| 45:2.0.1.1.1 | PART 140-143
| PARTS 140-143 [RESERVED] | |
| 45:2.0.1.1.2 | PART 144
| PART 144 - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE | |
| 45:2.0.1.1.2.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.2.1.1.1 | SECTION 144.101
| 144.101 Basis and purpose. | |
| 45:2.0.1.1.2.1.1.2 | SECTION 144.102
| 144.102 Scope and applicability. | |
| 45:2.0.1.1.2.1.1.3 | SECTION 144.103
| 144.103 Definitions. | |
| 45:2.0.1.1.2.2 | SUBPART B
| Subpart B - Qualified State Long-Term Care Insurance Partnerships: Reporting Requirements for Insurers | |
| 45:2.0.1.1.2.2.1.1 | SECTION 144.200
| 144.200 Basis. | |
| 45:2.0.1.1.2.2.1.2 | SECTION 144.202
| 144.202 Definitions. | |
| 45:2.0.1.1.2.2.1.3 | SECTION 144.204
| 144.204 Applicability of regulations. | |
| 45:2.0.1.1.2.2.1.4 | SECTION 144.206
| 144.206 Reporting requirements. | |
| 45:2.0.1.1.2.2.1.5 | SECTION 144.208
| 144.208 Deadlines for submission of reports. | |
| 45:2.0.1.1.2.2.1.6 | SECTION 144.210
| 144.210 Form and manner of reports. | |
| 45:2.0.1.1.2.2.1.7 | SECTION 144.212
| 144.212 Confidentiality of information. | |
| 45:2.0.1.1.2.2.1.8 | SECTION 144.214
| 144.214 Notifications of noncompliance with reporting requirements. | |
| 45:2.0.1.1.3 | PART 145
| PART 145 [RESERVED] | |
| 45:2.0.1.1.4 | PART 146
| PART 146 - REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET | |
| 45:2.0.1.1.4.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.4.1.1.1 | SECTION 146.101
| 146.101 Basis and scope. | |
| 45:2.0.1.1.4.2 | SUBPART B
| Subpart B - Requirements Relating to Access and Renewability of Coverage, and Limitations on Preexisting Condition Exclusion Periods | |
| 45:2.0.1.1.4.2.1.1 | SECTION 146.111
| 146.111 Preexisting condition exclusions. | |
| 45:2.0.1.1.4.2.1.2 | SECTION 146.113
| 146.113 Rules relating to creditable coverage. | |
| 45:2.0.1.1.4.2.1.3 | SECTION 146.115
| 146.115 Certification and disclosure of previous coverage. | |
| 45:2.0.1.1.4.2.1.4 | SECTION 146.117
| 146.117 Special enrollment periods. | |
| 45:2.0.1.1.4.2.1.5 | SECTION 146.119
| 146.119 HMO affiliation period as an alternative to a preexisting condition exclusion. | |
| 45:2.0.1.1.4.2.1.6 | SECTION 146.120
| 146.120 Interaction with the Family and Medical Leave Act. [Reserved] | |
| 45:2.0.1.1.4.2.1.7 | SECTION 146.121
| 146.121 Prohibiting discrimination against participants and beneficiaries based on a health factor. | |
| 45:2.0.1.1.4.2.1.8 | SECTION 146.122
| 146.122 Additional requirements prohibiting discrimination based on genetic information. | |
| 45:2.0.1.1.4.2.1.9 | SECTION 146.123
| 146.123 Special rule allowing integration of Health Reimbursement Arrangements (HRAs) and other account-based group health plans with individual health insurance coverage and Medicare and prohibiting discrimination in HRAs and other account-based group health plans. | |
| 45:2.0.1.1.4.2.1.10 | SECTION 146.125
| 146.125 Applicability dates. | |
| 45:2.0.1.1.4.3 | SUBPART C
| Subpart C - Requirements Related to Benefits | |
| 45:2.0.1.1.4.3.1.1 | SECTION 146.130
| 146.130 Standards relating to benefits for mothers and newborns. | |
| 45:2.0.1.1.4.3.1.2 | SECTION 146.136
| 146.136 Parity in mental health and substance use disorder benefits. | |
| 45:2.0.1.1.4.4 | SUBPART D
| Subpart D - Preemption and Special Rules | |
| 45:2.0.1.1.4.4.1.1 | SECTION 146.143
| 146.143 Preemption; State flexibility; construction. | |
| 45:2.0.1.1.4.4.1.2 | SECTION 146.145
| 146.145 Special rules relating to group health plans. | |
| 45:2.0.1.1.4.5 | SUBPART E
| Subpart E - Provisions Applicable to Only Health Insurance Issuers | |
| 45:2.0.1.1.4.5.1.1 | SECTION 146.150
| 146.150 Guaranteed availability of coverage for employers in the small group market. | |
| 45:2.0.1.1.4.5.1.2 | SECTION 146.152
| 146.152 Guaranteed renewability of coverage for employers in the group market. | |
| 45:2.0.1.1.4.5.1.3 | SECTION 146.160
| 146.160 Disclosure of information. | |
| 45:2.0.1.1.4.6 | SUBPART F
| Subpart F - Exclusion of Plans and Enforcement | |
| 45:2.0.1.1.4.6.1.1 | SECTION 146.180
| 146.180 Treatment of non-Federal governmental plans. | |
| 45:2.0.1.1.5 | PART 147
| PART 147 - HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS | |
| 45:2.0.1.1.5.0.1.1 | SECTION 147.100
| 147.100 Basis and scope. | |
| 45:2.0.1.1.5.0.1.2 | SECTION 147.102
| 147.102 Fair health insurance premiums. | |
| 45:2.0.1.1.5.0.1.3 | SECTION 147.103
| 147.103 State reporting. | |
| 45:2.0.1.1.5.0.1.4 | SECTION 147.104
| 147.104 Guaranteed availability of coverage. | |
| 45:2.0.1.1.5.0.1.5 | SECTION 147.106
| 147.106 Guaranteed renewability of coverage. | |
| 45:2.0.1.1.5.0.1.6 | SECTION 147.108
| 147.108 Prohibition of preexisting condition exclusions. | |
| 45:2.0.1.1.5.0.1.7 | SECTION 147.110
| 147.110 Prohibiting discrimination against participants, beneficiaries, and individuals based on a health factor. | |
| 45:2.0.1.1.5.0.1.8 | SECTION 147.116
| 147.116 Prohibition on waiting periods that exceed 90 days. | |
| 45:2.0.1.1.5.0.1.9 | SECTION 147.120
| 147.120 Eligibility of children until at least age 26. | |
| 45:2.0.1.1.5.0.1.10 | SECTION 147.126
| 147.126 No lifetime or annual limits. | |
| 45:2.0.1.1.5.0.1.11 | SECTION 147.128
| 147.128 Rules regarding rescissions. | |
| 45:2.0.1.1.5.0.1.12 | SECTION 147.130
| 147.130 Coverage of preventive health services. | |
| 45:2.0.1.1.5.0.1.13 | SECTION 147.131
| 147.131 Accommodations in connection with coverage of certain preventive health services. | |
| 45:2.0.1.1.5.0.1.14 | SECTION 147.132
| 147.132 Religious exemptions in connection with coverage of certain preventive health services. | |
| 45:2.0.1.1.5.0.1.15 | SECTION 147.133
| 147.133 Moral exemptions in connection with coverage of certain preventive health services. | |
| 45:2.0.1.1.5.0.1.16 | SECTION 147.136
| 147.136 Internal claims and appeals and external review processes. | |
| 45:2.0.1.1.5.0.1.17 | SECTION 147.138
| 147.138 Patient protections. | |
| 45:2.0.1.1.5.0.1.18 | SECTION 147.140
| 147.140 Preservation of right to maintain existing coverage. | |
| 45:2.0.1.1.5.0.1.19 | SECTION 147.145
| 147.145 Student health insurance coverage. | |
| 45:2.0.1.1.5.0.1.20 | SECTION 147.150
| 147.150 Coverage of essential health benefits. | |
| 45:2.0.1.1.5.0.1.21 | SECTION 147.160
| 147.160 Parity in mental health and substance use disorder benefits. | |
