
    amended by FASA to the extent that the regulation brings the FEHBAR 
    into conformance with the Federal Acquisition Regulation (FAR). 
    Nevertheless, there were a number of concerns regarding provisions on 
    the submission of cost or pricing data, as well as those concerning 
    Similarly Sized Subscriber Groups (SSSGs). These, as well as other 
    comments, are addressed as follows.
    
    Effective Date of the Regulation
    
        One of the comments concerned a perceived inconsistency in the 
    proposed effective date and the application of the regulation with 
    regard to SSSGs. The regulation will be applicable to the rate 
    instructions issued for the 1998 FEHB contract year. In the opinion of 
    the commenter, however, it appeared that OPM had already implemented 
    many of the changes administratively through the rate instructions for 
    the 1997 contract year. We would like to clarify any misconception that 
    OPM issues policy material in the FEHBP rate instructions. The rate 
    instructions contain guidance, clarifying information and examples that 
    elaborate on and describe how the policy in existing regulations is to 
    be implemented. The regulations introduce no changes in OPM's policy 
    with respect to SSSGs. The treatment of multi-year contracts and the 
    requirement that groups with point of service (POS) plans and separate 
    lines of business be included for consideration as SSSGs have been the 
    long standing practice under the SSSG concept.
    
    Intent of FASA/TINA
    
        Two commenters believe OPM has overlooked the intent of FASA to 
    minimize burdensome requirements, such as the requirement to submit 
    cost or pricing data, placed on Federal contractors. OPM understands 
    the commenters' concerns; however, we believe they overlook the fact 
    that Congress continues to recognize the need for cost or pricing data 
    where necessary to determine reasonableness of a price. Accordingly, 
    when the Government purchases a product or service that is not a 
    commercial item offered to the Government without modification and in 
    the same form in which it is sold in the commercial marketplace, it is 
    appropriate under the FAR and TINA to require cost or pricing data to 
    establish price reasonableness. As we stated in the preamble to the 
    proposed rule, with the complexities of the FEHB Program carriers' 
    rating systems, it is inaccurate to say that OPM is buying a commercial 
    off-the-shelf item or that the product that OPM purchases is purchased 
    at a market or catalog price. Thus, the FEHB Program community rated 
    contracts are neither contracts for commercial items, nor are they 
    catalog or market price contracts as those terms are intended by FASA, 
    FARA, and the FAR.
        One commenter noted that the purchase of insurance and HMO services 
    is typically governed by State insurance regulators and that OPM, in 
    obtaining cost or pricing data, is not only acting as a purchasing 
    agent, but is also performing a regulatory function akin to that of a 
    State insurance regulator. The commenter believes that the application 
    of the principles embodied in the proposed regulation to the FEHB 
    Program contracts is the minimum that OPM should require of contractors 
    given the substantial responsibilities placed upon OPM to obtain the 
    best possible terms, conditions, price and value for the Government and 
    enrollees in the FEHB Program.
    
    Cost or Pricing Data
    
        Prior to the enactment of Public Law 100-517, the Health 
    Maintenance Organization Amendments of 1988, community rated contracts 
    resembled market price contracts. Consequently, for lack of a more 
    precise fit with any other contract type, OPM identified the community 
    rated contracts as market price contracts when it initially published 
    regulations to implement the Act. These regulations were effective 
    January 1, 1990, before OPM had been able to assess the impact of the 
    1988 amendments.
        Historically, a community rate was more analogous to a market price 
    and services under FEHB Program contracts were more commonly thought of 
    as commercial items, because the community rate was often a single rate 
    that an HMO charged all of its groups. This is no longer true today. 
    The 1988 HMO amendments introduced a new level of complexity into the 
    community rating process. The 1988 HMO amendments authorized community 
    rated plans to use a new rating method called Adjusted Community Rating 
    (ACR). In spite of its name, ACR is actually a form of experience 
    rating, that is, prospective experience rating.
        Determining the reasonableness of the rates under ACR requires cost 
    or pricing data. Moreover, cost or pricing data is fundamental to the 
    development of the FEHB Program premiums. OPM has a responsibility 
    under the FEHB law to ensure that the FEHB Program premiums 
    ``reasonably and equitably reflect the cost of benefits provided'' [5 
    U.S.C. 8902(i)]. In carrying out this statutory mandate, OPM needs cost 
    or pricing data to achieve a fair and reasonable premium rate for 
    Federal enrollees. There are almost 400 plans in the Program, and the 
    premium is divided, with an average of 28% being paid by enrollees and 
    72% being paid from Government funds. Thus, both parties have a major 
    financial interest in the reasonableness of the rates.
        Furthermore, we would like to point out that the FEHB Program 
    premiums, once transmitted to OPM, are placed in a trust and are trust 
    fund monies which OPM has a statutory mandate to protect. OPM places 
    the premium monies collected in the U.S. Treasury for payment to the 
    FEHB Program carriers. The FEHB law authorizes the Secretary of the 
    Treasury to invest and reinvest the monies, as well as the interest 
    earned on their investments. Because of the nature of these monies, OPM 
    has a fiduciary responsibility to ensure a reasonable and equitable 
    rate for Federal enrollees as well as for the Government. One of the 
    ways OPM accomplishes this is to require the same discounts for the 
    FEHB Program that are enjoyed by the SSSGs; and analyzing cost or 
    pricing data is the only way OPM can achieve accountability. The 
    practice of requesting the data is widely accepted in the insurance 
    industry and, although we have requested this data for over 20 years, 
    no FEHB Program carrier has advised us that it was burdensome.
        By these regulations, we are implementing FASA, FARA, and the FAR 
    in the manner which best enables us to comply with the responsibility 
    that the FEHB law places on OPM. One has only to trace the FEHBAR 
    amendments over the years to understand that OPM has been trying, to 
    the maximum extent it could, to reconcile the Congressional intent 
    behind the HMO amendments with the FEHB law. OPM has attempted to fit 
    FEHB Program contracts into existing contract types under the FAR, 
    which lists contract types that were never entirely appropriate to our 
    situation. Accordingly, because of the unique nature of the FEHB 
    Program contracts, we are categorizing them as negotiated benefits 
    contracts to reflect more accurately their actual nature.
        One commenter suggested that OPM require pricing data only, and 
    that cost analysis is not an aspect of establishing the price of health 
    benefits coverage with large group purchasers. We disagree. Cost data, 
    the most fundamental of which is claims data, prescription drug, 
    hospital, and office visit benefits utilization data, and trend
    
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    data, are essential in evaluating the rate under ACR (experience 
    rating). The same commenter believes that, traditionally, when OPM has 
    asked for cost information it has generally been to examine the 
    derivation of the price for a specific benefit or loading. Prior to the 
    1988 HMO amendments, this was true. To a certain extent, OPM's rate 
    review was fairly straightforward before the 1988 HMO amendments 
    authorized alternative methods of community rating. Before 1981, 
    community rating was relatively simple, in that a group's rates were 
    normally based on the same underlying capitation rate (i.e., per member 
    per month rate). But, even under this early version of community 
    rating, a group's rates could not properly be thought of as a market 
    price. This is because, from the enactment of the HMO Act of 1973 
    onward, the community rating theory has always allowed for various 
    demographic adjustments that caused each group's rates to be uniquely 
    related to the characteristics of the group.
        In 1981, when the HMO Act of 1973 was amended to allow Federally 
    qualified plans to use Community Rating by Class (CRC), the situation 
    became much more complex. Under CRC, the plan could adjust the 
    community rates by a CRC factor which was derived by partitioning the 
    group into classes and applying so-called utilization factors, which 
    predicted differences in the use of HMO services by individuals or 
    families in each class.
        But, in 1988, the 1988 HMO amendments radically altered the nature 
    of community rating by allowing Federally qualified plans to use 
    Adjusted Community Rating (ACR). In retrospect, we have come to realize 
    that no rate based on ACR can possibly be construed to be a market 
    price. After the legislation was enacted and OPM's 1990 regulations 
    were published, OPM began to experience difficulties in verifying the 
    carriers' community rate. We continue to ask for cost and pricing data 
    for computing the rates under Traditional Community Rating (TCR) and 
    CRC. And, for ACR, we ask for all of the data developed for both the 
    FEHB Program and the SSSGs, which includes cost data.
        Contrary to the commenter's beliefs, these carriers using ACR do 
    not derive their rates from a single rate. Rather, these carriers base 
    their rate directly on the past experience of the Federal group. In no 
    sense can such a rate be considered a market price. The Act stated 
    that, under ACR, the rate for a particular group could be based on the 
    organization's revenue requirements for providing service to the group. 
    This means that ACR is a form of experience rating and, as such, 
    requires cost data. Thirty-five percent of the FEHB plans use ACR to 
    rate the Federal group, and the number of these plans is increasing 
    each year. Approximately thirty percent of the plans currently in the 
    FEHB Program use CRC to rate the Federal group.
        Two commenters were concerned that proposed FEHBAR 1602.170-5 does 
    not define cost or pricing data, but simply refers to the rate 
    instruction package. One of these commenters believes that the list of 
    cost or pricing data should be identified in regulation because the FAR 
    does not give agencies authority to set price guidelines outside the 
    scope of the regulation.
        In placing clarifying details in the rate instructions, OPM was 
    simply conforming to the principles of the Administration's National 
    Performance Review (NPR). A key element of the NPR is the replacing of 
    agency rules with policy directives and instructions, where 
    appropriate. Nevertheless, to assist the carriers in understanding what 
    OPM considers cost or pricing data, we have decided to cite in the 
    regulation some examples of the types of data that OPM considers to be 
    cost or pricing data. Like the examples listed in the FAR, the list is 
    illustrative and is not exhaustive. Additional data may be requested in 
    the rate instructions as deemed necessary by OPM for a particular 
    contract year. Again, this type of detail is merely clarifying 
    information and does not represent policy change. It conforms to the 
    definition of cost or pricing data in TINA and is information that OPM 
    has frequently requested in the past.
        One commenter noted that in the Supplementary Information to the 
    proposed rule OPM included actuarial estimates in its description of 
    cost or pricing data. The commenter stated that actuarial estimates are 
    judgmental and not factual and suggested that OPM remove these from 
    consideration as cost or pricing data. We are aware that FAR 15.801 
    defines ``cost or pricing data'' as factual and not judgmental, and we 
    believe that we are in compliance with the definition. OPM uses 
    actuarial estimates not to question what judgment the carrier used in 
    its actuarial estimates, but to verify, for example, that if an 
    actuarial estimate of 10% increase in claims was used for the FEHBP 
    group, the methodology used to establish that estimate was also used in 
    setting the SSSGs rates. In other words, OPM is not questioning what 
    judgment the carrier has applied in its projections, but the facts upon 
    which its projections are based.
        One commenter is concerned that the regulation will authorize OPM 
    to collect data that are difficult to collect and submit and that are 
    not directly related to OPM's responsibility to evaluate the 
    reasonableness of the prices given to the SSSGs. The respondent noted 
    that the FAR authorizes agencies to obtain ``other than cost or pricing 
    data,'' which the commenter believes is sufficient to verify prices. We 
    would like to reiterate that OPM will not ask for different data than 
    it currently requests in the rate setting process. However, the kind of 
    data that we ask for will be determined by the plan with regard to how 
    it chooses to rate its SSSGs. We look only at data directly related to 
    our responsibility under the FEHB law to evaluate a proposed rate in 
    order to ensure that the FEHBP rates accurately reflect the cost of 
    benefits provided. OPM neither requests nor desires information that is 
    irrelevant to this objective. Further, OPM disagrees with the commenter 
    that data other than cost or pricing data are sufficient to verify 
    prices.
    
