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e-CFR data is current as of November 23, 2020

Title 45Subtitle ASubchapter BPart 153


TITLE 45—Public Welfare

Subtitle A—DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS

PART 153—STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT

rule

Subpart A—GENERAL PROVISIONS

§153.10
Basis and scope.
§153.20
Definitions.
rule

Subpart B—STATE NOTICE OF BENEFIT AND PAYMENT PARAMETERS

§153.100
State notice of benefit and payment parameters.
§153.110
Standards for the State notice of benefit and payment parameters.
rule

Subpart C—STATE STANDARDS RELATED TO THE REINSURANCE PROGRAM

§153.200
[Reserved]
§153.210
State establishment of a reinsurance program.
§153.220
Collection of reinsurance contribution funds.
§153.230
Calculation of reinsurance payments made under the national contribution rate.
§153.232
Calculation of reinsurance payments made under a State additional contribution rate.
§153.234
Eligibility under health insurance market rules.
§153.235
Allocation and distribution of reinsurance contributions
§153.240
Disbursement of reinsurance payments.
§153.250
Coordination with high-risk pools.
§153.260
General oversight requirements for State-operated reinsurance programs.
§153.265
Restrictions on use of reinsurance funds for administrative expenses.
§153.270
HHS audits of State-operated reinsurance programs.
rule

Subpart D—STATE STANDARDS RELATED TO THE RISK ADJUSTMENT PROGRAM

§153.300
[Reserved]
§153.310
Risk adjustment administration.
§153.320
Federally certified risk adjustment methodology.
§153.330
State alternate risk adjustment methodology.
§153.340
Data collection under risk adjustment.
§153.350
Risk adjustment data validation standards.
§153.360
Application of risk adjustment to the small group market.
§153.365
General oversight requirements for State-operated risk adjustment programs.
rule

Subpart E—HEALTH INSURANCE ISSUER AND GROUP HEALTH PLAN STANDARDS RELATED TO THE REINSURANCE PROGRAM

§153.400
Reinsurance contribution funds.
§153.405
Calculation of reinsurance contributions.
§153.410
Requests for reinsurance payment.
§153.420
Data collection.
rule

Subpart F—HEALTH INSURANCE ISSUER STANDARDS RELATED TO THE RISK CORRIDORS PROGRAM

§153.500
Definitions.
§153.510
Risk corridors establishment and payment methodology.
§153.520
Attribution and allocation of revenue and expense items.
§153.530
Risk corridors data requirements.
§153.540
Compliance with risk corridors standards.
rule

Subpart G—HEALTH INSURANCE ISSUER STANDARDS RELATED TO THE RISK ADJUSTMENT PROGRAM

§153.600
[Reserved]
§153.610
Risk adjustment issuer requirements.
§153.620
Compliance with risk adjustment standards.
§153.630
Data validation requirements when HHS operates risk adjustment.
rule

Subpart H—DISTRIBUTED DATA COLLECTION FOR HHS-OPERATED PROGRAMS

§153.700
Distributed data environment.
§153.710
Data requirements.
§153.720
Establishment and usage of masked enrollee identification numbers.
§153.730
Deadline for submission of data.
§153.740
Failure to comply with HHS-operated risk adjustment and reinsurance data requirements.

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