| 45:2.0.1.1.5.0.1.22 | SECTION 147.200
| 147.200 Summary of benefits and coverage and uniform glossary. | |
| 45:2.0.1.1.5.0.1.23 | SECTION 147.210
| 147.210 Transparency in coverage - definitions. | |
| 45:2.0.1.1.5.0.1.24 | SECTION 147.211
| 147.211 Transparency in coverage - required disclosures to participants, beneficiaries, or enrollees. | |
| 45:2.0.1.1.5.0.1.25 | SECTION 147.212
| 147.212 Transparency in coverage - requirements for public disclosure. | |
| 45:2.0.1.1.6 | PART 148
| PART 148 - REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET | |
| 45:2.0.1.1.6.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.6.1.1.1 | SECTION 148.101
| 148.101 Basis and purpose. | |
| 45:2.0.1.1.6.1.1.2 | SECTION 148.102
| 148.102 Scope and applicability date. | |
| 45:2.0.1.1.6.2 | SUBPART B
| Subpart B - Requirements Relating to Access and Renewability of Coverage | |
| 45:2.0.1.1.6.2.1.1 | SECTION 148.120
| 148.120 Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage. | |
| 45:2.0.1.1.6.2.1.2 | SECTION 148.122
| 148.122 Guaranteed renewability of individual health insurance coverage. | |
| 45:2.0.1.1.6.2.1.3 | SECTION 148.124
| 148.124 Certification and disclosure of coverage. | |
| 45:2.0.1.1.6.2.1.4 | SECTION 148.126
| 148.126 Determination of an eligible individual. | |
| 45:2.0.1.1.6.2.1.5 | SECTION 148.128
| 148.128 State flexibility in individual market reforms - alternative mechanisms. | |
| 45:2.0.1.1.6.3 | SUBPART C
| Subpart C - Requirements Related to Benefits | |
| 45:2.0.1.1.6.3.1.1 | SECTION 148.170
| 148.170 Standards relating to benefits for mothers and newborns. | |
| 45:2.0.1.1.6.3.1.2 | SECTION 148.180
| 148.180 Prohibition of discrimination based on genetic information. | |
| 45:2.0.1.1.6.4 | SUBPART D
| Subpart D - Preemption; Excepted Benefits | |
| 45:2.0.1.1.6.4.1.1 | SECTION 148.210
| 148.210 Preemption. | |
| 45:2.0.1.1.6.4.1.2 | SECTION 148.220
| 148.220 Excepted benefits. | |
| 45:2.0.1.1.6.5 | SUBPART E
| Subpart E - Grants to States for Operation of Qualified High Risk Pools | |
| 45:2.0.1.1.6.5.1.1 | SECTION 148.306
| 148.306 Basis and scope. | |
| 45:2.0.1.1.6.5.1.2 | SECTION 148.308
| 148.308 Definitions. | |
| 45:2.0.1.1.6.5.1.3 | SECTION 148.310
| 148.310 Eligibility requirements for a grant. | |
| 45:2.0.1.1.6.5.1.4 | SECTION 148.312
| 148.312 Amount of grant payment. | |
| 45:2.0.1.1.6.5.1.5 | SECTION 148.314
| 148.314 Periods during which eligible States may apply for a grant. | |
| 45:2.0.1.1.6.5.1.6 | SECTION 148.316
| 148.316 Grant application instructions. | |
| 45:2.0.1.1.6.5.1.7 | SECTION 148.318
| 148.318 Grant application review. | |
| 45:2.0.1.1.6.5.1.8 | SECTION 148.320
| 148.320 Grant awards. | |
| 45:2.0.1.1.7 | PART 149
| PART 149 [RESERVED] | |
| 45:2.0.1.1.8 | PART 150
| PART 150 - CMS ENFORCEMENT IN GROUP AND INDIVIDUAL INSURANCE MARKETS | |
| 45:2.0.1.1.8.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.8.1.1.1 | SECTION 150.101
| 150.101 Basis and scope. | |
| 45:2.0.1.1.8.1.1.2 | SECTION 150.103
| 150.103 Definitions. | |
| 45:2.0.1.1.8.2 | SUBPART B
| Subpart B - CMS Enforcement Processes for Determining Whether States Are Failing To Substantially Enforce PHS Act Requirement | |
| 45:2.0.1.1.8.2.1.1 | SECTION 150.201
| 150.201 State enforcement. | |
| 45:2.0.1.1.8.2.1.2 | SECTION 150.203
| 150.203 Circumstances requiring CMS enforcement. | |
| 45:2.0.1.1.8.2.1.3 | SECTION 150.205
| 150.205 Sources of information triggering an investigation of State enforcement. | |
| 45:2.0.1.1.8.2.1.4 | SECTION 150.207
| 150.207 Procedure for determining that a State fails to substantially enforce PHS Act requirements. | |
| 45:2.0.1.1.8.2.1.5 | SECTION 150.209
| 150.209 Verification of exhaustion of remedies and contact with State officials. | |
| 45:2.0.1.1.8.2.1.6 | SECTION 150.211
| 150.211 Notice to the State. | |
| 45:2.0.1.1.8.2.1.7 | SECTION 150.213
| 150.213 Form and content of notice. | |
| 45:2.0.1.1.8.2.1.8 | SECTION 150.215
| 150.215 Extension for good cause. | |
| 45:2.0.1.1.8.2.1.9 | SECTION 150.217
| 150.217 Preliminary determination. | |
| 45:2.0.1.1.8.2.1.10 | SECTION 150.219
| 150.219 Final determination. | |
| 45:2.0.1.1.8.2.1.11 | SECTION 150.221
| 150.221 Transition to State enforcement. | |
| 45:2.0.1.1.8.3 | SUBPART C
| Subpart C - CMS Enforcement With Respect to Issuers and Non-Federal Governmental Plans - Civil Money Penalties | |
| 45:2.0.1.1.8.3.1.1 | SECTION 150.301
| 150.301 General rule regarding the imposition of civil money penalties. | |
| 45:2.0.1.1.8.3.1.2 | SECTION 150.303
| 150.303 Basis for initiating an investigation of a potential violation. | |
| 45:2.0.1.1.8.3.1.3 | SECTION 150.305
| 150.305 Determination of entity liable for civil money penalty. | |
| 45:2.0.1.1.8.3.1.4 | SECTION 150.307
| 150.307 Notice to responsible entities. | |
| 45:2.0.1.1.8.3.1.5 | SECTION 150.309
| 150.309 Request for extension. | |
| 45:2.0.1.1.8.3.1.6 | SECTION 150.311
| 150.311 Responses to allegations of noncompliance. | |
| 45:2.0.1.1.8.3.1.7 | SECTION 150.313
| 150.313 Market conduct examinations. | |
| 45:2.0.1.1.8.3.1.8 | SECTION 150.315
| 150.315 Amount of penalty - General. | |
| 45:2.0.1.1.8.3.1.9 | SECTION 150.317
| 150.317 Factors CMS uses to determine the amount of penalty. | |
| 45:2.0.1.1.8.3.1.10 | SECTION 150.319
| 150.319 Determining the amount of the penalty - mitigating circumstances. | |
| 45:2.0.1.1.8.3.1.11 | SECTION 150.321
| 150.321 Determining the amount of penalty - aggravating circumstances. | |
| 45:2.0.1.1.8.3.1.12 | SECTION 150.323
| 150.323 Determining the amount of penalty - other matters as justice may require. | |
| 45:2.0.1.1.8.3.1.13 | SECTION 150.325
| 150.325 Settlement authority. | |
| 45:2.0.1.1.8.3.1.14 | SECTION 150.341
| 150.341 Limitations on penalties. | |
| 45:2.0.1.1.8.3.1.15 | SECTION 150.343
| 150.343 Notice of proposed penalty. | |
| 45:2.0.1.1.8.3.1.16 | SECTION 150.345
| 150.345 Appeal of proposed penalty. | |
| 45:2.0.1.1.8.3.1.17 | SECTION 150.347
| 150.347 Failure to request a hearing. | |
| 45:2.0.1.1.8.4 | SUBPART D
| Subpart D - Administrative Hearings | |
| 45:2.0.1.1.8.4.1.1 | SECTION 150.401
| 150.401 Definitions. | |
| 45:2.0.1.1.8.4.1.2 | SECTION 150.403
| 150.403 Scope of ALJ's authority. | |
| 45:2.0.1.1.8.4.1.3 | SECTION 150.405
| 150.405 Filing of request for hearing. | |