    SSSGs
    
        One commenter is concerned that the legitimacy of a loading can be 
    based on non-SSSG rating practices. The commenter believes that this is 
    inconsistent with the SSSG concept. As stated in the OPM Reconciliation 
    Guidelines, the OPM audit staff may examine the rates and benefit 
    loadings of non-SSSG groups. The purpose of such analysis is to make 
    certain that the Federal group rates are fair in relation to the SSSG 
    rates. As one example (given in the guidelines), if an SSSG had a 
    special benefit not included in the Federal group benefit package, OPM 
    would compare what the plan charged the SSSG with what it charged non-
    SSSG groups for the benefit. Only by examining the non-SSSG groups 
    would we be able to determine if the SSSG had been given a discount to 
    its overall rates via a discount to the special loading. We do, 
    however, agree with the commenter that another example given in the 
    guidelines pertaining to late payment loadings is not a good example to 
    justify the principle of examining non-SSSG groups. We will remove this 
    example from future guideline documents.
        Another commenter believes that OPM fails to consider the contract 
    requirement that the FEHB rate be reconciled to the SSSG rates after 
    the contract period has begun. As part of the reconciliation process, 
    the contractor must provide information related to the rates offered to 
    the five groups closest in size to the Federal group. The commenter 
    believes that requiring cost
    
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    or pricing data for these contracts is entirely inconsistent with the 
    purpose of the reconciliation process.
        For non-SSSGs, OPM simply asks the carriers to list the plans they 
    did not select as SSSGs. However, OPM may ask the carrier to explain 
    why it did not select one or more as an SSSG. OPM has stated over the 
    years that it reserves the right to examine the rate development of 
    non-SSSG groups. OPM looks at a carrier's other groups only if all the 
    necessary information is not in the SSSG. For example, verifying that 
    there is no group closer in size to the Federal group than the plan's 
    chosen SSSGs could require analysis of non-SSSG groups. OPM will verify 
    such things as differences in loading and whether the carrier has 
    hidden a discount in a loading. We want to emphasize that the sole 
    purpose of such analysis is to make certain that the Federal group's 
    rates are equivalent to the SSSGs' rates. However, if we find that the 
    SSSG is not closest in size or if an SSSG had a special benefit (e.g., 
    dental benefit) not included in the Federal group benefit package, we 
    would compare what the carrier charged the SSSG with what it charged 
    other groups for this benefit. The purpose would be to verify that the 
    SSSG received no discount. Carriers need not be concerned that an OPM 
    review of a non-SSSG commercial group makes it a potential SSSG. We 
    would like to point out, though, that such comparisons with non-SSSGs 
    could work to the carrier's advantage as well as to its disadvantage if 
    a non-SSSG was not given a discount.
    
    SSSGs/Regional Rating Areas
    
        One of the commenters noted that a carrier may have to select an 
    SSSG from an entirely different area within a State even if that group 
    has no Federal employees in the rating area. This concerned the 
    commenter since the group rates in one regional rating area may be 
    significantly different than the rates in another area. The commenter 
    stated that it is unclear how OPM would adjust the rates of an SSSG in 
    one area to measure the Federal group in another area and suggests that 
    OPM limit its SSSG analysis to groups within a single FEHBP rating 
    area. This type of situation is not new to us. In such cases, we focus 
    on whether the carrier gave the groups a discount and whether it is 
    applying the rating method consistently. The rating method or benefit 
    structure may be entirely different and is, in fact, irrelevant.
    
    SSSGs/Purchasing Alliances
    
        One commenter suggested that OPM either remove the limitation on 
    the maximum number of employees allowable in a purchasing alliance, or 
    increase the number to 200, because some States offer voluntary 
    alliances in which the State may also dictate the rates. In addition, 
    two commenters believe that no State mandated purchasing alliance 
    should be treated as an SSSG because the alliances are not voluntary 
    and are usually a condition of doing business in the State, which 
    distinguishes them from the carriers' normal lines of business. After 
    considering the comments, we have adopted the suggestion that all 
    alliances be excluded from consideration as SSSGs where the State 
    mandates how the rate is set.
        We are also confirming that POS plans whose rate-setting is 
    mandated by the State may be excluded from consideration as SSSGs. 
    However, a POS plan whose rate-setting is not State-mandated must be 
    considered as an SSSG, even though it is primarily experience rated. 
    Usually the plan uses ACR and should not be excluded, regardless of the 
    portion of its services provided out of plan. We have had comparable 
    experience with ACR plans since 1988, and the rate setting for POS 
    plans with a large percentage of out-of-plan services is no more 
    difficult to accomplish than ACR. As we have said before, experience 
    shows that we have to be inclusive in considering plans as SSSGs. OPM 
    has always recognized that the rating method for the Federal group is 
    not necessarily the same as its SSSGs.
        OPM received a few plan-specific questions about SSSGs, which we 
    are reluctant to answer without more information. We will answer these 
    types of questions on an individual basis at the time of the rate 
    reconciliation.
        One commenter believes that the regulations should establish audit 
    standards that restrict OPM's Inspector General (IG) auditors to 
    comparing the prices charged to the SSSGs and to reviewing the 
    information necessary to verify that the SSSGs are appropriate. By 
    statute, OPM's Inspector General operates independently of OPM, and OPM 
    is not authorized to regulate to restrict its authority. We would like 
    to point out, however, that the IG looks only at data directly related 
    to OPM's responsibility under the FEHB law to evaluate a proposed rate 
    in order to ensure that the rates accurately reflect the cost of 
    benefits provided. The kind of data that the auditors would look at 
    will be determined by the plan with respect to how it chooses to rate 
    its SSSGs.
    
    SSSGs/Multi-year contracts
    
        One commenter believes OPM should not be allowed to isolate a 
    specific year in a multi-year contract to determine that a discount 
    occurred. Our intent is that if a plan's rates are affected by the 
    length of time the group signs up with the plan, then we simply want to 
    be able to capture that data. If the rates are affected, then we have 
    to make our analysis based on all the years that affect the rate.
        A commenter asked that OPM confirm its understanding that if the 
    aggregate revenues on a per member per month (PMPM) basis for the 
    Federal group are equivalent to or less than the corresponding 
    aggregate revenues for the SSSG, the carrier will be in compliance with 
    its community rating requirements with respect to that SSSG. OPM 
    confirms that under this scenario the carrier would be in compliance 
    with its community rating requirements.
        The same commenter would also like clarification of OPM's policy 
    with regard to multi-year contracts in which the group has the option 
    of renewing the agreement in any given year and does not renew. OPM 
    considers the contracts to be single-year agreements if the group 
    terminates the contract.
    
    Miscellaneous
    
        We converted FAR clauses 52.229-6, Taxes--Foreign Fixed-Price 
    Contracts, 52.243-1, Changes--Fixed Price, 52.245-2, Government 
    Property (Fixed-Price Contracts), 52.249-2, Termination for Convenience 
    of the Government (Fixed-Price), and 52.249-8, Default (Fixed-Price 
    Supply and Service) to FEHBAR clauses and have deleted language that 
    does not apply to negotiated benefits contracts.
        We have clarified the cost principle at 1631.205-75(b) pertaining 
    to selling costs to provide that personnel and related travel costs are 
    allowable for attendance at Open Season Health Fairs and other similar 
    activities where carriers give enrollees information about their 
    choices among health plans. Such events are not limited to those 
    sponsored by Government agencies, but may be sponsored by other groups 
    as well.
        One comment concerned 1652.215-70(b)(1)(iii), which states that if 
    the contracting officer determines that a price or cost reduction 
    should be made, the carrier may not raise as a defense the argument 
    that the contract was based on an agreement about the total cost of the 
    contract and there was no agreement about the cost of each item 
    procured under the contract. The commenter states that community rated 
    contracts
    
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    are based on price, not cost, analysis and cites FAR 15.803(c), which 
    provides that price negotiation does not require that agreement be 
    reached on every element of cost. The commenter believes, therefore, 
    that individual components of cost should not be subject to revision on 
    audit. OPM classified its review as price analysis pursuant to the HMO 
    amendments because it had been working with a simplified form of price 
    analysis up to that point, although technically even these community 
    rated contracts included an element of cost. But, after we gained some 
    experience with ACR (experience rating), we began to look not only at 
    special benefits loadings, but also at elements of the basic community 
    rate, such as demographic factors. Our approach has been consistent 
    with the FAR definition of ``price,'' which states that price is cost 
    plus any fee or profit applicable to the contract type. For the reasons 
    stated earlier, OPM is no longer classifying FEHB contracts as market 
    price, and OPM will collect both cost and pricing data. The new 
    regulations reflect this fact by clarifying that community rated 
    contracts are based on a combination of cost and price analysis. FEHBAR 
    1652.216-70(b)(1)(iii) is taken verbatim from FAR 52.215-22(c)(1)(iii) 
    and is appropriate when both cost and pricing data are required.
        The same commenter took exception to the requirement in 1652.215-
    70(b)(2)(ii)(A), which restricts a carrier's right to claim an offset 
    to an audit finding when the understated data was known by the carrier 
    to be understated at the time the certificate of current cost or 
    pricing data was signed. The commenter believes this provision is 
    inconsistent with FEHBAR 1652.215-70(b)(2)(i)(B) which allows a carrier 
    to revise a price following an audit finding if it proves that the cost 
    or pricing data were available before the date of agreement on the 
    price of the contract and that the data were not submitted before such 
    date. We would like to point out that these provisions are not 
    inconsistent with the FAR. In fact, they are repeated verbatim from the 
    FAR. Section 1652.215-70(b)(2)(ii)(A) prohibits an offset if the 
    carrier deliberately understated the data at the time the certificate 
    of current cost or pricing data was signed. OPM would not allow an 
    offset under these circumstances. In FEHBAR 1652.215-70(b)(2)(i)(B), 
    however, the carrier is allowed to prove that the data were not 
    submitted before the date of agreement on the price because of a 
    mistake on its part. OPM would allow the offset if the proof offered by 
    the carrier was clear and convincing.
        One commenter suggested that OPM increase the threshold for 
    preapproval of subcontracts to $200,000 to account for inflation since 
    the FEHBAR was first published in 1987. OPM has decided not to increase 
    the threshold at this time, but will consider doing so in a future 
    amendment to the FEHBAR.
        We are withdrawing our proposal to insert FAR 52.222-25, 
    Affirmative Action Compliance, in the Matrix because the clause is a 
    preaward clause that is intended to be inserted in solicitations. FEHB 
    Program contracts, by law, are exempted from competitive bidding 
    requirements, and OPM uses alternative methods of inviting health 
    benefits carriers to apply for participation in the FEHB Program.
        We are withdrawing our proposal to add a requirement in 1652.222-
    70, Notice of Significant Events, that carriers should inform OPM at 
    the time of a novation or change of name, rather than after the 
    novation or change of name occurs. OPM has determined that FEHBAR 
    1642.1204 and 1642.1205 sufficiently address OPM's concerns that 
    carriers are required to notify OPM of a novation and/or a change of 
    name in a timely manner.
        We have made a technical correction to 1652.232-71(c) that was 
    inadvertently omitted from OPM's interim regulation of April 20, 1992, 
    and published as a final rule on November 16, 1992 [57 FR 53981]. That 
    is, we have removed from the regulation the reference to the ability of 
    underwriters to make drawdowns from carriers' letter of credit (LOC) 
    accounts. OPM guidelines allow a carrier to delegate its authority to 
    make drawdowns from its LOC account to the underwriter of its plan.
        We have also included in the final regulations minor technical and 
    editorial changes and minor changes to the definitions of ``Carrier'' 
    and ``Health benefits plan'' to more closely align them with the 
    definitions contained in the National Association of Insurance 
    Commissioners (NAIC) guidelines.
    
