OPM details plans to offer health coverage to uninsured Americans
The Office of Personnel Management plans to sign contracts with at least two health care insurers in fiscal 2013 to provide coverage to millions of uninsured Americans.
OPM said in its fiscal 2013 budget justification, released Feb. 17, that its role in the Obama administration's massive health care overhaul will kick in next fiscal year. The Affordable Care Act requires OPM to set up multi-state plans on so-called "affordable insurance exchanges."
OPM said it will sign the contracts for the plans by September 2013. The exchanges will be created in October 2013, and will start covering uninsured people in January 2014.
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The multi-state plans will be run similarly to the government's Federal Employees Health Benefits Program. It will be the first time OPM will administer a health care plan for people other than federal employees, retirees or their families.
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http://www.federaltimes.com/article/20120220/PERSONNEL01/202200303/OPM-details-plans-offer-health-coverage-uninsured-Americans
Here's a more detailed analysis:
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Who has oversight for MSPs in the exchanges?
The OPM Director will contract with health insurance companies to offer MSP individual coverage and group coverage for small employers in exchanges for a one-year maximum term. This is different from the arrangements for other QHPs, which will contract directly with states. The MSP contracts will be automatically renewable for additional one-year terms. This approach is modeled on how OPM administers nationally available FEHBP plans.
MSPs must be licensed in each state and meet other state requirements similar to the intrastate QHPs, but it is the OPM Director that has general oversight of the MSPs. OPM will negotiate premiums, set profit margins, medical loss ratios, and other coverage terms with insurers and can prohibit them from offering plans that do not meet these terms. This is important because these are functions that states will carry out for other QHPs. OPM may go beyond state regulations to establish more rigorous review than states and to more actively pursue value-based purchasing or payment reform strategies, for example.
In addition, CMS has recently released rules6 governing state exchanges which further clarify that OPM will determine if MSPs meet all QHP standards and will certify, recertify, and decertify MSPs.7 OPM also will determine rates, transparency reporting, accreditation timelines and network adequacy standards for MSPs. In addition to exemption from state certification procedures for QHPs, MSPs are exempt from Exchange processes for receiving and considering rate increase justifications and for Exchange processes for receiving annual rate and benefit information.
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http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_A80A0AAA-5056-9D20-3D25B59C65680B79.pdf
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