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Frequently Asked Questions Insurance

What are the network adequacy standards proposed by OPM for the MSP Program?

An MSP Program issuer must ensure that the provider network of each of its MSP options, as available to all enrollees, meets the following standards:

• is sufficient in number and types of providers to ensure that all services will be accessible to enrollees without unreasonable delay;
• is consistent with the network adequacy provisions of section 2702(c) of the Public Health Service Act; and
• includes essential community providers in compliance with 45 C.F.R. § 156.235.
In addition, an MSP Program issuer must make its provider directory for each MSP available to the Exchange for publication online pursuant to guidance from the Exchange and to potential enrollees in hard copy upon request. In the provider directory, an MSP Program issuer must identify providers that are not accepting new patients.

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