On March 1, 2013, the U.S. Office of Personnel Management (OPM) published the final rule for the Multi-State Plan Program (MSPP) establishing standards for the MSPP and OPM’s approach to implementation of section 1334 of the Affordable Care Act. The MSPP is a new program that will promote competition in the new Health Insurance Marketplace, also known as the Affordable Insurance Exchanges, and will ensure that consumers have more high quality, affordable insurance choices.
The Affordable Care Act directs OPM to enter into contracts with private health insurance issuers to provide at least two Multi-State Plans (MSPs) to be offered in each State’s Marketplace beginning in 2014. At least one of these issuers must be a non-profit entity. Health insurance issuers who wish to participate in the MSPP will apply to OPM. OPM will determine which issuers are qualified to become MSPP issuers, enter into contracts with them, and certify their MSPs to be offered in the Marketplace.
OPM is committed to ensuring the MSPP offers high-quality health insurance products, promotes competition, and provides for MSPs to operate on a level playing field with other plans in the Marketplace. OPM continues to work with various stakeholders, including States, to meet these goals. OPM aims to administer the MSPP in a manner that is consistent with State insurance laws and that is informed by input from a broad array of stakeholders.
Objectives of the MSPP
The following objectives guide OPM's administration of the MSPP:
- Ensure a choice of at least two high-quality products to consumers participating in the Marketplace;
- Promote competition in the Marketplace to the benefit of all consumers;
- Offer plans from the same issuer to families or small businesses that may reside or operate in more than one State;
- Provide strong, effective contractual oversight of the issuers that choose to offer MSPs; and
- Work cooperatively with States and the U.S. Department of Health and Human Services (HHS) to ensure a level playing field for Qualified Health Plans (QHPs) and MSPs.
Drawing on OPM’s Experience in Contracting under the Federal Employees Health Benefits Program (FEHBP) to implement the MSPP
The Affordable Care Act directs OPM to implement the MSPP “in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers” under the Federal Employees Health Benefits Program (FEHBP). OPM is drawing on its successful experience of more than 50 years administering FEHBP in implementing the MSPP. OPM has been able to administer this robust health insurance program efficiently, keeping administrative costs low while providing strong consumer protections.
Highlights of the Final Rule
- The final rule establishes standards for MSPP issuers who want to participate in the MSPP. The Affordable Care Act sets forth the general requirement that the MSPP be governed by all State and Federal laws that apply to Qualified Health Plans (QHPs) and ensures that there are at least two issuers offering MSPs in at least 31 Marketplaces this year, with coverage to be extended to the Marketplaces in every State and the District of Columbia by 2017.
- The final rule reflects OPM’s commitment to collaborate with States to ensure that the MSPs are neither competitively advantaged nor disadvantaged in the Marketplaces. It preserves the States’ traditional role in regulating their insurance markets and establishes standards for the MSPP that are consistent with standards applicable to QHPs in each State. The rule also announces OPM’s intention to pursue memoranda of understanding with each State in which an MSP will be offered and establishes a process for informal resolution of disputes that arise in the future between States and OPM concerning MSPs.
- The final rule establishes standards related to how OPM will coordinate with States and HHS to approve rates, standards for rating, medical loss ratios, and an MSPP issuer’s participation in reinsurance, risk adjustment, and risk corridor programs.
- The final rule establishes OPM’s process for MSPP application and contracting procedures, including review of applications, contract negotiations, terms of the MSPP contract, and contract renewal and nonrenewal.
- The final rule establishes how OPM will monitor contract performance for the MSPP, including ensuring quality assurance, preventing fraud and abuse, and possible contract compliance actions.
- The final rule establishes a process and standards for handling appeals for enrollees that are denied claims for payment or service.
Timeline
The initial open enrollment period for MSPs, as with qualified health plans, begins October 1, 2013 for coverage beginning January 1, 2014. Individuals and small businesses wishing to enroll in MSPs will then be able to enroll through the Health Insurance Marketplace in their State. However, an MSP may not be available in every State until 2017.