The Centers for Medicare & Medicaid Services today issued a proposed rule further detailing parameters for several Patient Protection and Affordable Care Act provisions beginning in 2014. These include the ACA's risk adjustment, reinsurance, and risk corridors provisions, including calculation of reinsurance contributions to be paid by self-insured employer plans; user fees to be paid by health plans for participating in a federally facilitated insurance exchange; processing of cost-sharing reductions and advance payments of the premium tax credit to plans to avoid access barriers for low-income enrollees; implementing provisions for a federally facilitated Small Business Health Option Program; and changes to the medical loss ratio requirements including treatment of community service expenses for tax-exempt plans. The proposed rule will be published in the Dec. 7 Federal Register with comments accepted through Dec. 31. Also today, the Office of Personnel Management issued a proposed rule outlining the Multi-State Plan Program. The ACA directs OPM to contract with private health insurers to offer at least two multi-state plans on each state insurance exchange. The rule will be published in the Dec. 5 Federal Register with comments accepted for 30 days.