    Regulatory Flexibility Act
    
        I certify that this regulation will not have a significant economic 
    impact on a substantial number of small entities because all of the 
    small plan FEHB Program contracts fall below the threshold for 
    submitting cost or pricing data.
    
    List of Subjects in 48 CFR Parts 1602, 1603, 1604, 1615, 1616, 
    1629, 1631, 1643, 1644, 1645, 1649, 1652, and 1653
    
        Administrative practice and procedure, Government employees, Health 
    facilities, Health insurance, Health professions, Hostages, Iraq, 
    Kuwait, Lebanon, Reporting and recordkeeping requirements, Retirement.
    
        Office of Personnel Management.
    James B. King,
    Director.
        Accordingly, OPM is amending Chapter 16 of Title 48, Code of 
    Federal Regulations, as follows:
    
    CHAPTER 16--OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH 
    BENEFITS ACQUISITION REGULATION
    
        1. The authority citation for 48 CFR Parts 1602, 1603, 1604, 1615, 
    1616, 1631, 1644, 1649, 1652, and 1653 continues to read as follows:
    
        Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.
    
    PART 1602--DEFINITIONS OF WORDS AND TERMS
    
        2. Section 1602.170-1 is revised to read as follows:
    
    
    1602.170-1  Carrier.
    
        Carrier means a voluntary association, corporation, partnership, or 
    other nongovernmental organization which is lawfully engaged in 
    providing, delivering, paying for, or reimbursing the cost of health 
    care services under group insurance policies or contracts, medical or 
    hospital service agreements, membership or subscription contracts, 
    including a health maintenance organization, a nonprofit hospital and 
    health service corporation, or any other entity providing a plan of 
    health insurance, health benefits or health services, in consideration 
    of premiums or other periodic charges payable to the carrier.
        3. In Sec. 1602.170-2, paragraph (a) is revised to read as follows:
    
    
    1602.170-2  Community rate.
    
        (a) Community rate means a rate of payment based on a per member 
    per month capitation rate or its equivalent that applies to a 
    combination of the subscriber groups for a comprehensive medical plan 
    carrier. References in this subchapter to ``a combination of cost and 
    price analysis'' relating to the applicability of policy and contract 
    clauses refer to comprehensive medical plan carriers using community 
    rates.
    * * * * *
    
    [[Page 47574]]
    
        4. Sections 1602.170-10 through 1602.170-12 are redesignated as 
    Secs. 1602.170-12 through 1602.170-14 respectively, Secs. 1602.170-5 
    through 1602.170-9 are redesignated as Secs. 1602.170-6 through 
    1602.170-10, new Secs. 1602.170-5 and 1602.170-11 are added, and newly 
    redesignated Secs. 1602.170-9 and 1602.170-13 are revised to read as 
    follows:
    
    
    1602.170-5  Cost or pricing data.
    
        (a) Experience rated carriers. Cost or pricing data for experience 
    rated carriers includes information such as claims data; actual or 
    negotiated benefits payments made to providers of medical services for 
    the provision of health care such as capitation not adjusted for 
    specific groups, per diems, and Diagnostic Related Group (DRG) 
    payments; cost data; utilization data; and administrative expenses and 
    retentions.
        (b) Community rated carriers. Cost or pricing data for community 
    rated carriers is the specialized rating data used by carriers in 
    computing a rate that is appropriate for the Federal group and the 
    similarly sized subscriber groups (SSSGs). Such data include, but are 
    not limited to, capitation rates; prescription drug, hospital, and 
    office visit benefits utilization data; trend data; actuarial data; 
    rating methodologies for other groups; standardized presentation of the 
    carrier's rating method (age, sex, etc.) showing that the factor 
    predicts utilization; tiered rates information; ``step-up'' factors 
    information; demographics such as family size; special benefit loading 
    capitations; and adjustment factors for capitation.
    * * * * *
    
    
    1602.170-9  Health benefits plan.
    
        Health benefits plan means a group insurance policy, contract, 
    medical or hospital service agreement, membership or subscription 
    contract, or similar group arrangements provided by a carrier for the 
    purpose of providing, arranging for, delivering, paying for, or 
    reimbursing any of the costs of health care services.
    * * * * *
    
    
    1602.170-11  Negotiated benefits contracts.
    
        Negotiated benefits contracts are FEHBP contracts in which benefits 
    provided and subscription income are based on either community rating 
    or experience rating.
    * * * * *
    
    
    1602.170-13  Similarly sized subscriber groups.
    
        (a) Similarly sized subscriber groups (SSSGs) are a comprehensive 
    medical plan carrier's two employer groups that:
        (1) As of the date specified by OPM in the rate instructions, have 
    a subscriber enrollment closest to the FEHBP subscriber enrollment; 
    and,
        (2) Use any rating method other than retrospective experience 
    rating; and,
        (3) Meet the criteria specified in the rate instructions issued by 
    OPM.
        (b) Any group with which an FEHB carrier enters into an agreement 
    to provide health care services is a potential SSSG (including separate 
    lines of business, government entities, groups that have multi-year 
    contracts, and groups having point-of-service products).
        (c) Exceptions to the general rule stated in paragraph (b) of this 
    section are (and the following groups must be excluded from SSSG 
    consideration):
        (1) Groups the carrier rates by the method of retrospective 
    experience rating;
        (2) Groups consisting of the carrier's own employees;
        (3) Medicaid groups, Medicare groups, and groups that have only a 
    stand alone benefit (such as dental only);
        (4) A purchasing alliance whose rate-setting is mandated by the 
    State or local government.
        (d) OPM shall determine the FEHBP rate by selecting the lower of 
    the two rates derived by using rating methods consistent with those 
    used to derive the SSSG rates.
    
    PART 1603--IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF 
    INTEREST
    
    Subpart 1603.70 [Amended]
    
        5. In subpart 1603.70, sections 1603.701, 1603.702, and 1603.703 
    are redesignated as sections 1603.7001, 1603.7002, and 1603.7003 
    respectively.
    
    PART 1604--ADMINISTRATIVE MATTERS
    
    
    1604.705  [Amended]
    
        6. In subpart 1604.7, section 1604.705 is amended by removing the 
    words ``Audit--Negotiation,'' and adding in its place ``Audit & 
    Records--Negotiation.''
    
    PART 1615--CONTRACTING BY NEGOTIATION
    
        7. Section 1615.802 is revised to read as follows:
    
    
    1615.802  Policy.
    
        Pricing of FEHB contracts is governed by 5 U.S.C. 8902(i), 5 U.S.C. 
    8906, and other applicable law. FAR subpart 15.8 shall be implemented 
    by applying the policies and procedures--to the extent practicable--as 
    follows:
        (a) For both experience rated and community rated contracts for 
    which the FEHBP premiums for the contract term will be less than 
    $500,000, OPM shall not require the carrier to provide cost or pricing 
    data in the rate proposal for the following contract term.
        (b) Cost analysis shall be used for contracts where premiums and 
    subscription income are determined on the basis of experience rating.
        (c)(1) A combination of cost and price analysis shall be used for 
    contracts where premiums and subscription income are based on community 
    rates. For contracts for which the FEHBP premiums for the contract term 
    will be less than $500,000, OPM shall not require the carrier to 
    provide cost or pricing data. The carrier must submit only a rate 
    proposal and abbreviated utilization data for the applicable contract 
    year. OPM will evaluate the proposed rates by performing a basic 
    reasonableness test on the information submitted. Rates failing this 
    test will be subject to further review.
        (2) For contracts with fewer than 1,500 enrollee contracts for 
    which the FEHBP premiums for the contract term will be $500,000 or 
    more, OPM shall require the carrier to submit its rate proposal, 
    utilization data, and the certificate of accurate cost or pricing data 
    required in 1615.804-70. In addition, OPM shall require the carrier to 
    complete the proposed rates form containing cost and pricing data, and 
    the Community Rate Questionnaire, but shall not require the carrier to 
    send these documents to OPM. The carrier shall keep the documents on 
    file for periodic auditor and actuarial review in accordance with 
    1652.204-70. OPM shall perform a basic reasonableness test on the data 
    submitted. Rates that do not pass this test shall be subject to further 
    OPM review.
        (3) For contracts with 1,500 or more enrollee contracts for which 
    the FEHBP premiums for the contract term will be at least $500,000, OPM 
    shall require the carrier to provide the data and methodology used to 
    determine the FEHBP rates. OPM shall also require the data and 
    methodology used to determine the rates for the carrier's similarly 
    sized subscriber groups. The carrier shall provide cost or pricing data 
    required by OPM in its rate instructions for the applicable contract 
    period. OPM shall evaluate the data to ensure that the
    
    [[Page 47575]]
    
    rate is reasonable and consistent with the requirements in this 
    chapter. If necessary, OPM may require the carrier to provide 
    additional documentation.
        (4) Contracts shall be subject to a downward price adjustment if 
    OPM determines that the Federal group was charged more than it would 
    have been charged using a methodology consistent with that used for the 
    SSSGs. Such adjustments shall be based on the lower of the two rates 
    determined by using the methodology (including discounts) the Carrier 
    used for the two SSSGs.
        (5) FEHBP community rated carriers shall comply with SSSG criteria 
    provided by OPM in the rate instructions for the applicable contract 
    period.
        (d) The application of FAR 15.802(b)(2) should not be construed to 
    prohibit the consideration of preceding year surpluses or deficits in 
    carrier-held reserves in the rate adjustments for subsequent year 
    renewals of contracts based, in whole or in part, on cost analysis.
        8. Section 1615.804-70 is revised to read as follows:
    
    
    1615.804-70  Certificate of cost or pricing data for community rated 
    carriers.
    
        The contracting officer shall require a carrier with a contract 
    meeting the requirements in 1615.802(c)(2) or 1615.802(c)(3) to execute 
    the Certificate of Accurate Cost or Pricing Data contained in this 
    section. A carrier with a contract meeting the requirements in 
    1615.802(c)(2) shall complete the Certificate and keep it on file at 
    the carrier's place of business in accordance with 1652.204-70. A 
    carrier with a contract meeting the requirements in 1615.802(c)(3) 
    shall submit the Certificate to OPM along with its rate reconciliation, 
    which is submitted during the first quarter of the applicable contract 
    year.
    
