Health Center Regulatory Issues, Uncategorized

CMS Announces $3.8 billion in Loans for CO-OP Program and Issues Proposed Rule

By: Robert Kidney

The Affordable Care Act established the Consumer Operated and Oriented Plan (CO-OP) Program which provides loans to foster the creation of consumer-governed, private, non-profit health insurance issuers to offer qualified health plans in state-based insurance exchanges.  In addition to improving consumer choice and plan accountability, the CO-OP Program seeks to promote integrated models of care and enhance competition in the Exchanges.  The goal is to have at least one CO-OP plan in each state. NACHC responded to the initial request for comment (RFC) on March 1, 2011.

CMS will fund two types of loans—joint start-up and solvency loans, and just solvency loans.  To be eligible for a loan, the applicant must be a private non-profit member organization and must intend to become a CO-OP.  An organization licensed by a State as a health insurance issuer as of July 16, 2009 or it was a related entity or predecessor organization of such an issuer, is not eligible.  State or local government entities are also ineligible.  The first round of applications are due October 17, 2011. After the first round, subsequent loan applications have quarterly due dates until December 31, 2012 and CMS indicates that the anticipated notice of first round loan awards will be January 12, 2012.  CMS estimates that 51 applicants will be awarded joint start-up and solvency loans or only solvency loans because the health reform law envisions a CO-OP plan in each state and the District of Columbia.

Comments on the proposed rule are due September 16, 2011.

Read the CMS Press Release

Fact Sheet: CO-OP Health Plans