| 45:2.0.1.1.8.4.1.4 | SECTION 150.407
| 150.407 Form and content of request for hearing. | |
| 45:2.0.1.1.8.4.1.5 | SECTION 150.409
| 150.409 Amendment of notice of assessment or request for hearing. | |
| 45:2.0.1.1.8.4.1.6 | SECTION 150.411
| 150.411 Dismissal of request for hearing. | |
| 45:2.0.1.1.8.4.1.7 | SECTION 150.413
| 150.413 Settlement. | |
| 45:2.0.1.1.8.4.1.8 | SECTION 150.415
| 150.415 Intervention. | |
| 45:2.0.1.1.8.4.1.9 | SECTION 150.417
| 150.417 Issues to be heard and decided by ALJ. | |
| 45:2.0.1.1.8.4.1.10 | SECTION 150.419
| 150.419 Forms of hearing. | |
| 45:2.0.1.1.8.4.1.11 | SECTION 150.421
| 150.421 Appearance of counsel. | |
| 45:2.0.1.1.8.4.1.12 | SECTION 150.423
| 150.423 Communications with the ALJ. | |
| 45:2.0.1.1.8.4.1.13 | SECTION 150.425
| 150.425 Motions. | |
| 45:2.0.1.1.8.4.1.14 | SECTION 150.427
| 150.427 Form and service of submissions. | |
| 45:2.0.1.1.8.4.1.15 | SECTION 150.429
| 150.429 Computation of time and extensions of time. | |
| 45:2.0.1.1.8.4.1.16 | SECTION 150.431
| 150.431 Acknowledgment of request for hearing. | |
| 45:2.0.1.1.8.4.1.17 | SECTION 150.435
| 150.435 Discovery. | |
| 45:2.0.1.1.8.4.1.18 | SECTION 150.437
| 150.437 Submission of briefs and proposed hearing exhibits. | |
| 45:2.0.1.1.8.4.1.19 | SECTION 150.439
| 150.439 Effect of submission of proposed hearing exhibits. | |
| 45:2.0.1.1.8.4.1.20 | SECTION 150.441
| 150.441 Prehearing conferences. | |
| 45:2.0.1.1.8.4.1.21 | SECTION 150.443
| 150.443 Standard of proof. | |
| 45:2.0.1.1.8.4.1.22 | SECTION 150.445
| 150.445 Evidence. | |
| 45:2.0.1.1.8.4.1.23 | SECTION 150.447
| 150.447 The record. | |
| 45:2.0.1.1.8.4.1.24 | SECTION 150.449
| 150.449 Cost of transcripts. | |
| 45:2.0.1.1.8.4.1.25 | SECTION 150.451
| 150.451 Posthearing briefs. | |
| 45:2.0.1.1.8.4.1.26 | SECTION 150.453
| 150.453 ALJ decision. | |
| 45:2.0.1.1.8.4.1.27 | SECTION 150.455
| 150.455 Sanctions. | |
| 45:2.0.1.1.8.4.1.28 | SECTION 150.457
| 150.457 Review by Administrator. | |
| 45:2.0.1.1.8.4.1.29 | SECTION 150.459
| 150.459 Judicial review. | |
| 45:2.0.1.1.8.4.1.30 | SECTION 150.461
| 150.461 Failure to pay assessment. | |
| 45:2.0.1.1.8.4.1.31 | SECTION 150.463
| 150.463 Final order not subject to review. | |
| 45:2.0.1.1.8.4.1.32 | SECTION 150.465
| 150.465 Collection and use of penalty funds. | |
| 45:2.0.1.1.9 | PART 151
| PART 151 [RESERVED] | |
| 45:2.0.1.1.10 | PART 152
| PART 152 - PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM | |
| 45:2.0.1.1.10.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.10.1.1.1 | SECTION 152.1
| 152.1 Statutory basis. | |
| 45:2.0.1.1.10.1.1.2 | SECTION 152.2
| 152.2 Definitions. | |
| 45:2.0.1.1.10.2 | SUBPART B
| Subpart B - PCIP Program Administration | |
| 45:2.0.1.1.10.2.1.1 | SECTION 152.6
| 152.6 Program administration. | |
| 45:2.0.1.1.10.2.1.2 | SECTION 152.7
| 152.7 PCIP proposal process. | |
| 45:2.0.1.1.10.3 | SUBPART C
| Subpart C - Eligibility and Enrollment | |
| 45:2.0.1.1.10.3.1.1 | SECTION 152.14
| 152.14 Eligibility. | |
| 45:2.0.1.1.10.3.1.2 | SECTION 152.15
| 152.15 Enrollment and disenrollment process. | |
| 45:2.0.1.1.10.4 | SUBPART D
| Subpart D - Benefits | |
| 45:2.0.1.1.10.4.1.1 | SECTION 152.19
| 152.19 Covered benefits. | |
| 45:2.0.1.1.10.4.1.2 | SECTION 152.20
| 152.20 Prohibitions on pre-existing condition exclusions and waiting periods. | |
| 45:2.0.1.1.10.4.1.3 | SECTION 152.21
| 152.21 Premiums and cost-sharing. | |
| 45:2.0.1.1.10.4.1.4 | SECTION 152.22
| 152.22 Access to services. | |
| 45:2.0.1.1.10.5 | SUBPART E
| Subpart E - Oversight | |
| 45:2.0.1.1.10.5.1.1 | SECTION 152.26
| 152.26 Appeals procedures. | |
| 45:2.0.1.1.10.5.1.2 | SECTION 152.27
| 152.27 Fraud, waste, and abuse. | |
| 45:2.0.1.1.10.5.1.3 | SECTION 152.28
| 152.28 Preventing insurer dumping. | |
| 45:2.0.1.1.10.6 | SUBPART F
| Subpart F - Funding | |
| 45:2.0.1.1.10.6.1.1 | SECTION 152.32
| 152.32 Use of funds. | |
| 45:2.0.1.1.10.6.1.2 | SECTION 152.33
| 152.33 Initial allocation of funds. | |
| 45:2.0.1.1.10.6.1.3 | SECTION 152.34
| 152.34 Reallocation of funds. | |
| 45:2.0.1.1.10.6.1.4 | SECTION 152.35
| 152.35 Insufficient funds. | |
| 45:2.0.1.1.10.7 | SUBPART G
| Subpart G - Relationship to Existing Laws and Programs | |
| 45:2.0.1.1.10.7.1.1 | SECTION 152.39
| 152.39 Maintenance of effort. | |
| 45:2.0.1.1.10.7.1.2 | SECTION 152.40
| 152.40 Relation to State laws. | |
| 45:2.0.1.1.10.8 | SUBPART H
| Subpart H - Transition to Exchanges | |
| 45:2.0.1.1.10.8.1.1 | SECTION 152.44
| 152.44 End of PCIP program coverage. | |
| 45:2.0.1.1.10.8.1.2 | SECTION 152.45
| 152.45 Transition to the exchanges. | |
| 45:2.0.1.1.11 | PART 153
| PART 153 - STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT | |
| 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. | |
| 45:2.0.1.1.12 | PART 154
| PART 154 - HEALTH INSURANCE ISSUER RATE INCREASES: DISCLOSURE AND REVIEW REQUIREMENTS | |
| 45:2.0.1.1.12.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.12.1.1.1 | SECTION 154.101
| 154.101 Basis and scope. | |
| 45:2.0.1.1.12.1.1.2 | SECTION 154.102
| 154.102 Definitions. | |
| 45:2.0.1.1.12.1.1.3 | SECTION 154.103
| 154.103 Applicability. | |
| 45:2.0.1.1.12.2 | SUBPART B
| Subpart B - Disclosure and Review Provisions | |
| 45:2.0.1.1.12.2.1.1 | SECTION 154.200
| 154.200 Rate increases subject to review. | |
| 45:2.0.1.1.12.2.1.2 | SECTION 154.205
| 154.205 Unreasonable rate increases. | |
| 45:2.0.1.1.12.2.1.3 | SECTION 154.210
| 154.210 Review of rate increases subject to review by CMS or by a State. | |
| 45:2.0.1.1.12.2.1.4 | SECTION 154.215
| 154.215 Submission of rate filing justification. | |
| 45:2.0.1.1.12.2.1.5 | SECTION 154.220
| 154.220 Timing of providing the rate filing justification. | |
| 45:2.0.1.1.12.2.1.6 | SECTION 154.225
| 154.225 Determination by CMS or a State of an unreasonable rate increase. | |
| 45:2.0.1.1.12.2.1.7 | SECTION 154.230
| 154.230 Submission and posting of Final Justifications for unreasonable rate increases. | |
| 45:2.0.1.1.12.3 | SUBPART C
| Subpart C - Effective Rate Review Programs | |
| 45:2.0.1.1.12.3.1.1 | SECTION 154.301
| 154.301 CMS's determinations of Effective Rate Review Programs. | |
| 45:2.0.1.1.13 | PART 155
| PART 155 - EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT | |
| 45:2.0.1.1.13.1 | SUBPART A
