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.

• Authority: 42 U.S.C. 18031, 18041, and 18061 through 18063.
• Source: 77 FR 17245, Mar. 23, 2012, unless otherwise noted.

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

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