[Federal Register Volume 59, Number 232 (Monday, December 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-29809]
Federal Register / Vol. 59, No. 232 / Monday, December 5, 1994 /
[[Page Unknown]]
[Federal Register: December 5, 1994]
VOL. 59, NO. 232
Monday, December 5, 1994
OFFICE OF PERSONNEL MANAGEMENT
5 CFR Part 890
RIN 3206-AG40
Federal Employees Health Benefits Program; HMO Plan Applications
AGENCY: Office of Personnel Management.
ACTION: Interim regulations with request for comments.
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SUMMARY: The Office of Personnel Management (OPM) is issuing interim
regulations to clarify the policy under which it invites applications
from comprehensive medical plans (HMO's) after a determination that it
would be beneficial to enrollees and the Federal Employees Health
Benefits (FEHB) Program to do so. This clarification is necessary in
order to ensure that OPM and the HMO's are providing the best possible
service to FEHB enrollees.
DATES: Interim regulations are effective January 4, 1995. comments must
be received on or before February 3, 1995.
ADDRESSES: Written comments may be sent to Lucretia F. Myers, Assistant
Director for Insurance Programs, Retirement and Insurance Group, Office
of Personnel Management, P.O. Box 57, Washington, DC 20044; delivered
to OPM, room 4351, 1900 E Street, NW., Washington, DC; or FAXed to
(202) 606-0633.
FOR FURTHER INFORMATION CONTACT: Mary Ann Mercer, (202) 606-0191.
SUPPLEMENTARY INFORMATION: OPM is issuing interim regulations to
clarify the policy under which the Director of OPM invites applications
from HMOs interested in participating in the FEHB Program. As
administrator of the FEHB Program, it is necessary that OPM consider
the needs of FEHB enrollees and the FEHB Program in determining whether
to invite applications from HMOs for a given contract year.
Consequently, each year, the Director makes a determination whether or
not it would be beneficial to enrollees and the FEHB Program to invite
HMOs to apply. This authority parallels OPM's discretion to consider
changes in the rates and benefits of participating plans when the
Director of OPM deems it in the best interest of enrollees and the FEHB
Program (Sec. 890.203(b)).
With only limited possible exception, OPM does not intend to accept
HMO applications for the 1996 contract year. We also plan to keep in
place for the 1996 contract year the benefits that go into effect in
1995 for plans already participating in the FEHB Program. Further, OPM
will print no new plan brochures for existing plans or comparison guide
for contract year 1996.
On a limited basis, OPM will entertain applications from HMOs where
it would improve the access to medical care in a medically underserved
state. That is, we will consider applications from HMOs only in states
designated as medically underserved areas (MUAs), as determined by OPM
under the methodology cited in 5 U.S.C. 8902(m)(2)(A), where the choice
of an HMO is limited or would otherwise be nonexistent. To be
considered by OPM, the plan must be in a state that qualifies as an MUA
on January 31 of the year preceding the FEHB Program contract year for
which the application has been submitted. OPM expects that, under this
exception, plans will be accepted only under rare and unusual
circumstances.
Except in these situations, the information disseminated during the
November-December 1995 Open Season will be limited to rate change
information for plans currently participating in the Program. In the
future, OPM will publish a notice in the Federal Register inviting
applications from plans interested in participating in the FEHB
Program. We anticipate considering all applications for contract year
1997.
This course of action is necessary so that OPM may utilize its
resources in the most effective way and in a manner most beneficial to
enrollees. It is in the best interest of enrollees that OPM ensure that
FEHB Program contracts are administered so that benefits to enrollees
are optimum and the costs to enrollees and the FEHB Program are
minimized. OPM shares the concern of the Congress, the General
Accounting Office (GAO), and the Office of Management and Budget (OMB)
about contract administration under the FEHB Program. In order to
improve standards and oversight of insurance carriers and enhance our
overall program operations to improve service to OPM's customers,
additional emphasis needs to be placed on functions that, of necessity,
are given lower priority when staff are occupied with applications,
negotiations, and open season materials review.
During 1995, OPM will redirect resources to projects designed to
address weaknesses in the oversight of contractor performance as well
as improve communication with FEHB enrollees to ensure that we and our
participating carriers are meeting their needs. In future years, we
will prioritize functions.
While OPM is not required to issue regulations that clarify
existing policy, we understand that there is interest in this issue,
and we wish to give all parties an opportunity to comment. We are
publishing the regulation at this time before interested HMOs begin the
time-consuming application process.
Waiver of Notice of Proposed Rulemaking
Pursuant to section 553(b)(3)(A) of title 5 of the U.S. Code, I
find that good cause exists for waiving the general notice of proposed
rulemaking. The interim regulations simply clarify OPM's policy under
which it invites applications from HMO's interested in participating in
the FEHB Program.
E.O. 12866, Regulatory Review
This rule has been reviewed by OMB in accordance with E.O. 12866.
Regulatory Flexibility Act
I certify that these regulations will not have a significant
economic impact on a substantial number of small entities because they
primarily affect OPM's administrative procedures.
List of Subjects in 5 CFR Part 890
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 5 CFR part 890 as follows:
PART 890--FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
1. The authority citation for part 890 continues to read as
follows:
Authority: 5 U.S.C. 8913; Sec. 890.803 also issued under 50
U.S.C. 403p, 22 U.S.C. 4069c and 4069c-1; Subpart L also issued
under sec. 599C of Pub. L. 101-513, 104 Stat. 2064, as amended.
2. In Sec. 890.203, paragraph (a)(1) is revised, paragraphs (a)(2)
through (a)(4) are redesignated as paragraphs (a)(3) through (a)(5)
respectively, the last sentence in newly designated paragraph (a)(5) is
revised, a new paragraph (a)(2) is added, and a heading is added for
paragraph (b) to read as follows:
Sec. 890.203 Application for approval of, and proposal of amendments
to, health benefits plans.
(a) New plan applications. (1) The Director of OPM shall consider
applications to participate in the FEHB Program from comprehensive
medical plans (CMP's) at his or her discretion. If the Director of OPM
determines that it is beneficial to enrollees and the Federal Employees
Health Benefits Program to invite new plans to join the Program, OPM
will publish a notice in the Federal Register.
(2) When invited to participate, CMP's should apply for approval by
writing to the Office of Personnel Management, Washington, DC 20415.
Application letters must be accompanied by any descriptive material,
financial data, or other documentation required by OPM. Plans must
submit the letter and attachments in the OPM-specified format by
January 31 of the year preceding the contract year for which
applications are being accepted. Plans must submit evidence
demonstrating they meet all requirements for approval by March 31 of
the year preceding the contract year for which applications are being
accepted. Plans that miss either deadline cannot be considered for
participation in the next contract year. All newly approved plans must
submit benefit and rate proposals to OPM by May 31 of the year
preceding the contract year for which applications are being accepted
to be considered for participation in that contract year. OPM may make
counter-proposals at any time.
* * * * *
(5) * * * The extent of the data and documentation to be submitted
by a plan so certified by HHS, as well as by a non-certified plan, for
a particular review cycle may be obtained by writing directly to the
Office of Insurance Programs, Retirement and Insurance Group, Office of
Personnel Management, Washington, DC 20415.
* * * * *
(b) Participating plans. * * *
[FR Doc. 94-29809 Filed 12-2-94; 8:45 am]
BILLING CODE 6325-01-M