    Certificate of Accurate Cost or Pricing Data for Community Rated 
    Carriers
    
        This is to certify that, to the best of my knowledge and belief: 
    (1) The cost or pricing data submitted (or, if not submitted, 
    maintained and identified by the carrier as supporting 
    documentation) to the Contracting Officer or the Contracting 
    Officer's representative or designee, in support of the __________* 
    FEHBP rates were developed in accordance with the requirements of 48 
    CFR Chapter 16 and the FEHBP contract and are accurate, complete, 
    and current as of the date this certificate is executed; and (2) the 
    methodology used to determine the FEHBP rates is consistent with the 
    methodology used to determine the rates for the carrier's Similarly 
    Sized Subscriber Groups.
    Firm:------------------------------------------------------------------
    Name:------------------------------------------------------------------
    Signature:-------------------------------------------------------------
    Date of Execution:-----------------------------------------------------
        *Insert the year for which the rates apply. Normally, this will 
    be the year for which the rates are being reconciled.
    
    (End of Certificate)
    
    
    1615.804-7  [Removed and reserved]
    
        9. Section 1615.804-71 is removed and reserved.
        10. Section 1615.804-72 is revised to read as follows:
    
    
    1615.804-72  Rate reduction for defective pricing or defective cost or 
    pricing data.
    
        The clause set forth in section 1652.215-70 shall be inserted in 
    FEHBP contracts for $500,000 or more that are based on a combination of 
    cost and price analysis (community rated).
        11. Paragraph (a) of section 1615.805-70 is revised to read as 
    follows:
    
    
    1615.805-70  Carrier investment of FEHB funds.
    
        (a) This paragraph does not apply to contracts based on a 
    combination of cost and price analysis (community rated).
    * * * * *
    
    PART 1616--TYPES OF CONTRACTS
    
        12. Section 1616.102, is revised to read as follows:
    
    
    1616.102  Policies.
    
        All FEHBP contracts shall be negotiated benefits contracts.
    
    Subpart 1616.2  [Removed]
    
        13. Subpart 1616.2 is removed and subpart 1616.70 is added to read 
    as follows:
    
    Subpart 1616.70--Negotiated Benefits Contracts
    
    
    1616.7001  Clause--contracts based on a combination of cost and price 
    analysis (community rated).
    
        The clause at section 1652.216-70 shall be inserted in all FEHBP 
    contracts based on a combination of cost and price analysis (community 
    rated).
    
    
    1616.7002  Clause--contracts based on cost analysis (experience rated).
    
        The clause at section 1652.216-71 shall be inserted in all FEHBP 
    contracts based on cost analysis (experience rated).
    
    SUBCHAPTER E--GENERAL CONTRACTING REQUIREMENTS
    
        14. In Subchapter E, part 1629 is added to read as follows:
    
    PART 1629--TAXES
    
    Subpart 1629.4--Contract Clauses
    
    Sec.
    1629.402  Foreign contracts.
    
        Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.
    
    Subpart 1629.4--Contract Clauses
    
    
    1629.402  Foreign contracts.
    
        The clause set forth in section 1652.229-70 shall be inserted in 
    all FEHBP contracts performed outside the United States, its 
    possessions, and Puerto Rico.
    
    PART 1631--CONTRACT COST PRINCIPLES AND PROCEDURES
    
        15. In subpart 1631.2, section 1631.205-75, paragraph (b), is 
    revised to read as follows:
    
    
    1631.205-75  Selling costs.
    
    * * * * *
        (b) Selling costs are allowable costs to FEHBP contracts to the 
    extent that they are necessary for conducting annual contract 
    negotiations with the Government and for liaison activities necessary 
    for ongoing contract administration. Personnel and related travel costs 
    are allowable for attendance at Open Season Health fairs and other 
    similar activities at which carriers give enrollees information about 
    their choices among health plans (but see FAR 31.205-1 ``Public 
    relations and advertising costs'', and The Federal Employees Health 
    Benefits Handbook for Personnel and Payroll Offices, Subchapter S2-3(f) 
    ``Controlling contacts between employees and carriers'').
    
    SUBCHAPTER G--CONTRACT MANAGEMENT
    
        16. In Subchapter G, part 1643 is added to read as follows:
    
    PART 1643--CONTRACT MODIFICATIONS
    
    Subpart 1643.2--Changes
    
    Sec.
    1643.205-70  Contract clause.
    
        Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.
    
    Subpart 1643.2--Changes
    
    
    1643.205-70  Contract clause.
    
        The clause set forth in section 1652.243-70 shall be inserted in 
    all FEHB Program contracts.
    
    PART 1644--SUBCONTRACTING POLICIES AND PROCEDURES
    
        17. In Subpart 1644.1, section 1644.170 is revised to read as 
    follows:
    
    
    1644.170  Policy for FEHBP subcontracting consent.
    
        For all experience rated FEHBP contracts, advance approval shall be
    
    [[Page 47576]]
    
    required on subcontracts or modifications to subcontracts when the 
    amount charged against the FEHBP contract exceeds $100,000 and is at 
    least 25 percent of the total cost of the subcontract.
        18. In Subpart 1644.2, section 1644.270 is revised to read as 
    follows:
    
    
    1644.270  FEHBP contract clause.
    
        The clause set forth at section 1652.244-70 shall be inserted in 
    all experience rated FEHBP contracts.
        19. Part 1645 is added to read as follows:
    
    PART 1645--GOVERNMENT PROPERTY
    
    Subpart 1645.3--Providing Equipment
    
    Sec.
    1645.303-70  Contract clause.
    
        Authority: 5 U.S.C. 8913; 40 U.S.C. 486(c); 48 CFR 1.301.
    
    Subpart 1645.3--Providing Equipment
    
    
    1645.303-70  Contract clause.
    
        The clause set forth in section 1652.245-70 shall be inserted in 
    all FEHB Program contracts.
    
    PART 1649--TERMINATION OF CONTRACTS
    
        20. In subpart 1649.1, sections 1649.101-71 and 1649.101-72 are 
    added to read as follows:
    
    
    1649.101-71  FEHBP termination for convenience clause.
    
        The clause set forth in 1652.249-71 shall be inserted in all FEHBP 
    contracts.
    
    
    1649.101-72  FEHBP termination for default clause.
    
        The clause set forth in 1652.249-72 shall be inserted in all FEHBP 
    contracts.
    
    SUBCHAPTER H--CLAUSES AND FORMS
    
    PART 1652--CONTRACT CLAUSES
    
        21. In part 1652, section 1652.000 is revised to read as follows:
    
    
    1652.000  Applicable clauses.
    
        The clauses of FAR subpart 52.2 shall be applicable to FEHBP 
    contracts as specified in the FEHBAR Clause Matrix in subpart 1652.3.
    
    Section and Clause Title
    
    52.202-1  Definitions.
    52.203-3  Gratuities.
    52.203-5  Covenant Against Contingent Fees.
    52.203-7  Anti-Kickback Procedures.
    52.203-12  Limitation on Payments to Influence Certain Federal 
    Transactions.
    52.209-6  Protecting the Government's Interest When Subcontracting 
    With Contractors Debarred, Suspended, or Proposed for Debarment.
    52.215-2  Audit and Records--Negotiation.
    52.215-22  Price Reduction for Defective Cost or Pricing Data.
    52.215-24  Subcontractor Cost or Pricing Data.
    52.215-27  Termination of Defined Benefit Pension Plans.
    52.215-30  Facilities Capital Cost of Money.
    52.215-31  Waiver of Facilities Capital Cost of Money.
    52.215-39  Reversion or Adjustment of Plans for Postretirement 
    Benefits Other Than Pensions (PRB).
    52.219-8  Utilization of Small, Small Disadvantaged and Women-Owned 
    Small Business Concerns.
    52.222-1  Notice to the Government of Labor Disputes.
    52.222-3  Convict Labor.
    52.222-4  Contract Work Hours and Safety Standards Act--Overtime 
    Compensation--General.
    52.222-21  Certification of Nonsegregated Facilities.
    52.222-26  Equal Opportunity.
    52.222-28  Equal Opportunity Preaward Clearance of Subcontracts.
    52.222-29  Notification of Visa Denial.
    52.222-35  Affirmative Action for Special Disabled and Vietnam Era 
    Veterans.
    52.222-36  Affirmative Action for Handicapped Workers.
    52.222-37  Employment Reports on Special Disabled Veterans and 
    Veterans of the Vietnam Era.
    52.223-2  Clean Air and Water.
    52.223-6  Drug-Free Workplace.
    52.227-1  Authorization and Consent.
    52.227-2  Notice and Assistance Regarding Patent and Copyright 
    Infringement.
    52.229-3  Federal, State,and Local Taxes.
    52.229-4  Federal, State, and Local Taxes (Noncompetitive Contract).
    52.229-5  Taxes--Contracts Performed in U.S. Possessions or Puerto 
    Rico.
    52.230-2  Cost Accounting Standards.
    52.230-3  Disclosure and Consistency of Cost Accounting Practices.
    52.230-5  Administration of Cost Accounting Standards.
    52.232-8  Discounts for Prompt Payment.
    52.232-17  Interest.
    52.232-23  Assignment of Claims.
    52.232-33  Mandatory Information For Electronic Funds Transfer 
    Payment.
    52.233-1  Disputes.
    52.242-1  Notice of Intent to Disallow Costs.
    52.242-3  Penalties for Unallowable Costs.
    52.242-13  Bankruptcy.
    52.244-5  Competition in Subcontracting.
    52.244-6  Subcontracts for Commercial Items and Commercial 
    Components.
    52.246-25  Limitation of Liability--Services.
    52.247-63  Preference for U.S.-Flag Air Carriers.
    52.251-1  Government Supply Sources.
    52.232-2  Clauses Incorporated by Reference.
    52.252-4  Alterations in Contract.
    52.252-6  Authorized Deviations in Clauses.
    
        22. In subpart 1652.2, section 1652.203-70 is amended by removing 
    the reference ``1603.703'' and adding in its place ``1603.7003,'' 
    sections 1652.204-70 and 1652.215-70 are revised, section 1652.204-72 
    is amended by adding a date in the clause title.
    
    
    1652.204-70  Contractor records retention.
    
        As prescribed in 1604.705, the following clause shall be inserted 
    in all FEHBP contracts.
    
    Contractor Records Retention (Jan 1998)
    
        Notwithstanding the provisions of section 5.7 (FAR 52.215-2(f)) 
    ``Audit and Records-Negotiation,'' the Carrier shall retain and make 
    available all records applicable to a contract term that support the 
    annual statement of operations and, for contracts that exceed the 
    threshold at FAR 15.804-2(a)(1), the rate submission for that 
    contract term for a period of 5 years after the end of the contract 
    term to which the records relate, except that enrollee and/or 
    patient claim records shall be maintained for 3 years after the end 
    of the contract term to which the claim records relate.
    (End of Clause)
    * * * * *
    
    
    Sec. 1652.204-72  Filing Health Benefit Claims/Court of Disputed Claims
    
    * * * * *
    
    Filing Health Benefit Claims/Court Review of Disputed Claims (Mar 1995)
    
    * * * * *
    
    
    1652.215-70  Rate Reduction for Defective Pricing or Defective Cost or 
    Pricing Data.
    
