The CMS may contract with a third party to administer the public option plans and states may establish advisory councils to make recommendations to the CMS about the operation and policies of such plans. Further, the CMS must establish geographically adjusted premiums and negotiate provider payment rates for services and prescription drugs covered the plans. If a payment rate cannot be negotiated, the CMS must pay the amount for such service as required under traditional Medicare.

Medicare and Medicaid providers are automatically participants in public option plans unless they opt out, and providers not participating in Medicare or Medicaid may opt in.