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OPM Releases Final Rule on the Affordable Care Act’s Multi-State Plan Program

Erin Hertzog

Lindsey Murtagh

Melissa Bianchi

Donna Boswell

Margia K. Corner

Natalie Morris

04 March 2013
The U.S. Office of Personnel Management (OPM) released a final rule on March 1st establishing the Multi-State Plan Program (MSPP) pursuant to the Affordable Care Act. It is substantially the same as the proposed rule, with conforming changes to the non-discrimination provisions to conform to recent changes in the final Essential Health Benefits regulation.
OPM Releases Final Rule on the Affordable Care Act’s Multi-State Plan Program

The Affordable Care Act directs OPM to contract with private health insurance issuers to offer at least two multi-state health plans (MSPs) in the Exchange for each state. In the final rule, OPM clarifies that MSPs must comply with federal requirements regarding availability of plans in both the individual and SHOP exchanges, but with OPM discretion to phase in this participation to ensure that network capacity is sufficient. On the same basis, MSPs must comply with state SHOP requirements, including states that have combined the individual and small group market.

The final rule makes clear that MSPs are governed by State and Federal laws and regulations that apply to qualified health plans (QHPs), and that MSPs must comply with state laws relating to their benchmark, including a requirement that QHPs may not alter or modify the benchmark benefits. However, OPM will not require MSPs to comply with a state’s active purchaser exchange requirements or competitive bidding, as authority to select MSPs resides with OPM under federal law.

Open enrollment in MSPs begins October 1, 2013 in at least 31 marketplaces for the coverage year beginning in 2014. By 2017, MSPs will be available to consumers in all states and in D.C.

OPM also released a fact sheet summarizing the rule.

Erin Hertzog

Lindsey Murtagh

Melissa Bianchi

Donna Boswell

Margia K. Corner

Natalie Morris

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