        As prescribed in 1615.804-72, the following clause shall be 
    inserted in FEHBP contracts exceeding the threshold at FAR 15.804-
    2(a)(1) that are based on a combination of cost and price analysis 
    (community rated):
    
    Rate Reduction for Defective Pricing or Defective Cost or Pricing Data 
    (Jan 1998)
    
        (a) If any rate established in connection with this contract was 
    increased because (1) the Carrier submitted, or kept in its files in 
    support of the FEHBP rate, cost or pricing data that were not 
    complete, accurate, or current as certified in the Certificate of 
    Accurate Cost or Pricing Data (FEHBAR 1615.804-70); (2) the Carrier 
    submitted, or kept in its files in support of the FEHBP rate, cost 
    or pricing data that were not accurate as represented in the rate 
    proposal documents; (3) the Carrier developed FEHBP rates with a 
    rating methodology and structure inconsistent with that used to 
    develop rates for similarly sized subscriber groups (see FEHBAR 
    1602.170-13) as certified in the Certificate of Accurate Cost or 
    Pricing Data for Community Rated Carriers; or (4) the Carrier 
    submitted or, or kept in its files in support of the FEHBP rate, 
    data or information of any description that were not complete, 
    accurate, and current--then, the rate shall be reduced in the amount 
    by which the price was increased because of the defective data or 
    information.
        (b)(1) If the Contracting Officer determines under paragraph (a) 
    of this clause that a price
    
    [[Page 47577]]
    
    or cost reduction should be made, the Carrier agrees not to raise 
    the following matters as a defense:
        (i) The Carrier was a sole source supplier or otherwise was in a 
    superior bargaining position and thus the price of the contract 
    would not have been modified even if accurate, complete, and current 
    cost or pricing data had been submitted or maintained and 
    identified.
        (ii) The Contracting Officer should have known that the cost or 
    pricing data in issue were defective even though the Carrier took no 
    affirmative action to bring the character of the data to the 
    attention of the Contracting Officer.
        (iii) The contract was based on an agreement about the total 
    cost of the contract and there was no agreement about the cost of 
    each item procured under the contract.
        (iv) The Carrier did not submit or keep in its files a 
    Certificate of Current Cost or Pricing Data.
        (2)(i) Except as prohibited by subdivision (b)(2)(ii) of this 
    clause, an offset in an amount determined appropriate by the 
    Contracting Officer based upon the facts shall be allowed against 
    the amount of a contract price reduction if--
        (A) The Carrier certifies to the Contracting Officer that, to 
    the best of the Carrier's knowledge and belief, the Carrier is 
    entitled to the offset in the amount requested; and
        (B) The Carrier proves that the cost or pricing data were 
    available before the date of agreement on the price of the contract 
    (or price of the modification) and that the data were not submitted 
    before such date.
        (ii) An offset shall not be allowed if--
        (A) The understated data was known by the Carrier to be 
    understated when the Certificate of Current Cost or Pricing Data was 
    signed; or
        (B) The Government proves that the facts demonstrate that the 
    contract price would not have increased in the amount to be offset 
    even if the available data had been submitted before the date of 
    agreement on price.
        (c) When the Contracting Officer determines that the rates shall 
    be reduced and the Government is thereby entitled to a refund, the 
    Carrier shall be liable to and shall pay the FEHB Fund at the time 
    the overpayment is repaid--
        (1) Simple interest on the amount of the overpayment from the 
    date the overpayment was paid from the FEHB Fund to the Carrier 
    until the date the overcharge is liquidated. In calculating the 
    amount of interest due, the quarterly rate determinations by the 
    Secretary of the Treasury under the authority of 26 U.S.C. 
    6621(a)(2) applicable to the periods the overcharge was retained by 
    the Carrier shall be used; and,
        (2) A penalty equal to the amount of overpayment, if the Carrier 
    knowingly submitted cost or pricing data which was incomplete, 
    inaccurate, or noncurrent.
    
    (End of Clause)
    
        23. Section 1652.215-71 is amended by removing ``(Jan 1991)'' from 
    the title Investment Income and adding in its place ``(Jan 1998)'' and 
    by revising paragraph (f) to read as follows:
    
    
    1652.215-71  Investment Income.
    
    * * * * *
        (f) The Carrier shall credit the Special Reserve for income due 
    in accordance with this clause. All lost investment income payable 
    shall bear simple interest at the quarterly rate determined by the 
    Secretary of the Treasury under the authority of 26 U.S.C. 
    6621(a)(2) applicable to the periods in which the amount becomes 
    due, as provided in paragraphs (d) and (e) of this clause.
    * * * * *
        24. Section 1652.216-70 is revised to read as follows:
    
    
    1652.216-70  Accounting and price adjustment.
    
        As prescribed in section 1616.7001, the following clause shall be 
    inserted in all FEHBP contracts based on a combination of cost and 
    price analysis (community rated).
    
    Accounting and Price Adjustment (JAN 1998)
    
        (a) Annual Accounting Statement. The Carrier, not later than 90 
    days after the end of each contract period, shall furnish to OPM for 
    that contract period an accounting of its operations under the 
    contract. The accounting shall be in the form prescribed by OPM.
        (b) Adjustment. (1) This contract is community rated as defined 
    in FEHBAR 1602.170-2.
        (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.
        (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.
        (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.
        (5) No upward adjustment in the rate established for this 
    contract will be allowed or considered by the Government or will be 
    made by the Carrier in this or in any other contract period on the 
    basis of actual costs incurred, actual benefits provided, or actual 
    size or composition of the FEHBP group during this contract period.
        (6) In the event this contract is not renewed, neither the 
    Government nor the Carrier shall be entitled to any adjustment or 
    claim for the difference between the subscription rates prior to 
    rate reconciliation and the actual subscription rates.
    
    (End of Clause)
    
        25. In section 1652.216-71, the introductory sentence is revised to 
    read as follows:
    
    
    1652.216-71  Accounting and Allowable Cost.
    
        As prescribed in section 1616.7002, the following clause shall be 
    inserted in all FEHBP contracts based on cost analysis (experience 
    rated).
    * * * * *
        26. Section 1652.229-70 is added to read as follows:
    
    
    1652.229-70  Taxes--Foreign Negotiated benefits contracts.
    
        As prescribed in section 1629.402, the following clause shall be 
    inserted in all FEHBP contracts performed outside the United States, 
    its possessions, and Puerto Rico:
    
    Taxes--Foreign Negotiated Benefits Contracts (Jan 1998)
    
        (a) To the extent that this contract provides for performing 
    services outside the United States, its possessions, and Puerto 
    Rico, this clause applies in lieu of any Federal, State, and local 
    taxes clause of the contract.
        (b) ``Contract date,'' as used in this clause, means the 
    effective date of this contract or modification.
        ``Country concerned,'' as used in this clause, means any 
    country, other than the United States, its possessions, and Puerto 
    Rico, in which expenditures under this contract are made.
        ``Tax'' and ``taxes,'' as used in this clause, include fees and 
    charges for doing business that are levied by the government of the 
    country concerned or by its political subdivisions.
        ``All applicable taxes and duties,'' as used in this clause, 
    means all taxes and duties, in effect on the contract date, that the 
    taxing authority is imposing and collecting on the transactions 
    covered by this contract, pursuant to written ruling or regulation 
    in effect on the contract date.
        ``After-imposed tax,'' as used in this clause, means any new or 
    increased tax or duty, or tax that was exempted or excluded on the 
    contract date but whose exemption was later revoked or reduced 
    during the contract period, other than excepted tax, on the 
    transactions covered by this contract that the Carrier is required 
    to pay or bear as the result of legislative, judicial, or 
    administrative action taking effect after the contract date.
        ``After-relieved tax,'' as used in this clause, means any amount 
    of tax or duty, other than an excepted tax, that would otherwise 
    have been payable on the transactions covered by this contract, but 
    which the Carrier is not required to pay or bear, or for which the 
    Carrier obtains a refund, as the result of legislative, judicial, or 
    administrative action taking effect after the contract date.
        ``Excepted tax,'' as used in this clause, means social security 
    or other employment taxes, net income and franchise taxes, excess 
    profits taxes, capital stock taxes, transportation taxes, 
    unemployment compensation taxes, and property taxes. ``Excepted 
    tax'' does not include gross income taxes levied on or measured by 
    sales or receipts from sales covered by this contract, or any tax 
    assessed on the Carrier's possession of, interest in, or use of 
    property, title to which is in the U.S. Government.
    
    [[Page 47578]]
    
        (c) Unless otherwise provided in this contract, the contract 
    price includes all applicable taxes and duties, except taxes and 
    duties that the Government of the United States and the government 
    of the country concerned have agreed shall not be applicable to 
    expenditures in such country by or on behalf of the United States.
        (d) The contract price shall be increased by the amount of any 
    after-imposed tax or of any tax or duty specifically excluded from 
    the contract price by a provision of this contract that the Carrier 
    is required to pay or bear, including any interest or penalty, if 
    the Carrier states in writing that the contract price does not 
    include any contingency for such tax and if liability for such tax, 
    interest, or penalty was not incurred through the Carrier's fault, 
    negligence, or failure to follow instructions of the Contracting 
    Officer or to comply with the provisions of paragraph (i) below.
        (e) The contract price shall be decreased by the amount of any 
    after-relieved tax, including any interest or penalty. The 
    Government of the United States shall be entitled to interest 
    received by the Carrier incident to a refund of taxes to the extent 
    that such interest was earned after the Carrier was paid by the 
    Government of the United States for such taxes. The Government of 
    the United States shall be entitled to repayment of any penalty 
    refunded to the Carrier to the extent that the penalty was paid by 
    the Government.
        (f) The contract price shall be decreased by the amount of any 
    tax or duty, other than an excepted tax, that was included in the 
    contract and that the Carrier is required to pay or bear, or does 
    not obtain a refund of, through the Carrier's fault, negligence, or 
    failure to follow instructions of the Contracting Officer or to 
    comply with the provisions of paragraph (i) below.
        (g) No adjustment shall be made in the contract price under this 
    clause unless the amount of the adjustment exceeds $250.
        (h) If the Carrier obtains a reduction in tax liability under 
    the United States Internal Revenue Code (Title 26, U.S. Code) 
    because of the payment of any tax or duty that either was included 
    in the contract price or was the basis of an increase in the 
    contract price, the amount of the reduction shall be paid or 
    credited to the Government of the United States as the Contracting 
    Officer directs.
        (i) The Carrier shall take all reasonable action to obtain 
    exemption from or refund of any taxes or duties, including interest 
    or penalty, from which the United States Government, the Carrier, 
    any subcontractor, or the transactions covered by this contract are 
    exempt under the laws of the country concerned or its political 
    subdivisions or which the governments of the United States and of 
    the country concerned have agreed shall not be applicable to 
    expenditures in such country by or on behalf of the United States.
        (j) The Carrier shall promptly notify the Contracting Officer of 
    all matters relating to taxes or duties that reasonably may be 
    expected to result in either an increase or decrease in the contract 
    price and shall take appropriate action as the Contracting Officer 
    directs. The contract price shall be equitably adjusted to cover the 
    costs of action taken by the Carrier at the direction of the 
    Contracting Officer, including any interest, penalty, and reasonable 
    attorneys' fees.
    
