Title 45

PART 800

Part 800 - Multi-state Plan Program

PART 800 - MULTI-STATE PLAN PROGRAM Authority:Sec. 1334 of Pub. L. 111-148, 124 Stat. 119; Pub. L. 111-152, 124 Stat. 1029 (42 U.S.C. 18054). Source:80 FR 9655, Feb. 24, 2015; 80 FR 16577, Mar. 30, 2015, unless otherwise noted.

• Authority: Sec. 1334 of Pub. L. 111-148, 124 Stat. 119; Pub. L. 111-152, 124 Stat. 1029 (42 U.S.C. 18054).
• Source: 80 FR 9655, Feb. 24, 2015; 80 FR 16577, Mar. 30, 2015, unless otherwise noted.

45:4.1.4.5.1.1	SUBPART A	Subpart A - General Provisions and Definitions
45:4.1.4.5.1.1.6.1	SECTION 800.10	800.10 Basis and scope.
45:4.1.4.5.1.1.6.2	SECTION 800.20	800.20 Definitions.
45:4.1.4.5.1.2	SUBPART B	Subpart B - Multi-State Plan Program Issuer Requirements
45:4.1.4.5.1.2.6.1	SECTION 800.101	800.101 General requirements.
45:4.1.4.5.1.2.6.2	SECTION 800.102	800.102 Compliance with Federal law.
45:4.1.4.5.1.2.6.3	SECTION 800.103	800.103 Authority to contract with issuers.
45:4.1.4.5.1.2.6.4	SECTION 800.104	800.104 Phased expansion, etc.
45:4.1.4.5.1.2.6.5	SECTION 800.105	800.105 Benefits.
45:4.1.4.5.1.2.6.6	SECTION 800.106	800.106 Cost-sharing limits, advance payments of premium tax credits, and cost-sharing reductions.
45:4.1.4.5.1.2.6.7	SECTION 800.107	800.107 Levels of coverage.
45:4.1.4.5.1.2.6.8	SECTION 800.108	800.108 Assessments and user fees.
45:4.1.4.5.1.2.6.9	SECTION 800.109	800.109 Network adequacy.
45:4.1.4.5.1.2.6.10	SECTION 800.110	800.110 Service area.
45:4.1.4.5.1.2.6.11	SECTION 800.111	800.111 Accreditation requirement.
45:4.1.4.5.1.2.6.12	SECTION 800.112	800.112 Reporting requirements.
45:4.1.4.5.1.2.6.13	SECTION 800.113	800.113 Benefit plan material or information.
45:4.1.4.5.1.2.6.14	SECTION 800.114	800.114 Compliance with applicable State law.
45:4.1.4.5.1.2.6.15	SECTION 800.115	800.115 Level playing field.
45:4.1.4.5.1.2.6.16	SECTION 800.116	800.116 Process for dispute resolution.
45:4.1.4.5.1.3	SUBPART C	Subpart C - Premiums, Rating Factors, Medical Loss Ratios, and Risk Adjustment
45:4.1.4.5.1.3.6.1	SECTION 800.201	800.201 General requirements.
45:4.1.4.5.1.3.6.2	SECTION 800.202	800.202 Rating factors.
45:4.1.4.5.1.3.6.3	SECTION 800.203	800.203 Medical loss ratio.
45:4.1.4.5.1.3.6.4	SECTION 800.204	800.204 Reinsurance, risk corridors, and risk adjustment.
45:4.1.4.5.1.4	SUBPART D	Subpart D - Application and Contracting Procedures
45:4.1.4.5.1.4.6.1	SECTION 800.301	800.301 Application process.
45:4.1.4.5.1.4.6.2	SECTION 800.302	800.302 Review of applications.
45:4.1.4.5.1.4.6.3	SECTION 800.303	800.303 MSP Program contracting.
45:4.1.4.5.1.4.6.4	SECTION 800.304	800.304 Term of the contract.
45:4.1.4.5.1.4.6.5	SECTION 800.305	800.305 Contract renewal process.
45:4.1.4.5.1.4.6.6	SECTION 800.306	800.306 Nonrenewal.
45:4.1.4.5.1.5	SUBPART E	Subpart E - Compliance
45:4.1.4.5.1.5.6.1	SECTION 800.401	800.401 Contract performance.
45:4.1.4.5.1.5.6.2	SECTION 800.402	800.402 Contract quality assurance.
45:4.1.4.5.1.5.6.3	SECTION 800.403	800.403 Fraud and abuse.
45:4.1.4.5.1.5.6.4	SECTION 800.404	800.404 Compliance actions.
45:4.1.4.5.1.5.6.5	SECTION 800.405	800.405 Reconsideration of compliance actions.
45:4.1.4.5.1.6	SUBPART F	Subpart F - Appeals by Enrollees of Denials of Claims for Payment or Service
45:4.1.4.5.1.6.6.1	SECTION 800.501	800.501 General requirements.
45:4.1.4.5.1.6.6.2	SECTION 800.502	800.502 MSP issuer internal claims and appeals.
45:4.1.4.5.1.6.6.3	SECTION 800.503	800.503 External review.
45:4.1.4.5.1.6.6.4	SECTION 800.504	800.504 Judicial review.
45:4.1.4.5.1.7	SUBPART G	Subpart G - Miscellaneous
45:4.1.4.5.1.7.6.1	SECTION 800.601	800.601 Reservation of authority.
45:4.1.4.5.1.7.6.2	SECTION 800.602	800.602 Consumer choice with respect to certain services.
45:4.1.4.5.1.7.6.3	SECTION 800.603	800.603 Disclosure of information.

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