The Office of Personnel Management (OPM) has issued final regulations that modify the Multi-state Plan Program (MSPP) based on its experience to date administering the MSPP (see Practice Note, Multi-state Plans under the ACA). Among other changes (some of which are non-substantive and technical), the final regulations address benefits provided under the MSPP, the phased-in approach to coverage, application and contracting procedures, and compliance actions.

The February 2015 regulations finalize proposed regulations that:

The Affordable Care Act (ACA) established the MSPP, under which OPM was required to contract with private health insurers to offer at least two multi-state plans in each state and the District of Columbia beginning in 2014. OPM monitors MSPP performance and oversees plan compliance with applicable legal requirements and contractual terms, based on its experience administering the Federal Employees Health Benefits Program (FEHBP), which provides health benefits to federal employees and their dependents.

According to the preamble to the final regulations:

For 2015, OPM contracted with a second group of insurers and expanded MSPP coverage to 36 states.

To increase MSPP competition, the final regulations allow MSPP insurers to:

(45 C.F.R. § 800.105(b).)

OPM also clarified its policy on formularies under OPM-selected EHB-benchmark plans by allowing MSPP insurers to manage formularies around the needs of enrollees (including potential enrollees).

By way of reminder, OPM noted its intent to:

(45 C.F.R. § 800.105(d).)

Health insurers may gradually expand their MSPP participation, under a rule that allows them to offer multi-state plan options in an increasing percentage of states over time (see Practice Note, Multi-state Plans under the ACA: Phased Expansion). Regarding this phased approach, the final regulations:

(45 C.F.R. § 800.104(b).)

An MSPP insurer must, with respect to each of its multi-state plans, meet several requirements to ensure a "level playing field" with other insurers operating in the health insurance exchanges (see Practice Note, Multi-state Plans under the ACA: Level Playing Field). The final regulations clarify that all categories listed under a related ACA provision must comply with a requirement involving state law compliance, including:

(45 C.F.R. §§ 800.114 and 800.115.)

Health insurers must comply with OPM procedures when applying to participate in an MSPP and contracting to become an MSPP insurer (see Practice Note, Multi-state Plans under the ACA: Application and Contracting Procedures). Addressing a recommendation from commenters that renewal applicants be required to complete a full (rather than a streamlined) application, OPM indicated in the preamble that renewal applications require comprehensive responses from insurers so that OPM can determine whether to renew a contract with the insurer.

MSPP insurers must satisfy certain requirements regarding how they carry out their contracts with OPM. These requirements address contract performance, contract quality assurance and fraud detection (see Practice Note, Multi-state Plans under the ACA: Compliance). Addressing compliance requirements, the final regulations clarify that:

OPM also added nonrenewal of participation as a compliance action.

The final regulations were published in the Federal Register on February 24, 2015, and will take effect on March 26, 2015.