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Multi-State Plan Program on the Affordable Insurance Exchanges

 

Overview

OPM's Multi-State Plan Program (MSPP) was created by the Affordable Care Act. The MSPP will promote competition in the insurance marketplace and help ensure consumers have more high quality, affordable health insurance plans from which to choose. These health insurance plans, known as Multi-State Plans (MSPs), will be among several health insurance options from which individuals and small employers will be able to choose starting in 2014.

This website provides the latest information from OPM on the status of the MSPP.

To learn more about the Affordable Care Act and Exchanges, please visit HealthCare.gov.

Regulation

OPM published a Notice of Proposed Rulemaking (NPRM) November 30, 2012. The NPRM sets forth the proposed standards for the MSPP.

For more information on the regulation, please view our Fact Sheet.

Visit Regulations.gov to submit comments on MSPP NPRM, RIN: 3206-AM47. The comment period is December 5, 2012 to January 4, 2013.

MSPP Issuer Application

OPM published the final MSPP application on January 18, 2013. A health insurance issuer interested in offering Multi-State Plans on the Affordable Insurance Exchanges may view the application at the Federal Business Opportunities website to view questions and begin the process of gathering the required information.

To begin the application process, health insurance issuer applicants will need to submit a Notice of Intent to Apply (NOI) via email to MSPP@opm.gov. Once OPM confirms the entity submitting the NOI represents a health insurance issuer or group of issuers with potential nationwide scope, it will contact the entity with instructions on how and when to access the web-based MSPP application portal, which will be accessible in February 2013.

Submitting a NOI is not binding and does not commit an issuer to become an MSPP issuer. However, an issuer cannot submit an application without first submitting a NOI.

This final application represents policies included in proposed regulations for the MSPP. Accordingly, OPM reserves the right to modify this application, as necessary, and to request additional information from applicants.

To download the MSPP paper application, visit Federal Business Opportunities.

Factsheet: Proposed Rule for the Multi-State Plan Program

On November 30, 2012, the U.S. Office of Personnel Management (OPM) published a Notice of Proposed Rulemaking setting forth the proposed standards for the Multi-State Plan Program (MSPP). The MSPP is a new program established by the Affordable Care Act. The MSPP will promote competition in the insurance marketplace and ensure 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 on Exchanges 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 on Exchanges.

OPM is committed to ensuring the MSPP promotes competition and that the MSPs operate on a level playing field with other plans on the Exchanges in all States. 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.

We encourage the public to comment on this proposal.

Objectives of the MSPP

The proposed rule sets forth the following objectives in administering the MSPP:

  • To ensure a choice of at least two high-quality products to consumers participating on each Exchange;
  • To promote competition in the health insurance marketplace to the benefit of all consumers;
  • To offer plans from the same issuer to families or small businesses that may reside or operate in more than one State;
  • To provide strong, effective contractual oversight of the issuers that choose to offer MSPs; and
  • To 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 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.

Highlights of the Proposed Rule

  • The rule proposes standards for MSPP issuers who want to participate in the MSPP. The Affordable Care Act sets forth that the MSPP be governed by all State and Federal laws that apply to QHPs and ensures that there are at least two issuers offering MSPs on each Exchange in every State and the District of Columbia.
  • This proposed rule reflects the intention for the MSPs and MSPP issuers to adhere to all State and Federal laws applicable to QHPs and QHP issuers, except to the extent any such laws are inconsistent with these regulations, OPM guidance, or OPM’s contracts with MSPP issuers. OPM will monitor future developments around the State specific requirements that will be in place in 2014 and beyond and address inconsistencies as they arise.
  • The proposed rule sets forth 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 proposed rule sets forth 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 proposed rule sets forth how OPM will monitor contract performance for the MSPP, including ensuring quality assurance, preventing fraud and abuse, and possible contract compliance actions.
  • The proposed rule sets out a process and standards for handling appeals for enrollees that are denied claims for payment or service.

Public Comment

The deadline for submitting comments on the proposed regulation is December 30, 2012. OPM will review the comments and issue a final regulation next year. OPM will review the comments and issue a final regulation next year.

Presentations

Feedback and/or questions on the below MSPP presentations or marketing material can be emailed to mspp@opm.gov.

FileDateType
Overview of the Multi-State Plan Program December 19, 2012 Webinar