    (End of clause)
    
        27. Section 1652.232-70 is amended by adding a date in the clause 
    title to read as follows:
    
    
    1652.232-70  Payments--community rated contracts.
    
    * * * * *
    
    Payments (Jan 1989)
    
    * * * * *
        28. In section 1652.232-71, paragraph (c) is amended by removing 
    ``and/or underwriter'' and the clause title is amended by adding a date 
    to read as follows:
    
    
    1652.232-71  Payments--experience rated contracts.
    
    * * * * *
    
    Payments (May 1992)
    
    * * * * *
        29. Section 1652.243-70 is added to read as follows:
    
    
    1652.243-70  Changes--Negotiated benefits contracts.
    
        As prescribed in section 1643.205-70, the following clause shall be 
    inserted in all FEHBP contracts.
    
    Changes--Negotiated Benefits Contracts (Jan 1998)
    
        (a) The Contracting Officer may at any time, by written order, 
    and without notice to the sureties, if any, make changes within the 
    general scope of this contract in any one or more of the following:
        (1) Description of services to be performed.
        (2) Time of performance (i.e., hours of the day, days of the 
    week, etc.).
        (3) Place of performance of the services.
        (b) If any such change causes an increase or decrease in the 
    cost of, or the time required for, performance of any part of the 
    work under this contract, whether or not changed by the order, the 
    Contracting Officer shall make an equitable adjustment in the 
    contract price, the delivery schedule, or both, and shall modify the 
    contract.
        (c) The Carrier must assert its right to an adjustment under 
    this clause within 30 days from the date of receipt of the written 
    order. However, if the Contracting Officer decides that the facts 
    justify it, the Contracting Officer may receive and act upon a 
    proposal submitted before final payment of the contract.
        (d) Failure to agree to any adjustment shall be a dispute under 
    the Disputes clause. However, nothing in this clause shall excuse 
    the Carrier from proceeding with the contract as changed.
    
    (End of clause)
    
        30. Section 1652.244-70 is amended by revising the introductory 
    paragraph, clause date, and paragraph (a) of the clause to read as 
    follows:
    
    
    1652.244-70  Subcontracts.
    
        As prescribed by 1644.270, the following clause shall be inserted 
    in all FEHBP contracts based on cost analysis (experience rated):
    
    Subcontracts (Jan 1998)
    
        (a) The Carrier shall notify the Contracting Officer reasonably 
    in advance of entering into any subcontract, or any subcontract 
    modification, or as otherwise specified by this contract, if both 
    the amount of the subcontract or modification charged to the FEHB 
    Program exceeds $100,000 and is at least 25 percent of the total 
    cost of the subcontract.
    * * * * *
        31. Section 1652.245-70 is added to read as follows:
    
    
    1652.245-70  Government property (negotiated benefits contracts).
    
        As prescribed in section 1645.303-70, the following clause shall be 
    inserted in all FEHBP contracts.
    
    Government Property (Negotiated Benefits Contracts) (Jan 1998)
    
        (a) Government-furnished property. (1) The Government shall 
    deliver to the Carrier, for use in connection with and under the 
    terms of this contract, the Government-furnished property described 
    in this contract together with any related data and information that 
    the Carrier may request and is reasonably required for the intended 
    use of the property (hereinafter referred to as ``Government-
    furnished property'').
        (2) The delivery or performance dates for this contract are 
    based upon the expectation that Government-furnished property 
    suitable for use (except for property furnished ``as-is'') will be 
    delivered to the Carrier at the times stated in this contract or, if 
    not so stated, in sufficient time to enable the Carrier to meet the 
    contract's performance dates.
        (3) If Government-furnished property is received by the Carrier 
    in a condition not suitable for the intended use, the Carrier shall, 
    upon receipt of it, notify the Contracting Officer, detailing the 
    facts, and, as directed by the Contracting Officer and at Government 
    expense, either repair, modify, return, or otherwise dispose of the 
    property. After completing the directed action and upon written 
    request of the Carrier, the Contracting Officer shall make an 
    equitable adjustment as provided in paragraph (h) of this clause.
        (b) Changes in Government-furnished property. (1) The 
    Contracting Officer may, by written notice, (i) decrease the 
    Government-furnished property provided or to be provided under this 
    contract, or (ii) substitute other Government-furnished property for 
    the property to be provided by the Government, or to be acquired by 
    the Carrier for the Government, under this contract. The Carrier 
    shall promptly take such action as the Contracting Officer may 
    direct regarding the removal, shipment, or disposal of the property 
    covered by such notice.
        (2) Upon the Carrier's written request, the Contracting Officer 
    shall make an equitable
    
    [[Page 47579]]
    
    adjustment to the contract in accordance with paragraph (h) of this 
    clause, if the Government has agreed in this contract to make the 
    property available for performing this contract and there is any--
        (i) Decrease or substitution in this property pursuant to 
    subparagraph (b)(1) above; or
        (ii) Withdrawal of authority to use this property, if provided 
    under any other contract or lease.
        (c) Title in Government property. (1) The Government shall 
    retain title to all Government-furnished property.
        (2) All Government-furnished property and all property acquired 
    by the Carrier, title to which vests in the Government under this 
    paragraph (collectively referred to as ``Government property''), are 
    subject to the provisions of this clause. Title to Government 
    property shall not be affected by its incorporation into or 
    attachment to any property not owned by the Government, nor shall 
    Government property become a fixture or lose its identity as 
    personal property by being attached to any real property.
        (d) Use of Government property. The Government property shall be 
    used only for performing this contract, unless otherwise provided in 
    this contract or approved by the Contracting Officer.
        (e) Property administration. (1) The Carrier shall be 
    responsible and accountable for all Government property provided 
    under this contract and shall comply with Federal Acquisition 
    Regulation (FAR) subpart 45.5, as in effect on the date of this 
    contract.
        (2) The Carrier shall establish and maintain a program for the 
    use, maintenance, repair, protection, and preservation of Government 
    property in accordance with sound industrial practice and the 
    applicable provisions of subpart 45.5 of the FAR.
        (3) If damage occurs to Government property, the risk of which 
    has been assumed by the Government under this contract, the 
    Government shall replace the items or the Carrier shall make such 
    repairs as the Government directs. However, if the Carrier cannot 
    effect such repairs within the time required, the Carrier shall 
    dispose of the property as directed by the Contracting Officer. When 
    any property for which the Government is responsible is replaced or 
    repaired, the Contracting Officer shall make an equitable adjustment 
    in accordance with paragraph (h) of this clause.
        (4) The Carrier represents that the contract price does not 
    include any amount for repairs or replacement for which the 
    Government is responsible. Repair or replacement of property for 
    which the Carrier is responsible shall be accomplished by the 
    Carrier at its own expense.
        (f) Access. The Government and all its designees shall have 
    access at all reasonable times to the premises in which any 
    Government property is located for the purpose of inspecting the 
    Government property.
        (g) Risk of loss. Unless otherwise provided in this contract, 
    the Carrier assumes the risk of, and shall be responsible for, any 
    loss or destruction of, or damage to, Government property upon its 
    delivery to the Carrier. However, the Carrier is not responsible for 
    reasonable wear and tear to Government property or for Government 
    property properly consumed in performing this contract.
        (h) Equitable adjustment. When this clause specifies an 
    equitable adjustment, it shall be made to any affected contract 
    provision in accordance with the procedures of the Changes clause. 
    When appropriate, the Contracting Officer may initiate an equitable 
    adjustment in favor of the Government. The right to an equitable 
    adjustment shall be the Carrier's exclusive remedy. The Government 
    shall not be liable to suit for breach of contract for--
        (1) Any delay in delivery of Government-furnished property;
        (2) Delivery of Government-furnished property in a condition not 
    suitable for its intended use;
        (3) A decrease in or substitution of Government-furnished 
    property; or
        (4) Failure to repair or replace Government property for which 
    the Government is responsible.
        (i) Final accounting and disposition of Government property. 
    Upon completing this contract, or at such earlier dates as may be 
    fixed by the Contracting Officer, the Carrier shall submit, in a 
    form acceptable to the Contracting Officer, inventory schedules 
    covering all items of Government property (including any resulting 
    scrap) not consumed in performing this contract or delivered to the 
    Government. The Carrier shall prepare for shipment, deliver f.o.b. 
    origin, or dispose of the Government property as may be directed or 
    authorized by the Contracting Officer. The net proceeds of any such 
    disposal shall be credited to the contract price or shall be paid to 
    the Government as the Contracting Officer directs.
        (j) Abandonment and restoration of Carrier's premises. Unless 
    otherwise provided herein, the Government--
        (1) May abandon any Government property in place, at which time 
    all obligations of the Government regarding such abandoned property 
    shall cease; and
        (2) Has no obligation to restore or rehabilitate the Carrier's 
    premises under any circumstances (e.g., abandonment, disposition 
    upon completion of need, or upon contract completion). However, if 
    the Government-furnished property is withdrawn or is unsuitable for 
    the intended use, or if other Government property is substituted, 
    then the equitable adjustment under paragraph (h) of this clause may 
    properly include restoration or rehabilitation costs.
        (k) Communications. All communications under this clause shall 
    be in writing.
        (l) Overseas contracts. If this contract is to be performed 
    outside of the United States of America, its territories, or 
    possessions, the words ``Government'' and ``Government-furnished'' 
    (wherever they appear in this clause) shall be construed as ``United 
    States Government'' and ``United States Government-furnished'', 
    respectively.
    
    (End of clause)
    
        32. In Subpart 1652.2, new sections 1652.249-71 and 1652.249-72 are 
    added to read as follows:
    
    
    1652.249-71  FEHBP termination for convenience of the government--
    negotiated benefits contracts.
    
        As prescribed in section 1649.101-71, the following clause shall be 
    inserted in all FEHBP contracts.
    