| Subpart A - General Provisions. | |
| 45:2.0.1.1.13.1.1.1 | SECTION 155.10
| 155.10 Basis and scope. | |
| 45:2.0.1.1.13.1.1.2 | SECTION 155.20
| 155.20 Definitions. | |
| 45:2.0.1.1.13.2 | SUBPART B
| Subpart B - General Standards Related to the Establishment of an Exchange | |
| 45:2.0.1.1.13.2.1.1 | SECTION 155.100
| 155.100 Establishment of a State Exchange. | |
| 45:2.0.1.1.13.2.1.2 | SECTION 155.105
| 155.105 Approval of a State Exchange. | |
| 45:2.0.1.1.13.2.1.3 | SECTION 155.106
| 155.106 Election to operate an Exchange after 2014. | |
| 45:2.0.1.1.13.2.1.4 | SECTION 155.110
| 155.110 Entities eligible to carry out Exchange functions. | |
| 45:2.0.1.1.13.2.1.5 | SECTION 155.120
| 155.120 Non-interference with Federal law and non-discrimination standards. | |
| 45:2.0.1.1.13.2.1.6 | SECTION 155.130
| 155.130 Stakeholder consultation. | |
| 45:2.0.1.1.13.2.1.7 | SECTION 155.140
| 155.140 Establishment of a regional Exchange or subsidiary Exchange. | |
| 45:2.0.1.1.13.2.1.8 | SECTION 155.150
| 155.150 Transition process for existing State health insurance exchanges. | |
| 45:2.0.1.1.13.2.1.9 | SECTION 155.160
| 155.160 Financial support for continued operations. | |
| 45:2.0.1.1.13.2.1.10 | SECTION 155.170
| 155.170 Additional required benefits. | |
| 45:2.0.1.1.13.3 | SUBPART C
| Subpart C - General Functions of an Exchange | |
| 45:2.0.1.1.13.3.1.1 | SECTION 155.200
| 155.200 Functions of an Exchange. | |
| 45:2.0.1.1.13.3.1.2 | SECTION 155.205
| 155.205 Consumer assistance tools and programs of an Exchange. | |
| 45:2.0.1.1.13.3.1.3 | SECTION 155.206
| 155.206 Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges. | |
| 45:2.0.1.1.13.3.1.4 | SECTION 155.210
| 155.210 Navigator program standards. | |
| 45:2.0.1.1.13.3.1.5 | SECTION 155.215
| 155.215 Standards applicable to Navigators and Non-Navigator Assistance Personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a Federally-facilitated Exchange and to Non-Navigator Assistance Personnel funded through an Exchange Establishment Grant. | |
| 45:2.0.1.1.13.3.1.6 | SECTION 155.220
| 155.220 Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs. | |
| 45:2.0.1.1.13.3.1.7 | SECTION 155.221
| 155.221 Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities. | |
| 45:2.0.1.1.13.3.1.8 | SECTION 155.222
| 155.222 Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers. | |
| 45:2.0.1.1.13.3.1.9 | SECTION 155.225
| 155.225 Certified application counselors. | |
| 45:2.0.1.1.13.3.1.10 | SECTION 155.227
| 155.227 Authorized representatives. | |
| 45:2.0.1.1.13.3.1.11 | SECTION 155.230
| 155.230 General standards for Exchange notices. | |
| 45:2.0.1.1.13.3.1.12 | SECTION 155.240
| 155.240 Payment of premiums. | |
| 45:2.0.1.1.13.3.1.13 | SECTION 155.260
| 155.260 Privacy and security of personally identifiable information. | |
| 45:2.0.1.1.13.3.1.14 | SECTION 155.270
| 155.270 Use of standards and protocols for electronic transactions. | |
| 45:2.0.1.1.13.3.1.15 | SECTION 155.280
| 155.280 Oversight and monitoring of privacy and security requirements. | |
| 45:2.0.1.1.13.3.1.16 | SECTION 155.285
| 155.285 Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information. | |
| 45:2.0.1.1.13.4 | SUBPART D
| Subpart D - Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs | |
| 45:2.0.1.1.13.4.1.1 | SECTION 155.300
| 155.300 Definitions and general standards for eligibility determinations. | |
| 45:2.0.1.1.13.4.1.2 | SECTION 155.302
| 155.302 Options for conducting eligibility determinations. | |
| 45:2.0.1.1.13.4.1.3 | SECTION 155.305
| 155.305 Eligibility standards. | |
| 45:2.0.1.1.13.4.1.4 | SECTION 155.310
| 155.310 Eligibility process. | |
| 45:2.0.1.1.13.4.1.5 | SECTION 155.315
| 155.315 Verification process related to eligibility for enrollment in a QHP through the Exchange. | |
| 45:2.0.1.1.13.4.1.6 | SECTION 155.320
| 155.320 Verification process related to eligibility for insurance affordability programs. | |
| 45:2.0.1.1.13.4.1.7 | SECTION 155.330
| 155.330 Eligibility redetermination during a benefit year. | |
| 45:2.0.1.1.13.4.1.8 | SECTION 155.335
| 155.335 Annual eligibility redetermination. | |
| 45:2.0.1.1.13.4.1.9 | SECTION 155.340
| 155.340 Administration of advance payments of the premium tax credit and cost-sharing reductions. | |
| 45:2.0.1.1.13.4.1.10 | SECTION 155.345
| 155.345 Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan. | |
| 45:2.0.1.1.13.4.1.11 | SECTION 155.350
| 155.350 Special eligibility standards and process for Indians. | |
| 45:2.0.1.1.13.4.1.12 | SECTION 155.355
| 155.355 Right to appeal. | |
| 45:2.0.1.1.13.5 | SUBPART E
| Subpart E - Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans | |
| 45:2.0.1.1.13.5.1.1 | SECTION 155.400
| 155.400 Enrollment of qualified individuals into QHPs. | |
| 45:2.0.1.1.13.5.1.2 | SECTION 155.405
| 155.405 Single streamlined application. | |
| 45:2.0.1.1.13.5.1.3 | SECTION 155.410
| 155.410 Initial and annual open enrollment periods. | |
| 45:2.0.1.1.13.5.1.4 | SECTION 155.415
| 155.415 Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications. | |
| 45:2.0.1.1.13.5.1.5 | SECTION 155.420
| 155.420 Special enrollment periods. | |
| 45:2.0.1.1.13.5.1.6 | SECTION 155.430
| 155.430 Termination of Exchange enrollment or coverage. | |
| 45:2.0.1.1.13.6 | SUBPART F
| Subpart F - Appeals of Eligibility Determinations for Exchange Participation and Insurance Affordability Programs | |
| 45:2.0.1.1.13.6.1.1 | SECTION 155.500
| 155.500 Definitions. | |
| 45:2.0.1.1.13.6.1.2 | SECTION 155.505
| 155.505 General eligibility appeals requirements. | |
| 45:2.0.1.1.13.6.1.3 | SECTION 155.510
| 155.510 Appeals coordination. | |
| 45:2.0.1.1.13.6.1.4 | SECTION 155.515
| 155.515 Notice of appeal procedures. | |
| 45:2.0.1.1.13.6.1.5 | SECTION 155.520
| 155.520 Appeal requests. | |
| 45:2.0.1.1.13.6.1.6 | SECTION 155.525
| 155.525 Eligibility pending appeal. | |
| 45:2.0.1.1.13.6.1.7 | SECTION 155.530
| 155.530 Dismissals. | |
| 45:2.0.1.1.13.6.1.8 | SECTION 155.535
| 155.535 Informal resolution and hearing requirements. | |
| 45:2.0.1.1.13.6.1.9 | SECTION 155.540
| 155.540 Expedited appeals. | |
| 45:2.0.1.1.13.6.1.10 | SECTION 155.545
| 155.545 Appeal decisions. | |
| 45:2.0.1.1.13.6.1.11 | SECTION 155.550
| 155.550 Appeal record. | |
| 45:2.0.1.1.13.6.1.12 | SECTION 155.555
| 155.555 Employer appeals process. | |
