Source: https://www.federalregister.gov/articles/2013/08/08/2013-19222/federal-employees-health-benefits-program-members-of-congress-and-congressional-staff
Timestamp: 2016-07-30 13:03:54
Document Index: 728390372

Matched Legal Cases: ['§ 890', 'art 890', '§ 89', '§ 890', '§ 890', '§ 890', '§ 890', '§ 890', '§ 890', '§ 890', '§ 890', '§ 890']

Federal Register | Federal Employees Health Benefits Program: Members of Congress and Congressional Staff
Dates: OPM must receive comments on or before September 9, 2013.
78 FR 48337
-48339 (3 pages)
3206-AM85
Document Number: 2013-19222
Shorter URL: https://federalregister.gov/a/2013-19222 Related Topics
OPM-2013-0016
The U.S. Office of Personnel Management (OPM) is issuing a proposed rule to amend the Federal Employees Health Benefits (FEHB) Program regulations regarding coverage for Members of Congress and congressional staff.
Federal Employees Health Benefits Program: Members of Congress and Congressional Staff 2 actions from August 8th, 2013 to March 2014
Effective Date of Termination of Coverage
Clarification of Meaning of “Health Benefit Plan Under This Chapter” As Used in 5 U.S.C. 8905(b) and 5 U.S.C. 8906
OPM must receive comments on or before September 9, 2013.
Send written comments to Chelsea Ruediger, Planning and Policy Analysis, U.S. Office of Personnel Management, Room 2H28, 1900 E Street NW., Washington, DC 20415. You may also submit comments using the Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
This proposed rule is intended to amend FEHB Program eligibility regulations to comply with section 1312 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act, Public Law 111-152 (the Affordable Care Act or the Act). Subparagraph 1312(d)(3)(D) of the Affordable Care Act states that, “Notwithstanding any other provision of law . . . the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are—(I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).” The Act defines “Member of Congress” as any member of the House of Representatives or the Senate and “congressional staff” as all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.
While the Affordable Care Act does not amend 5 U.S.C. 8901, the effect of the “notwithstanding” clause of section 1312 is to limit the ability of Members of Congress and congressional staff to purchase health benefits plans for which OPM may contract under chapter 89. Section 1312 specifies that “the only health plans that the Federal Government may make available” are those that are either “created under” the ACA, or “offered through an Exchange established under” the Act. The health benefits plans for which OPM can contract under chapter 89 are not “created under” the ACA, nor are they offered through the Exchanges. Therefore, Members of Congress and congressional staff who are employed by the official office of a Member of Congress may no longer purchase the health benefits plans for which OPM contracts under chapter 89. As part of their service, they are limited to purchasing plans from Exchanges. This proposed rule implements this mandate.
Effective Date of Termination of Coverage Back to Top
Though the Affordable Care Act does not provide a specific effective date for Subparagraph 1312(d)(3)(D), OPM has concluded that the most reasonable reading of the statute is that enrollment in FEHB contracted plans under chapter 89 of title 5 will no longer be available to Members of Congress and congressional staff who are employed by the official office of a Member of Congress as of January 1, 2014, the date under the Act that Exchanges (also called Health Insurance Marketplaces) established under the Affordable Care Act will be available for providing health insurance coverage.
Accordingly, we are proposing that FEHB health plan enrollment for Members of Congress and congressional staff employed by the official office of a Member of Congress terminate (with a 31-day extension of coverage and opportunity for conversion) on the first day of the last pay period in which they are eligible for FEHB. FEHB coverage will continue through the end of the pay period in which enrollment is terminated. Therefore, the termination of coverage will be effective at midnight on December 31, 2013.
Members of Congress and Congressional Staff Back to Top
The proposed rule defines a “Member of Congress” as a member of the Senate or of the House of Representatives, a Delegate to the House of Representatives (which includes delegates from the District of Columbia and the territories), and the Resident Commissioner of Puerto Rico. Under the Affordable Care Act, territories are not required to establish an Exchange but may elect to do so. We seek comment on the health plans made available to Members of Congress who represent territories that do not establish Exchanges.
Based on research related to the administration of congressional staffing, including communication with the respective House and Senate administrative and disbursement offices, OPM has determined that Members' offices are best equipped to make the determination as to whether an individual is employed by the “official office” of that Member. OPM's understanding is that congressional staff often have allocated to them a percentage of work as personal staff and a percentage of work as committee or leadership committee staff. It also is common for the percentage to change during the year. Moreover, staff are often unaware of these percentages or budgetary source of their compensation. OPM believes that allowing the employing office to make the determination as to whether particular individuals are employed by the “official office” is most appropriate, and will allow such determinations to be made by the office of the Member of Congress, which is their employer. As part of their responsibility to make this determination, the employing offices shall be the final authority with respect to the determination for each individual. Under these proposed regulations, OPM will not review or overturn these determinations. OPM seeks comment on this proposed approach.
