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Statutory Text

SEC. 1334 [42 U.S.C. 18054]. MULTI-STATE PLANS.
[Section added by section 10104(q)]
(a) OVERSIGHT BY THE OFFICE OF PERSONNEL MANAGEMENT.—
(1) IN GENERAL.—The Director of the Office of Personnel
Management (referred to in this section as the ‘‘Director’’) shall
enter into contracts with health insurance issuers (which may
include a group of health insurance issuers affiliated either by
common ownership and control or by the common use of a nationally
licensed service mark), without regard to section 5 of
title 41, United States Code, or other statutes requiring competitive
bidding, to offer at least 2 multi-State qualified health
plans through each Exchange in each State. Such plans shall
provide individual, or in the case of small employers, group
coverage.
(2) TERMS.—Each contract entered into under paragraph
(1) shall be for a uniform term of at least 1 year, but may be
made automatically renewable from term to term in the absence
of notice of termination by either party. In entering into
such contracts, the Director shall ensure that health benefits
coverage is provided in accordance with the types of coverage
provided for under section 2701(a)(1)(A)(i) of the Public Health
Service Act.
(3) NON-PROFIT ENTITIES.—In entering into contracts under
paragraph (1), the Director shall ensure that at least one contract
is entered into with a non-profit entity.
(4) ADMINISTRATION.—The Director shall implement this
subsection in a manner similar to the manner in which the Director
implements the contracting provisions with respect to
carriers under the Federal employees health benefit program
under chapter 89 of title 5, United States Code, including
(through negotiating with each multi-state plan)—
(A) a medical loss ratio;
(B) a profit margin;
(C) the premiums to be charged; and
(D) such other terms and conditions of coverage as are
in the interests of enrollees in such plans.
(5) AUTHORITY TO PROTECT CONSUMERS.—The Director may
prohibit the offering of any multi-State health plan that does
not meet the terms and conditions defined by the Director with
respect to the elements described in subparagraphs (A)
through (D) of paragraph (4).
(6) ASSURED AVAILABILITY OF VARIED COVERAGE.—In entering
into contracts under this subsection, the Director shall ensure
that with respect to multi-State qualified health plans offered
in an Exchange, there is at least one such plan that does
not provide coverage of services described in section
1303(b)(1)(B)(i).
(7) WITHDRAWAL.—Approval of a contract under this subsection
may be withdrawn by the Director only after notice and
opportunity for hearing to the issuer concerned without regard
to subchapter II of chapter 5 and chapter 7 of title 5, United
States Code.
(b) ELIGIBILITY.—A health insurance issuer shall be eligible to
enter into a contract under subsection (a)(1) if such issuer—
(1) agrees to offer a multi-State qualified health plan that
meets the requirements of subsection (c) in each Exchange in
each State;
(2) is licensed in each State and is subject to all requirements
of State law not inconsistent with this section, including
the standards and requirements that a State imposes that do
not prevent the application of a requirement of part A of title
XXVII of the Public Health Service Act or a requirement of
this title;
(3) otherwise complies with the minimum standards prescribed
for carriers offering health benefits plans under section
8902(e) of title 5, United States Code, to the extent that such
standards do not conflict with a provision of this title; and
(4) meets such other requirements as determined appropriate
by the Director, in consultation with the Secretary.
(c) REQUIREMENTS FOR MULTI-STATE QUALIFIED HEALTH
PLAN.—
(1) IN GENERAL.—A multi-State qualified health plan
meets the requirements of this subsection if, in the determination
of the Director—
(A) the plan offers a benefits package that is uniform
in each State and consists of the essential benefits described
in section 1302;
(B) the plan meets all requirements of this title with
respect to a qualified health plan, including requirements
relating to the offering of the bronze, silver, and gold levels
of coverage and catastrophic coverage in each State Exchange;

(C) except as provided in paragraph (5), the issuer provides
for determinations of premiums for coverage under
the plan on the basis of the rating requirements of part A
of title XXVII of the Public Health Service Act; and
(D) the issuer offers the plan in all geographic regions,
and in all States that have adopted adjusted community
rating before the date of enactment of this Act.
(2) STATES MAY OFFER ADDITIONAL BENEFITS.—Nothing in
paragraph (1)(A) shall preclude a State from requiring that
benefits in addition to the essential health benefits required
under such paragraph be provided to enrollees of a multi-State
qualified health plan offered in such State.
