§9003 Contracting Authority

Summary

The Office of Personnel Management must hire one or more qualified insurance companies to offer long-term care policies without using the usual federal competitive-bidding rules. Contracts must be awarded based on the company’s qualifications, price, and reasonable competition. Each master contract must say what benefits are covered (with any limits or exclusions), what the premiums are and how they might be changed, how people enroll, and any other agreed terms. Premiums must fairly match the cost of the benefits and cannot be changed during the contract unless both OPM and the carrier agree. Contracts may not be automatically renewed. Carriers must pay benefits when an enrolled person is entitled to them. They must have fast internal claim-review procedures and, if needed, independent third-party reviews that both OPM and the carrier accept. Whether someone is eligible for coverage can be reviewed only as the contract allows. Appeals and other disputes follow the contract-appeals board OPM names, and U.S. district courts share original jurisdiction with the U.S. Court of Federal Claims for certain actions. Master contracts run for 7 years unless ended earlier, and coverage for enrolled people continues until their coverage ends or a successor contract takes effect. For timing, if contracts start before the program’s first 7-year period ends, special start-date rules apply based on the first coverage date. No later than 180 days after getting the program’s second report, the President must tell Congress whether to keep, end, or change the program; for 180 days after that recommendation OPM cannot rebid coverage that would start after the 7-year period. Coverage must stay with a person even if they leave government service or lose qualified-relative status. If a worker is furloughed or must work without pay because of a lapse in appropriations, their coverage continues and cannot be canceled for missed premium payments caused by the lapse.