The proposed rule also states that the designation will be effective for the entire FEHB Program plan year during which the staff member works for that Member of Congress. OPM believes that it would be unduly disruptive for an individual to move back and forth from Exchange coverage to FEHB Program coverage mid-year. In addition, due to the complexity of congressional staffing assignments, OPM's understanding is that payroll changes may be made without the congressional staff member being aware of these changes. Therefore, OPM has proposed that individuals maintain their designations for an entire year so long as they continue to be employed by the same Member of Congress. OPM seeks comment on the feasibility of this method.
Clarification of Meaning of “Health Benefit Plan Under This Chapter” As Used in 5 U.S.C. 8905(b) and 5 U.S.C. 8906 Back to Top
As noted above, the ACA circumscribes the ability of the Federal Government to offer health insurance to Members of Congress and certain congressional staff in connection with their service to only those plans offered on Exchanges. The ACA did not, however, alter the definition of “employee” as used in 5 U.S.C. 8901(1)(B) (C) or the definition of “health benefits plan” under 5 U.S.C. 8901(6). Although, pursuant to its authority under chapter 89 of title 5, OPM will have no role in “contracting for” or “approving” health benefit plans that are offered through the Exchanges, there is no doubt that such plans fit within the definition of “health benefit plan” under 8901(6). This proposed regulation imposes no new requirements on qualified health plans or Exchanges.
In order to establish that the contributions and withholdings will be appropriately accounted for pursuant to section 8909 of title 5, we have added new paragraph (h) to § 890.501. The two enrollment categories used by FEHB, self or self and family, are not generally applicable in an Exchange. In an Exchange, a family's premium will generally be based on the actual composition of the family (for example, one adult, two adults, one adult and two children, etc.). A state may also choose to establish family tiers that may differ from the two enrollment categories used by FEHB. Therefore, subparagraph (h)(1) reflects that OPM will apply the self and family contribution level to any Exchange enrollment category other than one adult/individual. Subparagraph (h)(2) clarifies the accounting issue with respect to payments for health benefits plans under Exchanges.
I certify that this regulation will not have a significant economic impact on a substantial number of small entities because the regulation only involves the issue of where Members of Congress and certain congressional staff may purchase their health insurance, and does not otherwise alter the FEHB program.
Administration and general provisions; Health benefits plans; Enrollment
Temporary extension of coverage and conversion; Contributions and withholdings; Transfers from retired FEHB Program; Benefits in medically underserved areas; Benefits for former spouses; Limit on inpatient hospital charges
and FEHB benefit payments; Administrative sanctions imposed against health care providers; Temporary continuation of coverage; Benefits for United States hostages in Iraq and Kuwait and United States hostages captured in Lebanon; Department of Defense Federal Employees Health Benefits Program demonstration project; Administrative practice and procedure
Accordingly, OPM is proposing to amend title 5, Code of Federal Regulations as follows:
1.The authority citation for part 890 is revised to read as follows: Authority:
5 U.S.C. 8913; Sec. 890.301 also issued under sec. 311 of Pub. L. 111-03, 123 Stat. 64; Sec. 890.111 also issued under section 1622(b) of Pub. L. 104-106, 110 Stat. 521; Sec. 890.112 also issued under section 1 of Pub. L. 110-279, 122 Stat. 2604; 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 101, 104 Stat. 2064, as amended; Sec. 890.102 also issued under sections 11202(f), 11232(e), 11246 (b) and (c) of Pub. L. 105-33, 111 Stat. 251; and section 721 of Pub. L. 105-261, 112 Stat. 2061; Public Law 111-148, as amended by Public Law 111-152.
2.Amend § 89 0.101 adding definitions for “congressional staff member” and “Member of Congress” to paragraph (a) to read as follows: § 890.101 Definitions; time computations.
3.Amend § 890.102 by adding paragraphs (c)(9) and (10) and revising paragraph (e) to read as follows: § 890.102 Coverage.
4.Amend § 890.303 by revising paragraph (b) to read as follows: § 890.303 Continuation of enrollment.
5.Amend § 890.304 by revising paragraph (a)(1)(iii) to read as follows. § 890.304 Termination of enrollment.
6.Amend § 890.501 by adding paragraph (h) to read as follows: § 890.501 Government contributions.
[FR Doc. 2013-19222 Filed 8-7-13; 8:45 am]