    FEHBP Termination for Convenience of the Government--Negotiated 
    Benefits Contracts (Jan 1998)
    
        (a) The Government may terminate performance of work under this 
    contract in whole or, from time to time, in part if the Contracting 
    Officer determines that a termination is in the Government's 
    interest. The Contracting Officer shall terminate by delivering to 
    the Carrier a Notice of Termination specifying the extent of 
    terminating and the effective date.
        (b) After receipt of a Notice of Termination, and except as 
    directed by the Contracting Officer, the Carrier shall immediately 
    proceed with the following obligations, regardless of any delay in 
    determining or adjusting any amounts due under this clause:
        (1) Stop work as specified in the notice.
        (2) Place no further subcontracts except as necessary to 
    complete the continued portion of the contract.
        (3) Terminate all subcontracts to the extent they relate to the 
    work terminated.
        (4) Assign to the Government, as directed by the Contracting 
    Officer, all right, title, and interest of the Carrier under the 
    subcontracts terminated, in which case the Government shall have the 
    right to settle or to pay any termination settlement proposal 
    arising out of those terminations.
        (5) With approval or ratification to the extent required by the 
    Contracting Officer, settle all outstanding liabilities and 
    termination settlement proposals arising from the termination of 
    subcontracts; the approval or ratification will be final for 
    purposes of this clause.
        (6) As directed by the Contracting Officer, deliver to the 
    Government any data, reports, or studies that, if the contract had 
    been completed, would be required to be furnished to the Government.
        (7) Complete performance of the work not terminated.
        (c) After termination, the Carrier shall submit a final 
    termination settlement proposal to the Contracting Officer in the 
    form and with the certification prescribed by the Contracting 
    Officer. The Carrier shall submit the proposal promptly, but no 
    later than 1 year from the effective date of termination, unless 
    extended in writing by the Contracting Officer upon written request 
    of the Carrier within this 1-year period. However, if the 
    Contracting Officer determines that the facts justify it, a 
    termination settlement proposal may be received and acted on after 1 
    year or any extension. If the Carrier fails to submit the proposal 
    within the time allowed, the Contracting Officer may determine, on 
    the basis of information available, the amount, if any, due the 
    Carrier because of the termination and shall pay the amount 
    determined.
        (d) Subject to paragraph (c) of this clause, the Carrier and the 
    Contracting Officer may agree upon the whole or any part of the
    
    [[Page 47580]]
    
    amount to be paid or remaining to be paid because of the 
    termination. The amount may include a reasonable allowance for 
    profit on work done. However, the agreed amount, whether under this 
    paragraph (d) or paragraph (e) of this clause, exclusive of costs 
    shown in subparagraph (e)(3) of this clause, may not exceed the 
    total contract price as reduced by (1) the amount of payments 
    previously made and (2) the contract price of work not terminated. 
    The contract shall be modified, and the Carrier paid the agreed 
    amount. Paragraph (e) of this clause shall not limit, restrict, or 
    affect the amount that may be agreed upon to be paid under this 
    paragraph.
        (e) If the Carrier and the Contracting Officer fail to agree on 
    the whole amount to be paid because of the termination of work, the 
    Contracting Officer shall pay the Carrier the amounts determined by 
    the Contracting Officer as follows, but without duplication of any 
    amounts agreed on under paragraph (d) above:
        (1) The contract price for completed services accepted by the 
    Government not previously paid for.
        (2) The total of--
        (i) The costs incurred in the performance of the work 
    terminated, including initial costs and preparatory expense 
    allocable thereto, but excluding any costs attributable to services 
    paid or to be paid under paragraph (e)(1) of this clause;
        (ii) The cost of settling and paying termination settlement 
    proposals under terminated subcontracts that are properly chargeable 
    to the terminated portion of the contract if not included in 
    subdivision (e)(2)(i) of this clause; and
        (iii) A sum, as profit on subdivision (e)(2)(i) of this clause, 
    determined by the Contracting Officer under 49.202 of the Federal 
    Acquisition Regulation, in effect on the date of this contract, to 
    be fair and reasonable.
        (3) The reasonable costs of settlement of the work terminated, 
    including--
        (i) Accounting, legal, clerical, and other expenses reasonably 
    necessary for the preparation of termination settlement proposals 
    and supporting data;
        (ii) The termination and settlement of subcontracts (excluding 
    the amounts of such settlements); and
        (f) The cost principles and procedures of part 31 of the Federal 
    Acquisition Regulation, in effect on the date of this contract, 
    shall govern all costs claimed, agreed to, or determined under this 
    clause.
        (g) The Carrier shall have the right of appeal, under the 
    Disputes clause, from any determination made by the Contracting 
    Officer under paragraph (c), (e), or (i) of this clause, except that 
    if the Carrier failed to submit the termination settlement proposal 
    or request for equitable adjustment within the time provided in 
    paragraph (c) or (i), respectively, and failed to request a time 
    extension, there is no right of appeal.
        (h) In arriving at the amount due the Carrier under this clause, 
    there shall be deducted--
        (1) All unliquidated advance or other payments to the Carrier 
    under the terminated portion of this contract;
        (2) Any claim which the Government has against the Carrier under 
    this contract; and
        (i) If the termination is partial, the Carrier may file a 
    proposal with the Contracting Officer for an equitable adjustment of 
    the price(s) of the continued portion of the contract. The 
    Contracting Officer shall make any equitable adjustment agreed upon. 
    Any proposal by the Carrier for an equitable adjustment under this 
    clause shall be requested within 90 days from the effective date of 
    termination unless extended in writing by the Contracting Officer.
        (j)(1) The Government may, under the terms and conditions it 
    prescribes, make partial payments and payments against costs 
    incurred by the Carrier for the terminated portion of the contract, 
    if the Contracting Officer believes the total of these payments will 
    not exceed the amount to which the Carrier will be entitled.
        (2) If the total payments exceed the amount finally determined 
    to be due, the Carrier shall repay the excess to the Government upon 
    demand, together with interest computed at the rate established by 
    the Secretary of the Treasury under 50 U.S.C. App. 1215(b)(2). 
    Interest shall be computed for the period from the date the excess 
    payment is received by the Carrier to the date the excess is repaid.
        (k) Unless otherwise provided in this contract or by statute, 
    the Carrier shall maintain all records and documents relating to the 
    terminated portion of this contract for 3 years after final 
    settlement. This includes all books and other evidence bearing on 
    the Carrier's costs and expenses under this contract. The Carrier 
    shall make these records and documents available to the Government, 
    at the Carrier's office, at all reasonable times, without any direct 
    charge. If approved by the Contracting Officer, photographs, 
    microphotographs, or other authentic reproductions may be maintained 
    instead of original records and documents.
    
    (End of clause)
    
    
    1652.249-72  FEHBP termination for default--negotiated benefits 
    contracts.
    
        As prescribed in Sec. 1649.101-72, the following clause shall be 
    inserted in all FEHBP contracts.
    
    FEHBP Termination for Default--Negotiated Benefits Contracts (Jan 1998)
    
        (a) (1) The Government may, subject to paragraphs (c) and (d) 
    below, by written notice of default to the Carrier, terminate this 
    contract in whole or in part if the Carrier fails to--
        (i) Perform the services within the time specified in this 
    contract or any extension;
        (ii) Make progress, so as to endanger performance of this 
    contract (but see subparagraph (a)(2) below); or
        (iii) Perform any of the other provisions of this contract (but 
    see subparagraph (a)(2) below).
        (2) The Government's right to terminate this contract under 
    subdivisions (1)(ii) and (1)(iii) above, may be exercised if the 
    Carrier does not cure such failure within 10 days (or more if 
    authorized in writing by the Contracting Officer) after receipt of 
    the notice from the Contracting Officer specifying the failure.
        (b) If the Government terminates this contract in whole or in 
    part, it may acquire, under the terms and in the manner the 
    Contracting Officer considers appropriate, supplies or service 
    similar to those terminated, and the Carrier will be liable to the 
    Government for any excess costs for those supplies or services. 
    However, the Carrier shall continue the work not terminated.
        (c) Except for defaults of subcontractors at any tier, the 
    Carrier shall not be liable for any excess costs if the failure to 
    perform the contract arises from causes beyond the control and 
    without the fault or negligence of the Carrier. Examples of such 
    causes include (1) acts of God or of the public enemy, (2) acts of 
    the Government in either its sovereign or contractual capacity, (3) 
    fires, (4) floods, (5) epidemics, (6) quarantine restrictions, (7) 
    strikes, (8) freight embargoes, and (9) unusually severe weather. In 
    each instance the failure to perform must be beyond the control and 
    without the fault or negligence of the Carrier.
        (d) If the failure to perform is caused by the default of a 
    subcontractor at any tier, and if the cause of the default is beyond 
    the control of both the Carrier and subcontractor, and without the 
    fault or negligence of either, the Carrier shall not be liable for 
    any excess costs for failure to perform, unless the subcontracted 
    supplies or services were obtainable from other sources in 
    sufficient time for the Carrier to meet the required delivery 
    schedule.
        (e) If this contract is terminated for default, the Government 
    may require the Carrier to transfer title and deliver to the 
    Government, as directed by the Contracting Officer, any completed or 
    partially completed information and contract rights that the Carrier 
    has specifically produced or acquired for the terminated portion of 
    this contract.
        (f) If, after termination, it is determined that the Carrier was 
    not in default, or that the default was excusable, the rights and 
    obligations of the parties shall be the same as if the termination 
    had been issued for the convenience of the Government.
        (g) The rights and remedies of the Government in this clause are 
    in addition to any other rights and remedies provided by law or 
    under this contract.
    
    (End of clause)
    
    Subpart 1652.3--FEHBP Clause Matrix
    
        33. In subpart 1652.3, Sec. 1652.370 paragraph (a) is amended by 
    removing the words ``established catalog or market price'' in the first 
    sentence and adding in its place the words ``a combination of cost and 
    price analysis;'' and by revising the FEHBP Clause Matrix to read as 
    follows:
    
    
    1652.370  Use of the matrix.
    
    * * * * *
    
    [[Page 47581]]
    
    
    