| 45:2.0.1.1.13.7 | SUBPART G
| Subpart G - Exchange Functions in the Individual Market: Eligibility Determinations for Exemptions | |
| 45:2.0.1.1.13.7.1.1 | SECTION 155.600
| 155.600 Definitions and general requirements. | |
| 45:2.0.1.1.13.7.1.2 | SECTION 155.605
| 155.605 Eligibility standards for exemptions. | |
| 45:2.0.1.1.13.7.1.3 | SECTION 155.610
| 155.610 Eligibility process for exemptions. | |
| 45:2.0.1.1.13.7.1.4 | SECTION 155.615
| 155.615 Verification process related to eligibility for exemptions. | |
| 45:2.0.1.1.13.7.1.5 | SECTION 155.620
| 155.620 Eligibility redeterminations for exemptions during a calendar year. | |
| 45:2.0.1.1.13.7.1.6 | SECTION 155.625
| 155.625 Options for conducting eligibility determinations for exemptions. | |
| 45:2.0.1.1.13.7.1.7 | SECTION 155.630
| 155.630 Reporting. | |
| 45:2.0.1.1.13.7.1.8 | SECTION 155.635
| 155.635 Right to appeal. | |
| 45:2.0.1.1.13.8 | SUBPART H
| Subpart H - Exchange Functions: Small Business Health Options Program (SHOP) | |
| 45:2.0.1.1.13.8.1.1 | SECTION 155.700
| 155.700 Standards for the establishment of a SHOP. | |
| 45:2.0.1.1.13.8.1.2 | SECTION 155.705
| 155.705 Functions of a SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.3 | SECTION 155.706
| 155.706 Functions of a SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.8.1.4 | SECTION 155.710
| 155.710 Eligibility standards for SHOP. | |
| 45:2.0.1.1.13.8.1.5 | SECTION 155.715
| 155.715 Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.6 | SECTION 155.716
| 155.716 Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.8.1.7 | SECTION 155.720
| 155.720 Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.8 | SECTION 155.721
| 155.721 Record retention and IRS Reporting for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.8.1.9 | SECTION 155.725
| 155.725 Enrollment periods under SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.10 | SECTION 155.726
| 155.726 Enrollment periods under SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.8.1.11 | SECTION 155.730
| 155.730 Application standards for SHOP for plan year beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.12 | SECTION 155.731
| 155.731 Application standards for SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.8.1.13 | SECTION 155.735
| 155.735 Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.14 | SECTION 155.740
| 155.740 SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.13.8.1.15 | SECTION 155.741
| 155.741 SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018. | |
| 45:2.0.1.1.13.9 | SUBPART I
| Subparts I-J [Reserved] | |
| 45:2.0.1.1.13.10 | SUBPART K
| Subpart K - Exchange Functions: Certification of Qualified Health Plans | |
| 45:2.0.1.1.13.10.1.1 | SECTION 155.1000
| 155.1000 Certification standards for QHPs. | |
| 45:2.0.1.1.13.10.1.2 | SECTION 155.1010
| 155.1010 Certification process for QHPs. | |
| 45:2.0.1.1.13.10.1.3 | SECTION 155.1020
| 155.1020 QHP issuer rate and benefit information. | |
| 45:2.0.1.1.13.10.1.4 | SECTION 155.1030
| 155.1030 QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions. | |
| 45:2.0.1.1.13.10.1.5 | SECTION 155.1040
| 155.1040 Transparency in coverage. | |
| 45:2.0.1.1.13.10.1.6 | SECTION 155.1045
| 155.1045 Accreditation timeline. | |
| 45:2.0.1.1.13.10.1.7 | SECTION 155.1050
| 155.1050 Establishment of Exchange network adequacy standards. | |
| 45:2.0.1.1.13.10.1.8 | SECTION 155.1055
| 155.1055 Service area of a QHP. | |
| 45:2.0.1.1.13.10.1.9 | SECTION 155.1065
| 155.1065 Stand-alone dental plans. | |
| 45:2.0.1.1.13.10.1.10 | SECTION 155.1075
| 155.1075 Recertification of QHPs. | |
| 45:2.0.1.1.13.10.1.11 | SECTION 155.1080
| 155.1080 Decertification of QHPs. | |
| 45:2.0.1.1.13.10.1.12 | SECTION 155.1090
| 155.1090 Request for reconsideration. | |
| 45:2.0.1.1.13.11 | SUBPART L
| Subpart L [Reserved] | |
| 45:2.0.1.1.13.12 | SUBPART M
| Subpart M - Oversight and Program Integrity Standards for State Exchanges | |
| 45:2.0.1.1.13.12.1.1 | SECTION 155.1200
| 155.1200 General program integrity and oversight requirements. | |
| 45:2.0.1.1.13.12.1.2 | SECTION 155.1210
| 155.1210 Maintenance of records. | |
| 45:2.0.1.1.13.13 | SUBPART N
| Subpart N - State Flexibility | |
| 45:2.0.1.1.13.13.1.1 | SECTION 155.1300
| 155.1300 Basis and purpose. | |
| 45:2.0.1.1.13.13.1.2 | SECTION 155.1302
| 155.1302 Coordinated waiver process. | |
| 45:2.0.1.1.13.13.1.3 | SECTION 155.1304
| 155.1304 Definitions. | |
| 45:2.0.1.1.13.13.1.4 | SECTION 155.1308
| 155.1308 Application procedures. | |
| 45:2.0.1.1.13.13.1.5 | SECTION 155.1312
| 155.1312 State public notice requirements. | |
| 45:2.0.1.1.13.13.1.6 | SECTION 155.1316
| 155.1316 Federal public notice and approval process. | |
| 45:2.0.1.1.13.13.1.7 | SECTION 155.1318
| 155.1318 Modification from the normal public notice requirements during the public health emergency. | |
| 45:2.0.1.1.13.13.1.8 | SECTION 155.1320
| 155.1320 Monitoring and compliance. | |
| 45:2.0.1.1.13.13.1.9 | SECTION 155.1324
| 155.1324 State reporting requirements. | |
| 45:2.0.1.1.13.13.1.10 | SECTION 155.1328
| 155.1328 Periodic evaluation requirements. | |
| 45:2.0.1.1.13.14 | SUBPART O
| Subpart O - Quality Reporting Standards for Exchanges | |
| 45:2.0.1.1.13.14.1.1 | SECTION 155.1400
| 155.1400 Quality rating system. | |
| 45:2.0.1.1.13.14.1.2 | SECTION 155.1405
| 155.1405 Enrollee satisfaction survey system. | |
| 45:2.0.1.1.14 | PART 156
| PART 156 - HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES | |
| 45:2.0.1.1.14.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.14.1.1.1 | SECTION 156.10
| 156.10 Basis and scope. | |
| 45:2.0.1.1.14.1.1.2 | SECTION 156.20
| 156.20 Definitions. | |
| 45:2.0.1.1.14.1.1.3 | SECTION 156.50
| 156.50 Financial support. | |
| 45:2.0.1.1.14.1.1.4 | SECTION 156.80
| 156.80 Single risk pool. | |
| 45:2.0.1.1.14.2 | SUBPART B
| Subpart B - Essential Health Benefits Package | |
| 45:2.0.1.1.14.2.1.1 | SECTION 156.100
| 156.100 State selection of benchmark plan for plan years beginning prior to January 1, 2020. | |
| 45:2.0.1.1.14.2.1.2 | SECTION 156.105
| 156.105 Determination of EHB for multi-state plans. | |
| 45:2.0.1.1.14.2.1.3 | SECTION 156.110
| 156.110 EHB-benchmark plan standards. | |
| 45:2.0.1.1.14.2.1.4 | SECTION 156.111
| 156.111 State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020, and annual reporting of state-required benefits. | |
