e-CFR data is current as of January 14, 2021
TITLE 45—Public Welfare
Subtitle A—DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS PART 155—EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT
Subpart A—GENERAL PROVISIONS.
Subpart B—GENERAL STANDARDS RELATED TO THE ESTABLISHMENT OF AN EXCHANGE
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| Establishment of a State Exchange. |
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| Approval of a State Exchange. |
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| Election to operate an Exchange after 2014. |
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| Entities eligible to carry out Exchange functions. |
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| Non-interference with Federal law and non-discrimination standards. |
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| Stakeholder consultation. |
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| Establishment of a regional Exchange or subsidiary Exchange. |
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| Transition process for existing State health insurance exchanges. |
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| Financial support for continued operations. |
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| Additional required benefits. |
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Subpart C—GENERAL FUNCTIONS OF AN EXCHANGE
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| Functions of an Exchange. |
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| Consumer assistance tools and programs of an Exchange. |
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| Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges. |
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| Navigator program standards. |
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| 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. |
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| Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs. |
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| Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities. |
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| Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers. |
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| Certified application counselors. |
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| Authorized representatives. |
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| General standards for Exchange notices. |
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| Privacy and security of personally identifiable information. |
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| Use of standards and protocols for electronic transactions. |
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| Oversight and monitoring of privacy and security requirements. |
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| Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information. |
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Subpart D—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ELIGIBILITY DETERMINATIONS FOR EXCHANGE PARTICIPATION AND INSURANCE AFFORDABILITY PROGRAMS
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| Definitions and general standards for eligibility determinations. |
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| Options for conducting eligibility determinations. |
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| Verification process related to eligibility for enrollment in a QHP through the Exchange. |
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| Verification process related to eligibility for insurance affordability programs. |
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| Eligibility redetermination during a benefit year. |
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| Annual eligibility redetermination. |
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| Administration of advance payments of the premium tax credit and cost-sharing reductions. |
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| Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan. |
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| Special eligibility standards and process for Indians. |
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Subpart E—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ENROLLMENT IN QUALIFIED HEALTH PLANS
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| Enrollment of qualified individuals into QHPs. |
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| Single streamlined application. |
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| Initial and annual open enrollment periods. |
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| Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications. |
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| Special enrollment periods. |
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| Termination of Exchange enrollment or coverage. |
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Subpart F—APPEALS OF ELIGIBILITY DETERMINATIONS FOR EXCHANGE PARTICIPATION AND INSURANCE AFFORDABILITY PROGRAMS
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| General eligibility appeals requirements. |
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| Notice of appeal procedures. |
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| Eligibility pending appeal. |
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| Informal resolution and hearing requirements. |
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| Employer appeals process. |
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Subpart G—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ELIGIBILITY DETERMINATIONS FOR EXEMPTIONS
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| Definitions and general requirements. |
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| Eligibility standards for exemptions. |
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| Eligibility process for exemptions. |
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| Verification process related to eligibility for exemptions. |
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| Eligibility redeterminations for exemptions during a calendar year. |
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| Options for conducting eligibility determinations for exemptions. |
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Subpart H—EXCHANGE FUNCTIONS: SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)
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| Standards for the establishment of a SHOP. |
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| Functions of a SHOP for plan years beginning prior to January 1, 2018. |
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| Functions of a SHOP for plan years beginning on or after January 1, 2018. |
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| Eligibility standards for SHOP. |
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| Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018. |
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| Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018. |
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| Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018. |
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| Record retention and IRS Reporting for plan years beginning on or after January 1, 2018. |
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| Enrollment periods under SHOP for plan years beginning prior to January 1, 2018. |
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| Enrollment periods under SHOP for plan years beginning on or after January 1, 2018. |
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| Application standards for SHOP for plan year beginning prior to January 1, 2018. |
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| Application standards for SHOP for plan years beginning on or after January 1, 2018. |
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| Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018. |
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| SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018. |
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| SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018. |
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Subparts I-J [Reserved]
Subpart K—EXCHANGE FUNCTIONS: CERTIFICATION OF QUALIFIED HEALTH PLANS
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| Certification standards for QHPs. |
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| Certification process for QHPs. |
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| QHP issuer rate and benefit information. |
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| QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions. |
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| Transparency in coverage. |
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| Establishment of Exchange network adequacy standards. |
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| Stand-alone dental plans. |
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| Request for reconsideration. |
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Subpart L—[RESERVED]
Subpart M—OVERSIGHT AND PROGRAM INTEGRITY STANDARDS FOR STATE EXCHANGES
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| General program integrity and oversight requirements. |
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Subpart N—STATE FLEXIBILITY
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| Coordinated waiver process. |
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| State public notice requirements. |
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| Federal public notice and approval process. |
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| Modification from the normal public notice requirements during the public health emergency. |
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| Monitoring and compliance. |
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| State reporting requirements. |
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| Periodic evaluation requirements. |
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Subpart O—QUALITY REPORTING STANDARDS FOR EXCHANGES
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| Enrollee satisfaction survey system. |
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