PPACA Impact and Opportunities : Health Care Lawyer & Attorney : Epstein Becker Green Law Firm : Insurance & Costs : Health Reform Musings Blog

by Lynn Shapiro Snyder,  Shawn M. Gilman,  Adam C. Solander, and Constance A. Wilkinson

On June 16, 2011, the Office of Personnel Management (“OPM”) released the Request for Information (“RFI”) regarding Section 1334 of the Affordable Care Act, which requires OPM to contract with health insurers to offer multi-state qualified health plans (“MSQHPs”). The purpose of the RFI is to provide OPM with information that will allow it to better understand the “interests and capabilities” of health insurance issuers that will offer MSQHPs through Health Insurance Exchanges. This alert summarizes the substantive information requested by OPM in the RFI.  Additionally, this alert provides the statutory context in which OPM is operating pursuant to Section 1334 of the Affordable Care Act.

Read the full alert online 

David C. Gibbons, a Summer Associate (not admitted to the practice of law) in EpsteinBeckerGreen's Washington, DC, office, contributed significantly to the preparation of this alert.

Much of the work of the Commonwealth Fund and others seems to presume that payors are a necessary intermediary and should be the entities doling out population prepayment (aka capitation before it was a nasty word). However, it need not work out that way – particularly with House Dems’ concern that Medicare Advantage was profiteering.

It would be a small step for the new public plan likely to be created to make “population prepayments” directly to integrated health systems particularly because the covered lives under such a plan are likely to have the benefit of public reinsurance. Also, since that coverage will not be employer based it will be easier for those integrated systems to assume risk for that plan’s lives (no need for national networks).

Through such direct health system participation those systems would be incented to create the high performance integration these studies suggest is desirable. The Commonwealth Fund is about to release its new blue print . It will be interesting to see if such an evolution is being thought about.