| 45:2.0.1.1.14.2.1.5 | SECTION 156.115
| 156.115 Provision of EHB. | |
| 45:2.0.1.1.14.2.1.6 | SECTION 156.120
| 156.120 Collection of data to define essential health benefits. | |
| 45:2.0.1.1.14.2.1.7 | SECTION 156.122
| 156.122 Prescription drug benefits. | |
| 45:2.0.1.1.14.2.1.8 | SECTION 156.125
| 156.125 Prohibition on discrimination. | |
| 45:2.0.1.1.14.2.1.9 | SECTION 156.130
| 156.130 Cost-sharing requirements. | |
| 45:2.0.1.1.14.2.1.10 | SECTION 156.135
| 156.135 AV calculation for determining level of coverage. | |
| 45:2.0.1.1.14.2.1.11 | SECTION 156.140
| 156.140 Levels of coverage. | |
| 45:2.0.1.1.14.2.1.12 | SECTION 156.145
| 156.145 Determination of minimum value. | |
| 45:2.0.1.1.14.2.1.13 | SECTION 156.150
| 156.150 Application to stand-alone dental plans inside the Exchange. | |
| 45:2.0.1.1.14.2.1.14 | SECTION 156.155
| 156.155 Enrollment in catastrophic plans. | |
| 45:2.0.1.1.14.3 | SUBPART C
| Subpart C - Qualified Health Plan Minimum Certification Standards | |
| 45:2.0.1.1.14.3.1.1 | SECTION 156.200
| 156.200 QHP issuer participation standards. | |
| 45:2.0.1.1.14.3.1.2 | SECTION 156.210
| 156.210 QHP rate and benefit information. | |
| 45:2.0.1.1.14.3.1.3 | SECTION 156.215
| 156.215 Advance payments of the premium tax credit and cost-sharing reduction standards. | |
| 45:2.0.1.1.14.3.1.4 | SECTION 156.220
| 156.220 Transparency in coverage. | |
| 45:2.0.1.1.14.3.1.5 | SECTION 156.221
| 156.221 Access to and exchange of health data and plan information. | |
| 45:2.0.1.1.14.3.1.6 | SECTION 156.225
| 156.225 Marketing and Benefit Design of QHPs. | |
| 45:2.0.1.1.14.3.1.7 | SECTION 156.230
| 156.230 Network adequacy standards. | |
| 45:2.0.1.1.14.3.1.8 | SECTION 156.235
| 156.235 Essential community providers. | |
| 45:2.0.1.1.14.3.1.9 | SECTION 156.245
| 156.245 Treatment of direct primary care medical homes. | |
| 45:2.0.1.1.14.3.1.10 | SECTION 156.250
| 156.250 Meaningful access to qualified health plan information. | |
| 45:2.0.1.1.14.3.1.11 | SECTION 156.255
| 156.255 Rating variations. | |
| 45:2.0.1.1.14.3.1.12 | SECTION 156.260
| 156.260 Enrollment periods for qualified individuals. | |
| 45:2.0.1.1.14.3.1.13 | SECTION 156.265
| 156.265 Enrollment process for qualified individuals. | |
| 45:2.0.1.1.14.3.1.14 | SECTION 156.270
| 156.270 Termination of coverage or enrollment for qualified individuals. | |
| 45:2.0.1.1.14.3.1.15 | SECTION 156.272
| 156.272 Issuer participation for the full plan year. | |
| 45:2.0.1.1.14.3.1.16 | SECTION 156.275
| 156.275 Accreditation of QHP issuers. | |
| 45:2.0.1.1.14.3.1.17 | SECTION 156.280
| 156.280 Separate billing and segregation of funds for abortion services. | |
| 45:2.0.1.1.14.3.1.18 | SECTION 156.285
| 156.285 Additional standards specific to SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.14.3.1.19 | SECTION 156.286
| 156.286 Additional standards specific to SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.14.3.1.20 | SECTION 156.290
| 156.290 Non-certification and decertification of QHPs. | |
| 45:2.0.1.1.14.3.1.21 | SECTION 156.295
| 156.295 Prescription drug distribution and cost reporting. | |
| 45:2.0.1.1.14.4 | SUBPART D
| Subpart D - Standards for Qualified Health Plan Issuers on Federally-Facilitated Exchanges and State-Based Exchanges on the Federal Platform | |
| 45:2.0.1.1.14.4.1.1 | SECTION 156.330
| 156.330 Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges. | |
| 45:2.0.1.1.14.4.1.2 | SECTION 156.340
| 156.340 Standards for downstream and delegated entities. | |
| 45:2.0.1.1.14.4.1.3 | SECTION 156.350
| 156.350 Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform. | |
| 45:2.0.1.1.14.5 | SUBPART E
| Subpart E - Health Insurance Issuer Responsibilities With Respect to Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions | |
| 45:2.0.1.1.14.5.1.1 | SECTION 156.400
| 156.400 Definitions. | |
| 45:2.0.1.1.14.5.1.2 | SECTION 156.410
| 156.410 Cost-sharing reductions for enrollees. | |
| 45:2.0.1.1.14.5.1.3 | SECTION 156.420
| 156.420 Plan variations. | |
| 45:2.0.1.1.14.5.1.4 | SECTION 156.425
| 156.425 Changes in eligibility for cost-sharing reductions. | |
| 45:2.0.1.1.14.5.1.5 | SECTION 156.430
| 156.430 Payment for cost-sharing reductions. | |
| 45:2.0.1.1.14.5.1.6 | SECTION 156.440
| 156.440 Plans eligible for advance payments of the premium tax credit and cost-sharing reductions. | |
| 45:2.0.1.1.14.5.1.7 | SECTION 156.460
| 156.460 Reduction of enrollee's share of premium to account for advance payments of the premium tax credit. | |
| 45:2.0.1.1.14.5.1.8 | SECTION 156.470
| 156.470 Allocation of rates for advance payments of the premium tax credit. | |
| 45:2.0.1.1.14.5.1.9 | SECTION 156.480
| 156.480 Oversight of the administration of the cost-sharing reductions and advance payments of the premium tax credit programs. | |
| 45:2.0.1.1.14.6 | SUBPART F
| Subpart F - Consumer Operated and Oriented Plan Program | |
| 45:2.0.1.1.14.6.1.1 | SECTION 156.500
| 156.500 Basis and scope. | |
| 45:2.0.1.1.14.6.1.2 | SECTION 156.505
| 156.505 Definitions. | |
| 45:2.0.1.1.14.6.1.3 | SECTION 156.510
| 156.510 Eligibility. | |
| 45:2.0.1.1.14.6.1.4 | SECTION 156.515
| 156.515 CO-OP standards. | |
| 45:2.0.1.1.14.6.1.5 | SECTION 156.520
| 156.520 Loan terms. | |
| 45:2.0.1.1.14.7 | SUBPART G
| Subpart G - Minimum Essential Coverage | |
| 45:2.0.1.1.14.7.1.1 | SECTION 156.600
| 156.600 The definition of minimum essential coverage. | |
| 45:2.0.1.1.14.7.1.2 | SECTION 156.602
| 156.602 Other coverage that qualifies as minimum essential coverage. | |
| 45:2.0.1.1.14.7.1.3 | SECTION 156.604
| 156.604 Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart. | |
| 45:2.0.1.1.14.7.1.4 | SECTION 156.606
| 156.606 HHS audit authority. | |
| 45:2.0.1.1.14.8 | SUBPART H
| Subpart H - Oversight and Financial Integrity Standards for Issuers of Qualified Health Plans in Federally-Facilitated Exchanges | |
| 45:2.0.1.1.14.8.1.1 | SECTION 156.705
| 156.705 Maintenance of records for Federally-facilitated Exchanges. | |
| 45:2.0.1.1.14.8.1.2 | SECTION 156.715
| 156.715 Compliance reviews of QHP issuers in Federally-facilitated Exchanges. | |
| 45:2.0.1.1.14.9 | SUBPART I
| Subpart I - Enforcement Remedies in Federally-Facilitated Exchanges | |
| 45:2.0.1.1.14.9.1.1 | SECTION 156.800
