The Office of Personnel Management recently issued a final rule on the multi-state plan program in which it attempts to standardize contracting processes and state rules to, in theory, make it easier for insurers to enter new markets while limiting the extent to which multi-state plan issuers can bypass state consumer protections and preserving a level playing field in exchanges. Christine Monahan discusses how OPM has attempted to balance these competing pressures and discusses where multi-state plans may or may not have flexibility.