Title 45

PART 153

Part 153 - Standards Related To Reinsurance, Risk Corridors, And Risk Adjustment Under The Affordable Care Act

PART 153 - STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT Authority:42 U.S.C. 18031, 18041, and 18061 through 18063. Source:77 FR 17245, Mar. 23, 2012, unless otherwise noted.

45:2.0.1.1.11.1SUBPART A
Subpart A - General Provisions
45:2.0.1.1.11.1.1.1SECTION 153.10
   153.10 Basis and scope.
45:2.0.1.1.11.1.1.2SECTION 153.20
   153.20 Definitions.
45:2.0.1.1.11.2SUBPART B
Subpart B - State Notice of Benefit and Payment Parameters
45:2.0.1.1.11.2.1.1SECTION 153.100
   153.100 State notice of benefit and payment parameters.
45:2.0.1.1.11.2.1.2SECTION 153.110
   153.110 Standards for the State notice of benefit and payment parameters.
45:2.0.1.1.11.3SUBPART C
Subpart C - State Standards Related to the Reinsurance Program
45:2.0.1.1.11.3.1.1SECTION 153.200
   153.200 [Reserved]
45:2.0.1.1.11.3.1.2SECTION 153.210
   153.210 State establishment of a reinsurance program.
45:2.0.1.1.11.3.1.3SECTION 153.220
   153.220 Collection of reinsurance contribution funds.
45:2.0.1.1.11.3.1.4SECTION 153.230
   153.230 Calculation of reinsurance payments made under the national contribution rate.
45:2.0.1.1.11.3.1.5SECTION 153.232
   153.232 Calculation of reinsurance payments made under a State additional contribution rate.
45:2.0.1.1.11.3.1.6SECTION 153.234
   153.234 Eligibility under health insurance market rules.
45:2.0.1.1.11.3.1.7SECTION 153.235
   153.235 Allocation and distribution of reinsurance contributions
45:2.0.1.1.11.3.1.8SECTION 153.240
   153.240 Disbursement of reinsurance payments.
45:2.0.1.1.11.3.1.9SECTION 153.250
   153.250 Coordination with high-risk pools.
45:2.0.1.1.11.3.1.10SECTION 153.260
   153.260 General oversight requirements for State-operated reinsurance programs.
45:2.0.1.1.11.3.1.11SECTION 153.265
   153.265 Restrictions on use of reinsurance funds for administrative expenses.
45:2.0.1.1.11.3.1.12SECTION 153.270
   153.270 HHS audits of State-operated reinsurance programs.
45:2.0.1.1.11.4SUBPART D
Subpart D - State Standards Related to the Risk Adjustment Program
45:2.0.1.1.11.4.1.1SECTION 153.300
   153.300 [Reserved]
45:2.0.1.1.11.4.1.2SECTION 153.310
   153.310 Risk adjustment administration.
45:2.0.1.1.11.4.1.3SECTION 153.320
   153.320 Federally certified risk adjustment methodology.
45:2.0.1.1.11.4.1.4SECTION 153.330
   153.330 State alternate risk adjustment methodology.
45:2.0.1.1.11.4.1.5SECTION 153.340
   153.340 Data collection under risk adjustment.
45:2.0.1.1.11.4.1.6SECTION 153.350
   153.350 Risk adjustment data validation standards.
45:2.0.1.1.11.4.1.7SECTION 153.360
   153.360 Application of risk adjustment to the small group market.
45:2.0.1.1.11.4.1.8SECTION 153.365
   153.365 General oversight requirements for State-operated risk adjustment programs.
45:2.0.1.1.11.5SUBPART E
Subpart E - Health Insurance Issuer and Group Health Plan Standards Related to the Reinsurance Program
45:2.0.1.1.11.5.1.1SECTION 153.400
   153.400 Reinsurance contribution funds.
45:2.0.1.1.11.5.1.2SECTION 153.405
   153.405 Calculation of reinsurance contributions.
45:2.0.1.1.11.5.1.3SECTION 153.410
   153.410 Requests for reinsurance payment.
45:2.0.1.1.11.5.1.4SECTION 153.420
   153.420 Data collection.
45:2.0.1.1.11.6SUBPART F
Subpart F - Health Insurance Issuer Standards Related to the Risk Corridors Program
45:2.0.1.1.11.6.1.1SECTION 153.500
   153.500 Definitions.
45:2.0.1.1.11.6.1.2SECTION 153.510
   153.510 Risk corridors establishment and payment methodology.
45:2.0.1.1.11.6.1.3SECTION 153.520
   153.520 Attribution and allocation of revenue and expense items.
45:2.0.1.1.11.6.1.4SECTION 153.530
   153.530 Risk corridors data requirements.
45:2.0.1.1.11.6.1.5SECTION 153.540
   153.540 Compliance with risk corridors standards.
45:2.0.1.1.11.7SUBPART G
Subpart G - Health Insurance Issuer Standards Related to the Risk Adjustment Program
45:2.0.1.1.11.7.1.1SECTION 153.600
   153.600 [Reserved]
45:2.0.1.1.11.7.1.2SECTION 153.610
   153.610 Risk adjustment issuer requirements.
45:2.0.1.1.11.7.1.3SECTION 153.620
   153.620 Compliance with risk adjustment standards.
45:2.0.1.1.11.7.1.4SECTION 153.630
   153.630 Data validation requirements when HHS operates risk adjustment.
45:2.0.1.1.11.8SUBPART H
Subpart H - Distributed Data Collection for HHS-Operated Programs
45:2.0.1.1.11.8.1.1SECTION 153.700
   153.700 Distributed data environment.
45:2.0.1.1.11.8.1.2SECTION 153.710
   153.710 Data requirements.
45:2.0.1.1.11.8.1.3SECTION 153.720
   153.720 Establishment and usage of masked enrollee identification numbers.
45:2.0.1.1.11.8.1.4SECTION 153.730
   153.730 Deadline for submission of data.
45:2.0.1.1.11.8.1.5SECTION 153.740
   153.740 Failure to comply with HHS-operated risk adjustment and reinsurance data requirements.