| 156.800 Available remedies; Scope. | |
| 45:2.0.1.1.14.9.1.2 | SECTION 156.805
| 156.805 Bases and process for imposing civil money penalties in Federally-facilitated Exchanges. | |
| 45:2.0.1.1.14.9.1.3 | SECTION 156.806
| 156.806 Notice of non-compliance. | |
| 45:2.0.1.1.14.9.1.4 | SECTION 156.810
| 156.810 Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange. | |
| 45:2.0.1.1.14.9.1.5 | SECTION 156.815
| 156.815 Plan suppression. | |
| 45:2.0.1.1.14.10 | SUBPART J
| Subpart J - Administrative Review of QHP Issuer Sanctions in Federally-Facilitated Exchanges | |
| 45:2.0.1.1.14.10.1.1 | SECTION 156.901
| 156.901 Definitions. | |
| 45:2.0.1.1.14.10.1.2 | SECTION 156.903
| 156.903 Scope of Administrative Law Judge's (ALJ) authority. | |
| 45:2.0.1.1.14.10.1.3 | SECTION 156.905
| 156.905 Filing of request for hearing. | |
| 45:2.0.1.1.14.10.1.4 | SECTION 156.907
| 156.907 Form and content of request for hearing. | |
| 45:2.0.1.1.14.10.1.5 | SECTION 156.909
| 156.909 Amendment of notice of assessment or decertification request for hearing. | |
| 45:2.0.1.1.14.10.1.6 | SECTION 156.911
| 156.911 Dismissal of request for hearing. | |
| 45:2.0.1.1.14.10.1.7 | SECTION 156.913
| 156.913 Settlement. | |
| 45:2.0.1.1.14.10.1.8 | SECTION 156.915
| 156.915 Intervention. | |
| 45:2.0.1.1.14.10.1.9 | SECTION 156.917
| 156.917 Issues to be heard and decided by ALJ. | |
| 45:2.0.1.1.14.10.1.10 | SECTION 156.919
| 156.919 Forms of hearing. | |
| 45:2.0.1.1.14.10.1.11 | SECTION 156.921
| 156.921 Appearance of counsel. | |
| 45:2.0.1.1.14.10.1.12 | SECTION 156.923
| 156.923 Communications with the ALJ. | |
| 45:2.0.1.1.14.10.1.13 | SECTION 156.925
| 156.925 Motions. | |
| 45:2.0.1.1.14.10.1.14 | SECTION 156.927
| 156.927 Form and service of submissions. | |
| 45:2.0.1.1.14.10.1.15 | SECTION 156.929
| 156.929 Computation of time and extensions of time. | |
| 45:2.0.1.1.14.10.1.16 | SECTION 156.931
| 156.931 Acknowledgment of request for hearing. | |
| 45:2.0.1.1.14.10.1.17 | SECTION 156.935
| 156.935 Discovery. | |
| 45:2.0.1.1.14.10.1.18 | SECTION 156.937
| 156.937 Submission of briefs and proposed hearing exhibits. | |
| 45:2.0.1.1.14.10.1.19 | SECTION 156.939
| 156.939 Effect of submission of proposed hearing exhibits. | |
| 45:2.0.1.1.14.10.1.20 | SECTION 156.941
| 156.941 Prehearing conferences. | |
| 45:2.0.1.1.14.10.1.21 | SECTION 156.943
| 156.943 Standard of proof. | |
| 45:2.0.1.1.14.10.1.22 | SECTION 156.945
| 156.945 Evidence. | |
| 45:2.0.1.1.14.10.1.23 | SECTION 156.947
| 156.947 The record. | |
| 45:2.0.1.1.14.10.1.24 | SECTION 156.951
| 156.951 Posthearing briefs. | |
| 45:2.0.1.1.14.10.1.25 | SECTION 156.953
| 156.953 ALJ decision. | |
| 45:2.0.1.1.14.10.1.26 | SECTION 156.955
| 156.955 Sanctions. | |
| 45:2.0.1.1.14.10.1.27 | SECTION 156.957
| 156.957 Review by Administrator. | |
| 45:2.0.1.1.14.10.1.28 | SECTION 156.959
| 156.959 Judicial review. | |
| 45:2.0.1.1.14.10.1.29 | SECTION 156.961
| 156.961 Failure to pay assessment. | |
| 45:2.0.1.1.14.10.1.30 | SECTION 156.963
| 156.963 Final order not subject to review. | |
| 45:2.0.1.1.14.11 | SUBPART K
| Subpart K - Cases Forwarded to Qualified Health Plans and Qualified Health Plan Issuers in Federally-facilitated Exchanges | |
| 45:2.0.1.1.14.11.1.1 | SECTION 156.1010
| 156.1010 Standards. | |
| 45:2.0.1.1.14.12 | SUBPART L
| Subpart L - Quality Standards | |
| 45:2.0.1.1.14.12.1.1 | SECTION 156.1105
| 156.1105 Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges. | |
| 45:2.0.1.1.14.12.1.2 | SECTION 156.1110
| 156.1110 Establishment of patient safety standards for QHP issuers. | |
| 45:2.0.1.1.14.12.1.3 | SECTION 156.1120
| 156.1120 Quality rating system. | |
| 45:2.0.1.1.14.12.1.4 | SECTION 156.1125
| 156.1125 Enrollee satisfaction survey system. | |
| 45:2.0.1.1.14.12.1.5 | SECTION 156.1130
| 156.1130 Quality improvement strategy. | |
| 45:2.0.1.1.14.13 | SUBPART M
| Subpart M - Qualified Health Plan Issuer Responsibilities | |
| 45:2.0.1.1.14.13.1.1 | SECTION 156.1210
| 156.1210 Dispute submission. | |
| 45:2.0.1.1.14.13.1.2 | SECTION 156.1215
| 156.1215 Payment and collections processes. | |
| 45:2.0.1.1.14.13.1.3 | SECTION 156.1220
| 156.1220 Administrative appeals. | |
| 45:2.0.1.1.14.13.1.4 | SECTION 156.1230
| 156.1230 Direct enrollment with the QHP issuer in a manner considered to be through the Exchange. | |
| 45:2.0.1.1.14.13.1.5 | SECTION 156.1240
| 156.1240 Enrollment process for qualified individuals. | |
| 45:2.0.1.1.14.13.1.6 | SECTION 156.1250
| 156.1250 Acceptance of certain third party payments. | |
| 45:2.0.1.1.14.13.1.7 | SECTION 156.1255
| 156.1255 Renewal and re-enrollment notices. | |
| 45:2.0.1.1.14.13.1.8 | SECTION 156.1256
| 156.1256 Other notices. | |
| 45:2.0.1.1.15 | PART 157
| PART 157 - EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION | |
| 45:2.0.1.1.15.1 | SUBPART A
| Subpart A - General Provisions | |
| 45:2.0.1.1.15.1.1.1 | SECTION 157.10
| 157.10 Basis and scope. | |
| 45:2.0.1.1.15.1.1.2 | SECTION 157.20
| 157.20 Definitions. | |
| 45:2.0.1.1.15.2 | SUBPART B
| Subpart B [Reserved] | |
| 45:2.0.1.1.15.3 | SUBPART C
| Subpart C - Standards for Qualified Employers | |
| 45:2.0.1.1.15.3.1.1 | SECTION 157.200
| 157.200 Eligibility of qualified employers to participate in a SHOP. | |
| 45:2.0.1.1.15.3.1.2 | SECTION 157.205
| 157.205 Qualified employer participation process in a SHOP for plan years beginning prior to January 1, 2018. | |
| 45:2.0.1.1.15.3.1.3 | SECTION 157.206
| 157.206 Qualified employer participation process in a SHOP for plan years beginning on or after January 1, 2018. | |
| 45:2.0.1.1.16 | PART 158
| PART 158 - ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS | |
| 45:2.0.1.1.16.0.1.1 | SECTION 158.101
| 158.101 Basis and scope. | |
| 45:2.0.1.1.16.0.1.2 | SECTION 158.102
| 158.102 Applicability. | |
| 45:2.0.1.1.16.0.1.3 | SECTION 158.103
| 158.103 Definitions. | |
| 45:2.0.1.1.16.1 | SUBPART A
| Subpart A - Disclosure and Reporting | |
| 45:2.0.1.1.16.1.1.1 | SECTION 158.110
| 158.110 Reporting requirements related to premiums and expenditures. | |
| 45:2.0.1.1.16.1.1.2 | SECTION 158.120
| 158.120 Aggregate reporting. | |
| 45:2.0.1.1.16.1.1.3 | SECTION 158.121
| 158.121 Newer experience. | |
| 45:2.0.1.1.16.1.1.4 | SECTION 158.130
| 158.130 Premium revenue. | |
| 45:2.0.1.1.16.1.1.5 | SECTION 158.140
