Medically Underserved Areas

Up to and including 2014, fee-for-service FEHB carriers have been required to provide benefits to plan participants in Medically Underserved Areas (MUAs) who use any health provider licensed to perform specific medical services. This was a requirement of the Federal Employees Health Benefits law, which provided that a state must be designated as a Medically Underserved Area if 25 percent or more of its population lived in an area identified by the Department of Health and Human Services as a primary medical care manpower shortage area. In 2014, the states that met this definition were Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming.

Now all of that is out the window. On December 17, 2014, OPM issued a direct final rule to discontinue the annual determination of the Medically Underserved Areas for the FEHB program. The reason for this abrupt change is the enactment of Section 2706(a) of the Public Health Service Act. That section states that a health insurance issuer or group health plan offering coverage can’t discriminate against any health care provider who performs covered services when acting within the scope of their license or certification under applicable state law in any area of a state. In other words, HHS’s need to evaluate and identify states who met the Medically Underserved Area designation has been superseded by a federal law covering every state. In short, from now on “a plan or issuer shall not discriminate based on a provider’s license or certification under applicable state law.”

However, “this provision does not require plans or issuers to accept all types of providers into a network … [it] also does not govern provider reimbursement rates, which may be subject to quality, performance, or market standards and considerations.”

Seldom does the Congress make things easier to administer. This time it did.