The Obama administration is proposing regulatory changes that it hopes will attract insurers that have been hesitant to offer multistate plans on the health insurance exchanges.
The Multi-State Plan Program was conceived as a way to increase competition among health plans offered through the exchanges set up under the Patient Protection and Affordable Care Act.
The U.S. Office of Personnel Management, which coordinates contracts for the plans, has noted that if not for the program, consumers in Alaska, New Hampshire and West Virginia would have access to only one type of insurance plan. The Blue Cross and Blue Shield Association was the first insurer to offer multi-state plans across a large portion of the country, agreeing last year to offer about 150 plans in 30 states and Washington, D.C. In the second enrollment period, consumers also have the option of choosing multistate options from the not-for-profit organizations that run Consumer Operated and Oriented Plans, or CO-OPs, which expand the program to five additional states.
Insurers previously expressed concern that the requirements for MSPs were too cumbersome. In an attempt to attract more competition to the MSP program, OPM is proposing broadening eligibility and easing standards that require issuers to provide statewide coverage, according to documents posted on the website of the Federal Register on Friday.
Currently, MSP participants may include a group of issuers affiliated by common ownership and control or by the use of a nationally licensed service mark. Participants can also be an affiliation of health insurance issuers and an entity that is not an issuer but owns a nationally licensed service mark, like the Blue Cross and Blue Shield Association.
OPM is seeking comment on whether this definition allows for alternative structures, such as a consortium of health insurers or organizations that might join together and offer multistate plans. Broadening the language to include these structures could encourage hesitant insurers to team up to offer multistate plans.
In an attempt to eliminate obstacles, the agency proposes getting rid of a standard that requires MSP issuers to submit a plan to offer statewide coverage. Instead, OPM would negotiate with them to determine how viable statewide coverage would be given other commitments and financial constraints.
The agency also has proposed allowing issuers to decide on a state-by-state basis whether to make the plans comparable to the minimum benefits set by a state-benchmarked plan or a federally benchmarked plan, or both.
There has been some confusion about prescription drug formulary standards, according to the document. OPM says it will work with issuers to negotiate an appropriate formulary and is seeking comment on the feasibility of using the formularies included in state benchmark plans instead.
Consumers and state regulators, meanwhile, have expressed concern that issuers of multistate plans have not been transparent about whether plans included or excluded coverage for abortion services—the agency proposed that they be required to disclose coverage or exclusion of these services before a consumer enrolls.
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