The Centers for Medicare and Medicaid Services (CMS) released final rules on December 13 on the Consumer Operated and Oriented Plan (CO-OP) provisions under section 1322 of the Affordable Care Act (ACA). Section 1322 authorizes up to $3.8 billion in federal loans to foster the creation of consumer-governed private non-profit health insurance issuers that will offer qualified health plan coverage through health insurance exchanges by January 2014. The objective is to launch at least one new CO-OP in every state in order to promote development of plans focused on delivery of integrated care, increase health insurance choices for consumers and small businesses, and spur competition over premiums among all plans that will be available to consumers and small businesses through the exchanges. The CMS rules describe standards that CO-OPs must meet and a process through which CO-OPs can apply for federal loans to cover start-up and other capitalization costs. CO-OPs can qualify for such loans only if they satisfy financial viability requirements and submit adequate business and operational plans with timelines. Start-up loans must be repaid within 5 years and loans to meet state insurance solvency and reserve requirements must be repaid within 15 years. CMS may award loans beginning in 2012 at interest rates benchmarked to Treasury securities with comparable maturity periods. The final rules are effective February 13, 2012.