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.

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