| 158.140 Reimbursement for clinical services provided to enrollees. | |
| 45:2.0.1.1.16.1.1.6 | SECTION 158.150
| 158.150 Activities that improve health care quality. | |
| 45:2.0.1.1.16.1.1.7 | SECTION 158.151
| 158.151 Expenditures related to Health Information Technology and meaningful use requirements. | |
| 45:2.0.1.1.16.1.1.8 | SECTION 158.160
| 158.160 Other non-claims costs. | |
| 45:2.0.1.1.16.1.1.9 | SECTION 158.161
| 158.161 Reporting of Federal and State licensing and regulatory fees. | |
| 45:2.0.1.1.16.1.1.10 | SECTION 158.162
| 158.162 Reporting of Federal and State taxes. | |
| 45:2.0.1.1.16.1.1.11 | SECTION 158.170
| 158.170 Allocation of expenses. | |
| 45:2.0.1.1.16.2 | SUBPART B
| Subpart B - Calculating and Providing the Rebate | |
| 45:2.0.1.1.16.2.1.1 | SECTION 158.210
| 158.210 Minimum medical loss ratio. | |
| 45:2.0.1.1.16.2.1.2 | SECTION 158.211
| 158.211 Requirement in States with a higher medical loss ratio. | |
| 45:2.0.1.1.16.2.1.3 | SECTION 158.220
| 158.220 Aggregation of data in calculating an issuer's medical loss ratio. | |
| 45:2.0.1.1.16.2.1.4 | SECTION 158.221
| 158.221 Formula for calculating an issuer's medical loss ratio. | |
| 45:2.0.1.1.16.2.1.5 | SECTION 158.230
| 158.230 Credibility adjustment. | |
| 45:2.0.1.1.16.2.1.6 | SECTION 158.231
| 158.231 Life-years used to determine credible experience. | |
| 45:2.0.1.1.16.2.1.7 | SECTION 158.232
| 158.232 Calculating the credibility adjustment. | |
| 45:2.0.1.1.16.2.1.8 | SECTION 158.240
| 158.240 Rebating premium if the applicable medical loss ratio standard is not met. | |
| 45:2.0.1.1.16.2.1.9 | SECTION 158.241
| 158.241 Form of rebate. | |
| 45:2.0.1.1.16.2.1.10 | SECTION 158.242
| 158.242 Recipients of rebates. | |
| 45:2.0.1.1.16.2.1.11 | SECTION 158.243
| 158.243 De minimis rebates. | |
| 45:2.0.1.1.16.2.1.12 | SECTION 158.244
| 158.244 Unclaimed rebates. | |
| 45:2.0.1.1.16.2.1.13 | SECTION 158.250
| 158.250 Notice of rebates. | |
| 45:2.0.1.1.16.2.1.14 | SECTION 158.251
| 158.251 Notice of MLR information. | |
| 45:2.0.1.1.16.2.1.15 | SECTION 158.260
| 158.260 Reporting of rebates. | |
| 45:2.0.1.1.16.2.1.16 | SECTION 158.270
| 158.270 Effect of rebate payments on solvency. | |
| 45:2.0.1.1.16.3 | SUBPART C
| Subpart C - Potential Adjustment to the MLR for a State's Individual Market | |
| 45:2.0.1.1.16.3.1.1 | SECTION 158.301
| 158.301 Standard for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.2 | SECTION 158.310
| 158.310 Who may request adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.3 | SECTION 158.311
| 158.311 Duration of adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.4 | SECTION 158.320
| 158.320 Information supporting a request for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.5 | SECTION 158.321
| 158.321 Information regarding the State's individual health insurance market. | |
| 45:2.0.1.1.16.3.1.6 | SECTION 158.322
| 158.322 Proposal for adjusted medical loss ratio. | |
| 45:2.0.1.1.16.3.1.7 | SECTION 158.323
| 158.323 State contact information. | |
| 45:2.0.1.1.16.3.1.8 | SECTION 158.330
| 158.330 Criteria for assessing request for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.9 | SECTION 158.340
| 158.340 Process for submitting request for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.10 | SECTION 158.341
| 158.341 Treatment as a public document. | |
| 45:2.0.1.1.16.3.1.11 | SECTION 158.342
| 158.342 Invitation for public comments. | |
| 45:2.0.1.1.16.3.1.12 | SECTION 158.343
| 158.343 Optional State hearing. | |
| 45:2.0.1.1.16.3.1.13 | SECTION 158.344
| 158.344 Secretary's discretion to hold a hearing. | |
| 45:2.0.1.1.16.3.1.14 | SECTION 158.345
| 158.345 Determination on a State's request for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.3.1.15 | SECTION 158.346
| 158.346 Request for reconsideration. | |
| 45:2.0.1.1.16.3.1.16 | SECTION 158.350
| 158.350 Subsequent requests for adjustment to the medical loss ratio. | |
| 45:2.0.1.1.16.4 | SUBPART D
| Subpart D - HHS Enforcement | |
| 45:2.0.1.1.16.4.1.1 | SECTION 158.401
| 158.401 HHS enforcement. | |
| 45:2.0.1.1.16.4.1.2 | SECTION 158.402
| 158.402 Audits. | |
| 45:2.0.1.1.16.4.1.3 | SECTION 158.403
| 158.403 Circumstances in which a State is conducting audits of issuers. | |
| 45:2.0.1.1.16.5 | SUBPART E
| Subpart E - Additional Requirements on Issuers | |
| 45:2.0.1.1.16.5.1.1 | SECTION 158.501
| 158.501 Access to facilities and records. | |
| 45:2.0.1.1.16.5.1.2 | SECTION 158.502
| 158.502 Maintenance of records. | |
| 45:2.0.1.1.16.6 | SUBPART F
| Subpart F - Federal Civil Penalties | |
| 45:2.0.1.1.16.6.1.1 | SECTION 158.601
| 158.601 General rule regarding the imposition of civil penalties. | |
| 45:2.0.1.1.16.6.1.2 | SECTION 158.602
| 158.602 Basis for imposing civil penalties. | |
| 45:2.0.1.1.16.6.1.3 | SECTION 158.603
| 158.603 Notice to responsible entities. | |
| 45:2.0.1.1.16.6.1.4 | SECTION 158.604
| 158.604 Request for extension. | |
| 45:2.0.1.1.16.6.1.5 | SECTION 158.605
| 158.605 Responses to allegations of noncompliance. | |
| 45:2.0.1.1.16.6.1.6 | SECTION 158.606
| 158.606 Amount of penalty - general. | |
| 45:2.0.1.1.16.6.1.7 | SECTION 158.607
| 158.607 Factors HHS uses to determine the amount of penalty. | |
| 45:2.0.1.1.16.6.1.8 | SECTION 158.608
| 158.608 Determining the amount of the penalty - mitigating circumstances. | |
| 45:2.0.1.1.16.6.1.9 | SECTION 158.609
| 158.609 Determining the amount of penalty - aggravating circumstances. | |
| 45:2.0.1.1.16.6.1.10 | SECTION 158.610
| 158.610 Determining the amount of penalty - other matters as justice may require. | |
| 45:2.0.1.1.16.6.1.11 | SECTION 158.611
| 158.611 Settlement authority. | |
| 45:2.0.1.1.16.6.1.12 | SECTION 158.612
| 158.612 Limitations on penalties. | |
| 45:2.0.1.1.16.6.1.13 | SECTION 158.613
| 158.613 Notice of proposed penalty. | |
| 45:2.0.1.1.16.6.1.14 | SECTION 158.614
| 158.614 Appeal of proposed penalty. | |
| 45:2.0.1.1.16.6.1.15 | SECTION 158.615
| 158.615 Failure to request a hearing. | |
| 45:2.0.1.1.17 | PART 159
| PART 159 - HEALTH CARE REFORM INSURANCE WEB PORTAL | |
| 45:2.0.1.1.17.0.1.1 | SECTION 159.100
| 159.100 Basis and scope. | |
| 45:2.0.1.1.17.0.1.2 | SECTION 159.110
| 159.110 Definitions. | |
| 45:2.0.1.1.17.0.1.3 | SECTION 159.120
| 159.120 Data submission for the individual and small group markets. | |