The final rule (which was published the in Federal Register on March 11, 2013) implements the Multi-State Plan Program (MSPP) under ACA §1334 which requires the OPM, which administers the Federal Employees Health Benefits Program (FEHBP), to contract with at least two Multi-State Plans (MSPs) on each of the Affordable Insurance Exchanges.

The MSPP is intended to promote competition in the insurance marketplace and help ensure individuals and small employers have higher quality, affordable health insurance plans from which to choose beginning in 2014. An MSPP issuer may phase in the States in which it offers coverage over four years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuerparticipates in the MSPP. Health insurance issuers who wish to offer MSPs will complete an application. Although the MSPP is a federal program it will offer products through the state-level exchanges. In addition to compliance with the ACA's requirements that apply to all qualified health plans (QHPs), MSP's must also comply with applicable FEHBP requirements and be licensed by the states in which they do business. Under the ACA, OPM will negotiate a contract with each multi-state QHP in order for that plan to be certified for participation in that state's Exchange. QHPs are health plans that have been certified by an Exchange, provide essential health benefits (§1301) and follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts).

The ACA requires implementation of a uniform, nationally applicable external review process for MSP options, similar to the process administered by OPM under the FEHB Program. This process will ensure that MSP Program contracts are administered consistently throughout all 51 jurisdictions that would be served by an MSP option. In addition to requests for external review, MSP enrollees may contact OPM about inquiries or complaints regarding MSP options, which may be referred to other appropriate entities such as state insurance departments, state consumer assistance programs, and the U.S. Department of Health and Human Services.

On November 13, 2013, the Departments of Treasury, Labor, and Health and Human Services jointly published "Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008; Technical Amendment to External Review for Multi-State Plan Program". The MHPAEA final rules retain provisions from the March 21, 2013 final rule, while implementing a technical amendment related to external review. The MHPAEA final rules specify that §1334 requires that MSP insurers must comply with either a state external review process or the federal external review process.

Prior guidance can be found at: http://www.hhs.gov/healthcare/index.html 

Upcoming Events 

Integrating Medicare and Medicaid for Dual Eligible Individuals

Implementation Council Meeting

Friday, December 20, 2013

1:00 PM -3:00 PM

State Transportation Building, Conference Room 1-3

10 Park Plaza

Boston, MA

Meetings of the Implementation Council are open to stakeholders and members of the public with an interest in One Care. Reasonable accommodations will be made for participants who need assistance. Please send your request for accommodations to Donna Kymalainen at Donna.Kymalainen@state.ma.us.