                                                                       FEHBP Clause Matrix                                                                  
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                Use with experience     Use with community  
                Clause No.                  Text reference             Title                Use status            rated contracts         rated contracts   
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    FAR 52.202-1......................  FAR 2.2..............  Definitions..........  M                       T                       T                     
    FAR 52.203-3......................  FAR 3.202............  Gratuities...........  M                       T                       T                     
    FAR 52.203-5......................  FAR 3.404(c).........  Covenant Against       M                       T                       T                     
                                                                Contingent Fees.                                                                            
    FAR 52.203-7......................  FAR 3.502-3..........  Anti-Kickback          M                       T                       T                     
                                                                Procedures.                                                                                 
    FAR 52.203-12.....................  FAR 3.808............  Limitation on          M                       T                       T                     
                                                                Payments to                                                                                 
                                                                Influence Certain                                                                           
                                                                Federal Transactions.                                                                       
    1652.203-70.......................  1603.703.............  Misleading,            M                       T                       T                     
                                                                Deceptive, or Unfair                                                                        
                                                                Advertising.                                                                                
    1652.204-70.......................  1604.705.............  Contractor Records     M                       T                       T                     
                                                                Retention.                                                                                  
    1652.204-71.......................  1604.7001............  Coordination of        M                       T                       T                     
                                                                Benefits.                                                                                   
    1652.204-72.......................  1604.7101............  Filing Health Benefit  M                       T                       T                     
                                                                Claims/Court Review                                                                         
                                                                of Disputed Claims.                                                                         
    FAR 52.209-6......................  FAR 9.409(b).........  Protecting the         M                       T                       T                     
                                                                Government's                                                                                
                                                                Interest When                                                                               
                                                                Subcontracting With                                                                         
                                                                Contractors                                                                                 
                                                                Debarred, Suspended,                                                                        
                                                                or Proposed for                                                                             
                                                                Debarment.                                                                                  
    FAR 52.215-2......................  FAR 15.105-2(b)......  Audit & Records--      M                       T                       T                     
                                                                Negotiations.                                                                               
    FAR 52.215-22.....................  FAR 15.804-8(a)......  Price Reduction for    M                       T                                             
                                                                Defective Cost or                                                                           
                                                                Pricing Data.                                                                               
    FAR 52.215-24.....................  FAR 15.804-8(c)......  Subcontractor Cost or  M                       T                                             
                                                                Pricing Data.                                                                               
    FAR 52.215-27.....................  FAR 15.804-8(e)......  Termination of         M                       T                                             
                                                                Defined Benefit                                                                             
                                                                Pension Plans.                                                                              
    FAR 52.215-30.....................  FAR 15.904(a)........  Facilities Capital     M                       T                                             
                                                                Cost of Money.                                                                              
    FAR 52.215-31.....................  FAR 15.904(b)........  Waiver of Facilities   A                       T                                             
                                                                Capital Cost of                                                                             
                                                                Money.                                                                                      
    FAR 52.215-39.....................  FAR 15.804-8(f)......  Reversion or           M                       T                                             
                                                                Adjustment of Plans                                                                         
                                                                for Post Retirement                                                                         
                                                                Benefits Other Than                                                                         
                                                                Pensions (PRB).                                                                             
    FAR 52.215-70.....................  1615.804-72..........  Rate Reduction for     M                       ......................  T                     
                                                                Defective Pricing or                                                                        
                                                                Defective Cost or                                                                           
                                                                Pricing Data.                                                                               
    1652.215-71.......................  1615.805-71..........  Investment Income....  M                       T                                             
    1652.216-70.......................  1616.7001............  Accounting and Price   M                                               T                     
                                                                Adjustment.                                                                                 
    1652.216-71.......................  1616.7002............  Accounting and         M                       T                                             
                                                                Allowable Cost.                                                                             
    FAR 52.219-8......................  FAR 19.708(a)........  Utilization of Small,  M                       T                       T                     
                                                                Small Disadvantaged                                                                         
                                                                and Women-Owned                                                                             
                                                                Small Business                                                                              
                                                                Concerns.                                                                                   
    FAR 52.222-1......................  FAR 22.103-5(a)......  Notice to the          M                       T                       T                     
                                                                Government of Labor                                                                         
                                                                Disputes.                                                                                   
    FAR 52.222-3......................  FAR 22.202...........  Convict Labor........  M                       T                       T                     
    FAR 52.222-4......................  FAR 22.305(a)........  Contract Work Hours    M                       T                       T                     
                                                                and Safety Standards                                                                        
                                                                Act--Overtime                                                                               
                                                                Compensation--Genera                                                                        
                                                                l.                                                                                          
    FAR 52.222-21.....................  FAR 22.810(a)(1).....  Certification of       M                       T                       T                     
                                                                Nonsegregated                                                                               
                                                                Facilities.                                                                                 
    FAR 52.222-26.....................  FAR 22.810(a)........  Equal Opportunity....  M                       T                       T                     
    FAR 52.222-28.....................  FAR 22.810(g)........  Equal Opportunity      M                       T                       T                     
                                                                Preaward Clearance                                                                          
                                                                of Subcontracts.                                                                            
    FAR 52.222-29.....................  FAR 22.810(h)........  Notification of Visa   A                       T                       T                     
                                                                Denial.                                                                                     
    FAR 52.222-35.....................  FAR 22.1308(a).......  Affirmative Action     M                       T                       T                     
                                                                for Special Disabled                                                                        
                                                                and Vietnam Era                                                                             
                                                                Veterans.                                                                                   
    
    [[Page 47582]]
    
                                                                                                                                                            
    FAR 52.222-36.....................  FAR 22.1408(a).......  Affirmative Action     M                       T                       T                     
                                                                for Handicapped                                                                             
                                                                Workers.                                                                                    
    FAR 52.222-37.....................  FAR 22.1308(b).......  Employment Reports on  M                       T                       T                     
                                                                Special Disability                                                                          
                                                                Veterans of the                                                                             
                                                                Vietnam Era.                                                                                
    1652.222-70.......................  1622.103-70..........  Notice of Significant  M                       T                       T                     
                                                                Events.                                                                                     
    FAR 52.223-2......................  FAR 23.105(b)........  Clean Air and Water..  A                       T                       T                     
    FAR 52.223-6......................  FAR 23.505(b)........  Drug-Free Workplace..  A                       T                       T                     
    1652.224-70.......................  1624.104.............  Confidentiality of     M                       T                       T                     
                                                                Records.                                                                                    
    FAR 52.227-1......................  FAR 27.201-2(a)......  Authorization and      M                       T                       T                     
                                                                Consent.                                                                                    
    FAR 52.227-2......................  FAR 27.202-2.........  Notice and Assistance  M                       T                       T                     
                                                                Regarding Patent and                                                                        
                                                                Copyright                                                                                   
                                                                Infringement.                                                                               
    FAR 52.229-3......................  FAR 29.401-3.........  Federal, State and     M                                               T                     
                                                                Local Taxes.                                                                                
    FAR 52.229-4......................  FAR 29.401-4.........  Federal, State and     M                       T                                             
                                                                Local Taxes                                                                                 
                                                                (Noncompetitive                                                                             
                                                                Contract).                                                                                  
    FAR 52.229-5......................  FAR 29.401-5.........  Taxes--Contracts       A                       T                       T                     
                                                                Performed in U.S.                                                                           
                                                                Possessions or                                                                              
                                                                Puerto Rico.                                                                                
    1652.229-70.......................  FEHBAR 1629.402......  Taxes--Foreign         A                       T                       T                     
                                                                Negotiated Benefits                                                                         
                                                                Contracts.                                                                                  
    FAR 52.230-2......................  FAR 30.201-4(a)(1)...  Cost Accounting        A                       T                       T                     
                                                                Standards.                                                                                  
    FAR 52.230-3-.....................  FAR 30.201-4(b)(1)...  Disclosure and         A                       T                       T                     
                                                                Consistency of Cost                                                                         
                                                                Accounting Practices.                                                                       
    FAR 52.230-6......................  FAR 30.201-4(d)(1)...  Administration of      A                       T                       T                     
                                                                Cost Accounting                                                                             
                                                                Standards.                                                                                  
    FAR 52.232-8......................  FAR 32.111(c)(1).....  Discounts for Prompt   M                       T                       T                     
                                                                Payment.                                                                                    
    FAR 52.232-17.....................  FAR 32.617(a)          Interest.............  M                       T                       T                     
                                         Modification:                                                                                                      
                                         1632.617.                                                                                                          
    FAR 52.232-23.....................  FAR 32.806(a)(1).....  Assignment of Claims.  A                       T                       T                     
    FAR 52.232-33.....................  FAR 32.1103(a)&(c)...  Mandatory Information  M                       T                       T                     
                                                                for Electronic Funds                                                                        
                                                                Transfer Payment.                                                                           
    1652.232-70.......................  1632.171.............  Payments--Contracts    A                                               T                     
                                                                Without Letter of                                                                           
                                                                Credit Payment                                                                              
                                                                Arrangements.                                                                               
    1652.323-71.......................  1632.172.............  Payments--Contracts    A                       T                                             
                                                                With Letter of                                                                              
                                                                Credit Payment                                                                              
                                                                Arrangements.                                                                               
    1652.232-72.......................  1632.772.............  Non-Commingling of     M                       T                                             
                                                                FEHBP Funds.                                                                                
    1652.232-73.......................  1632.806-70..........  Approval for           M                       T                       T                     
                                                                Assignment of Claims.                                                                       
    FAR 52.233-1......................  FAR 33.215...........  Disputes.............  M                       T                       T                     
    FAR 52.242-1......................  FAR 42.802...........  Notice of Intent to    M                       T                       T                     
                                                                Disallow Costs.                                                                             
    FAR 52.242-3......................  FAR 42.709-6.........  Penalties for          M                       T                                             
                                                                Unallowable Costs.                                                                          
    FAR 52.242-13.....................  FAR 42.903...........  Bankruptcy...........  M                       T                       T                     
    1652.243-70.......................  1643.205-70..........  Changes--Negotiated    M                       T                       T                     
                                                                Benefits Contracts.                                                                         
    FAR 52.244-5......................  FAR 44.204(e)........  Competition in         M                       T                       ......................
                                                                Subcontracting.                                                                             
    FAR 52.244-6......................  FAR 44.403...........  Subcontracts for       M                       T                                             
                                                                Commercial Items and                                                                        
                                                                Commercial                                                                                  
                                                                Components.                                                                                 
    1652.244-70.......................  1644.270.............  Subcontracts.........  M                       T                                             
    1652.245-70.......................  FAR 1645.303-70......  Government Property    M                       T                       T                     
                                                                (Negotiated Benefits                                                                        
                                                                Contracts).                                                                                 
    
    [[Page 47583]]
    
                                                                                                                                                            
    FAR 52.246-25.....................  FAR 46.805(a)(4).....  Limitation of          M                       T                                             
                                                                Liability--Services.                                                                        
    1652.246-70.......................  1646.301.............  FEHB Inspection......  M                       T                       T                     
    FAR 52.247-63.....................  FAR 47.405...........  Preference for U.S.-   M                       T                       T                     
                                                                Flag Carriers.                                                                              
    1652.249-70.......................  1649.101-70..........  Renewal and            M                       T                       T                     
                                                                Withdrawal of                                                                               
                                                                Approval.                                                                                   
    1652.249-71.......................  1649.101-71..........  FEHBP Termination for  M                       T                       T                     
                                                                Convenience of the                                                                          
                                                                Government--Negotiat                                                                        
                                                                ed Benefits                                                                                 
                                                                Contracts.                                                                                  
    1652.249-72.......................  1649.101-72..........  FEHBP Termination for  M                       T                       T                     
                                                                Default--Negotiated                                                                         
                                                                Benefits Contracts.                                                                         
    FAR 52.251-1......................  FAR 51.107...........  Government Supply      M                       T                                             
                                                                Sources.                                                                                    
    FAR 52.252-4......................  FAR 52.107(d)........  Alterations in         M                       T                       T                     
                                                                Contract.                                                                                   
    FAR 52.252-6......................  FAR 52.107(f)........  Authorized Deviations  M                       T                       T                     
                                                                in Clauses.                                                                                 
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    
    PART 1653--FORMS [AMENDED]
    
        34. Part 1653 is amended by removing all references to Sec. 53.215-
    2(b), Sec. 53.301-1412, and SF-1412 in the chart.
    
    [FR Doc. 97-23883 Filed 9-9-97; 8:45 am]
    BILLING CODE 6325-01-P
    
    
    

Document Information

Effective Date:
10/10/1997
Published:
09/10/1997
Department:
Personnel Management Office
Entry Type:
Rule
Action:
Final rulemaking.
Document Number:
97-23883
Dates:
October 10, 1997.
Pages:
47569-47583 (15 pages)
RINs:
3206-AH45: Federal Employees Health Benefits Program Acquisition Regulation: Truth in Negotiations Act and Related Changes
RIN Links:
https://www.federalregister.gov/regulations/3206-AH45/federal-employees-health-benefits-program-acquisition-regulation-truth-in-negotiations-act-and-relat
PDF File:
97-23883.pdf
CFR: (4)
48 CFR 1629.402
48 CFR 1643.205-70
48 CFR 1645.303-70
48 CFR 1652.204-72