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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
Subpart A—GENERAL PROVISIONS
Subpart B—STATE NOTICE OF BENEFIT AND PAYMENT PARAMETERS
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| State notice of benefit and payment parameters. |
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| Standards for the State notice of benefit and payment parameters. |
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Subpart C—STATE STANDARDS RELATED TO THE REINSURANCE PROGRAM
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| State establishment of a reinsurance program. |
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| Collection of reinsurance contribution funds. |
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| Calculation of reinsurance payments made under the national contribution rate. |
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| Calculation of reinsurance payments made under a State additional contribution rate. |
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| Eligibility under health insurance market rules. |
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| Allocation and distribution of reinsurance contributions |
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| Disbursement of reinsurance payments. |
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| Coordination with high-risk pools. |
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| General oversight requirements for State-operated reinsurance programs. |
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| Restrictions on use of reinsurance funds for administrative expenses. |
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| HHS audits of State-operated reinsurance programs. |
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Subpart D—STATE STANDARDS RELATED TO THE RISK ADJUSTMENT PROGRAM
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| Risk adjustment administration. |
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| Federally certified risk adjustment methodology. |
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| State alternate risk adjustment methodology. |
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| Data collection under risk adjustment. |
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| Risk adjustment data validation standards. |
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| Application of risk adjustment to the small group market. |
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| General oversight requirements for State-operated risk adjustment programs. |
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Subpart E—HEALTH INSURANCE ISSUER AND GROUP HEALTH PLAN STANDARDS RELATED TO THE REINSURANCE PROGRAM
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| Reinsurance contribution funds. |
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| Calculation of reinsurance contributions. |
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| Requests for reinsurance payment. |
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Subpart F—HEALTH INSURANCE ISSUER STANDARDS RELATED TO THE RISK CORRIDORS PROGRAM
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| Risk corridors establishment and payment methodology. |
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| Attribution and allocation of revenue and expense items. |
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| Risk corridors data requirements. |
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| Compliance with risk corridors standards. |
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Subpart G—HEALTH INSURANCE ISSUER STANDARDS RELATED TO THE RISK ADJUSTMENT PROGRAM
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| Risk adjustment issuer requirements. |
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| Compliance with risk adjustment standards. |
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| Data validation requirements when HHS operates risk adjustment. |
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Subpart H—DISTRIBUTED DATA COLLECTION FOR HHS-OPERATED PROGRAMS
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| Distributed data environment. |
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| Establishment and usage of masked enrollee identification numbers. |
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| Deadline for submission of data. |
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| Failure to comply with HHS-operated risk adjustment and reinsurance data requirements. |
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