(3) CREDITS.—
(A) IN GENERAL.—An individual enrolled in a multi-State
qualified health plan under this section shall be eligible
for credits under section 36B of the Internal Revenue
Code of 1986 and cost sharing assistance under section
1402 in the same manner as an individual who is enrolled
in a qualified health plan.
(B) NO ADDITIONAL FEDERAL COST.—A requirement by
a State under paragraph (2) that benefits in addition to
the essential health benefits required under paragraph
(1)(A) be provided to enrollees of a multi-State qualified
health plan shall not affect the amount of a premium tax
credit provided under section 36B of the Internal Revenue
Code of 1986 with respect to such plan.
(4) STATE MUST ASSUME COST.—A State shall make payments—
(A) to an individual enrolled in a multi-State qualified
health plan offered in such State; or
(B) on behalf of an individual described in subparagraph
(A) directly to the multi-State qualified health plan
in which such individual is enrolled;
to defray the cost of any additional benefits described in paragraph
(2).
(5) APPLICATION OF CERTAIN STATE RATING REQUIRE- MENTS.—With respect to a multi-State qualified health plan
that is offered in a State with age rating requirements that are
lower than 3:1, the State may require that Exchanges operating
in such State only permit the offering of such multi-State
qualified health plans if such plans comply with the State’s
more protective age rating requirements.
(d) PLANS DEEMED TO BE CERTIFIED.—A multi-State qualified
health plan that is offered under a contract under subsection (a)
shall be deemed to be certified by an Exchange for purposes of section
1311(d)(4)(A).
(e) PHASE-IN.—Notwithstanding paragraphs (1) and (2) of subsection
(b), the Director shall enter into a contract with a health
insurance issuer for the offering of a multi-State qualified health
plan under subsection (a) if—
(1) with respect to the first year for which the issuer offers
such plan, such issuer offers the plan in at least 60 percent of
the States;
(2) with respect to the second such year, such issuer offers
the plan in at least 70 percent of the States;
(3) with respect to the third such year, such issuer offers
the plan in at least 85 percent of the States; and
(4) with respect to each subsequent year, such issuer offers
the plan in all States.
(f) APPLICABILITY.—The requirements under chapter 89 of title
5, United States Code, applicable to health benefits plans under
such chapter shall apply to multi-State qualified health plans provided
for under this section to the extent that such requirements
do not conflict with a provision of this title.
(g) CONTINUED SUPPORT FOR FEHBP.—
(1) MAINTENANCE OF EFFORT.—Nothing in this section
shall be construed to permit the Director to allocate fewer financial
or personnel resources to the functions of the Office of
Personnel Management related to the administration of the
Federal Employees Health Benefit Program under chapter 89
of title 5, United States Code.
(2) SEPARATE RISK POOL.—Enrollees in multi-State qualified
health plans under this section shall be treated as a separate
risk pool apart from enrollees in the Federal Employees
Health Benefit Program under chapter 89 of title 5, United
States Code.
(3) AUTHORITY TO ESTABLISH SEPARATE ENTITIES.—The Director
may establish such separate units or offices within the
Office of Personnel Management as the Director determines to
be appropriate to ensure that the administration of multi-State
qualified health plans under this section does not interfere
with the effective administration of the Federal Employees
Health Benefit Program under chapter 89 of title 5, United
States Code.
(4) EFFECTIVE OVERSIGHT.—The Director may appoint such
additional personnel as may be necessary to enable the Director
to carry out activities under this section.
(5) ASSURANCE OF SEPARATE PROGRAM.—In carrying out
this section, the Director shall ensure that the program under
this section is separate from the Federal Employees Health
Benefit Program under chapter 89 of title 5, United States
Code. Premiums paid for coverage under a multi-State qualified
health plan under this section shall not be considered to
be Federal funds for any purposes.
(6) FEHBP PLANS NOT REQUIRED TO PARTICIPATE.—Nothing
in this section shall require that a carrier offering coverage
under the Federal Employees Health Benefit Program under
chapter 89 of title 5, United States Code, also offer a multi-State
qualified health plan under this section.
(h) ADVISORY BOARD.—The Director shall establish an advisory
board to provide recommendations on the activities described in
this section. A significant percentage of the members of such board
shall be comprised of enrollees in a multi-State qualified health
plan, or representatives of such enrollees.
(i) AUTHORIZATION OF APPROPRIATIONS.—There is authorized to
be appropriated, such sums as may be necessary to carry out this
section.