What are the network adequacy standards proposed by OPM for the MSPP?
An MSPP issuer must ensure that the provider network of each of its MSPs, 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 MSPP 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 MSPP issuer must identify providers that are not accepting new patients.
OPM will issue guidance containing the criteria and standards that it will use to determine the adequacy of a provider network. A draft MSPP application was published September 20, 2012 on Federal Business Opportunities website. OPM accepted comments on the draft MSPP application through October 22, 2012 and is carefully reviewing comments submitted. In this draft application, OPM proposed specific standards for network adequacy. The draft application, Solicitation Number: OPM35-12-R-0006, can be viewed on the Federal Business Opportunities website available at MSPP Draft Application. OPM will publish the final MSPP application in early 2013.
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