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Feds propose PPACA multi-state plan regs

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The U.S. Office of Personnel Management (OPM) is proposing regulations for  a new “Multi-State Plan Program” (MSPP) that could, in effect, give ordinary consumers access to health plans that are similar to the plans federal employees use.

OPM has posted a 122-page preliminary version of the MSPP regulations on the Web.

The regulations are set to appear in the Federal Register Dec. 5.

Comments will be due 30 days after the official Federal Register publication date.

Drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) included the MSPP provision in PPACA in an effort to give Americans access to the kind of health coverage that members of Congress get.

PPACA requires state or federal regulators to provide health insurance exchange programs — Web-based health insurance supermarkets — throughout all U.S. states and the District of Columbia. Individuals and small groups are supposed to be able to use new tax subsidies to buy high-quality “qualified health plan” (QHP) coverage through the exchanges.

Each exchange user is supposed to have access to two “multi-state plans” (MSPs) — plans administered by OPM that have the ability to operate across state lines.

OPM runs the popular Federal Employees’ Health Benefits Program, a plan that offers members of Congress, congressional staffers, and most other federal employees access to a menu of health benefits options from many different carriers.

In a preamble to the proposed regulations, officials said of MSP vendors that:

  • An MSP can phase in the states in which it offers coverage over four years, but it must offer MSPs through all operating PPACA exchanges within four years after joining the MSP program.
  • The term of an MSP contract would be at least 12 months.
  • Vendors might have to pay user fees, to help OPM cover the cost of running the MSP program.
  • OPM is still thinking about whether and how to require MSPs to offer coverage in all areas of all states in which they operate.
  • OPM would work with states to regulate MSP rates, but the final authority over MSP rates would rest with OPM.
  • OPM intends for MSPs to be subject to any federal or state regulations concerning how risk pools will be combined or split.
  • An MSP would have to participate in the new PPACA programs that are supposed to help manage PPACA-related antiselection risk.

OPM recently posted information about a job opening for an MSPP program analyst who would help support the process of contracting with MSPP contractors.

One question has been how federal regulators will reconcile the desire to make multi-state plans available with many health policy specialists’ concerns about the possibility of MSPs evading state benefits mandates or other state health insurance laws, such as laws governing complaint processes.

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“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,” OPM officials said.

PPACA “generally requires that the MSPP be governed by all state and federal laws that apply to QHPs,” officials said. “The act, however, grants discretion to the [OPM] director to administer the MSPP in a manner that fulfills OPM’s statutory responsibility to ensure that there are at least two issuers offering MSPs on each exchange in every state and the District of Columbia. OPM recognizes that potential MSPP issuers seek administrative simplicity and some uniformity of standards in the MSPP. Accordingly, in unusual circumstances, it may be necessary for the director to adopt standards or requirements for the MSPP that differ from standards and requirements applicable to QHPs under either state or federal law.”

The proposed regulation “reflects the director’s 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,” officials said. 

“It is not possible at this time, however, to identify with specificity the laws that OPM deems to be inconsistent with these regulations, OPM guidance, or OPM’s contracts with MSPP issuers,” officials said.

OPM officials noted that the PPACA “essential health benefits” (EHB) provisions will require all health plans sold through the PPACA exchange program, including the MSPs, to offer the EHB package of benefits. Each state is getting to choose its own EHB package, but within parameters set by the U.S. Department of Health and Human Services. 

OPM is thinking about letting any MSP choose between offering the state EHB package approved in each state in which it operates, or offering any EHB benchmark plan selected by OPM.

The OPM EHB benchmark plan might include more pediatric dental, vision and habilitative services than some states’ benchmark plans, officials said.

“We request comment on these options,” officials said.

An MSP would have to comply with the same cost-sharing rules that apply to other premium plans, and, like other exchange plans, it would have to offer coverage at least two of the four “metal levels” of coverage that can be offered through an exchange — gold-level coverage and silver-level coverage. An MSP would not necessarily have to offer platinum-level or bronze-level coverage.

If an MSP offered any coverage with a particular metal level, it would have to offer child-only coverage at that metal level.

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