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Title 45Subtitle ASubchapter BPart 156


TITLE 45—Public Welfare

Subtitle A—DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS

PART 156—HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES

rule

Subpart A—GENERAL PROVISIONS

§156.10
Basis and scope.
§156.20
Definitions.
§156.50
Financial support.
§156.80
Single risk pool.
rule

Subpart B—ESSENTIAL HEALTH BENEFITS PACKAGE

§156.100
State selection of benchmark plan for plan years beginning prior to January 1, 2020.
§156.105
Determination of EHB for multi-state plans.
§156.110
EHB-benchmark plan standards.
§156.111
State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020.
§156.115
Provision of EHB.
§156.120
Collection of data to define essential health benefits.
§156.122
Prescription drug benefits.
§156.125
Prohibition on discrimination.
§156.130
Cost-sharing requirements.
§156.135
AV calculation for determining level of coverage.
§156.140
Levels of coverage.
§156.145
Determination of minimum value.
§156.150
Application to stand-alone dental plans inside the Exchange.
§156.155
Enrollment in catastrophic plans.
rule

Subpart C—QUALIFIED HEALTH PLAN MINIMUM CERTIFICATION STANDARDS

§156.200
QHP issuer participation standards.
§156.210
QHP rate and benefit information.
§156.215
Advance payments of the premium tax credit and cost-sharing reduction standards.
§156.220
Transparency in coverage.
§156.225
Marketing and Benefit Design of QHPs.
§156.230
Network adequacy standards.
§156.235
Essential community providers.
§156.245
Treatment of direct primary care medical homes.
§156.250
Meaningful access to qualified health plan information.
§156.255
Rating variations.
§156.260
Enrollment periods for qualified individuals.
§156.265
Enrollment process for qualified individuals.
§156.270
Termination of coverage or enrollment for qualified individuals.
§156.272
Issuer participation for the full plan year.
§156.275
Accreditation of QHP issuers.
§156.280
Segregation of funds for abortion services.
§156.285
Additional standards specific to SHOP for plan years beginning prior to January 1, 2018.
§156.286
Additional standards specific to SHOP for plan years beginning on or after January 1, 2018.
§156.290
Non-certification and decertification of QHPs.
§156.295
Prescription drug distribution and cost reporting.
rule

Subpart D—STANDARDS FOR QUALIFIED HEALTH PLAN ISSUERS ON FEDERALLY-FACILITATED EXCHANGES AND STATE-BASED EXCHANGES ON THE FEDERAL PLATFORM

§156.330
Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.
§156.340
Standards for downstream and delegated entities.
§156.350
Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform.
rule

Subpart E—HEALTH INSURANCE ISSUER RESPONSIBILITIES WITH RESPECT TO ADVANCE PAYMENTS OF THE PREMIUM TAX CREDIT AND COST-SHARING REDUCTIONS

§156.400
Definitions.
§156.410
Cost-sharing reductions for enrollees.
§156.420
Plan variations.
§156.425
Changes in eligibility for cost-sharing reductions.
§156.430
Payment for cost-sharing reductions.
§156.440
Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.
§156.460
Reduction of enrollee's share of premium to account for advance payments of the premium tax credit.
§156.470
Allocation of rates for advance payments of the premium tax credit.
§156.480
Oversight of the administration of the cost-sharing reductions and advance payments of the premium tax credit programs.
rule

Subpart F—CONSUMER OPERATED AND ORIENTED PLAN PROGRAM

§156.500
Basis and scope.
§156.505
Definitions.
§156.510
Eligibility.
§156.515
CO-OP standards.
§156.520
Loan terms.
rule

Subpart G—MINIMUM ESSENTIAL COVERAGE

§156.600
The definition of minimum essential coverage.
§156.602
Other coverage that qualifies as minimum essential coverage.
§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.
§156.606
HHS audit authority.
rule

Subpart H—OVERSIGHT AND FINANCIAL INTEGRITY STANDARDS FOR ISSUERS OF QUALIFIED HEALTH PLANS IN FEDERALLY-FACILITATED EXCHANGES

§156.705
Maintenance of records for Federally-facilitated Exchanges.
§156.715
Compliance reviews of QHP issuers in Federally-facilitated Exchanges.
rule

Subpart I—ENFORCEMENT REMEDIES IN FEDERALLY-FACILITATED EXCHANGES

§156.800
Available remedies; Scope.
§156.805
Bases and process for imposing civil money penalties in Federally-facilitated Exchanges.
§156.806
Notice of non-compliance.
§156.810
Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange.
§156.815
Plan suppression.
rule

Subpart J—ADMINISTRATIVE REVIEW OF QHP ISSUER SANCTIONS IN FEDERALLY-FACILITATED EXCHANGES

§156.901
Definitions.
§156.903
Scope of Administrative Law Judge's (ALJ) authority.
§156.905
Filing of request for hearing.
§156.907
Form and content of request for hearing.
§156.909
Amendment of notice of assessment or decertification request for hearing.
§156.911
Dismissal of request for hearing.
§156.913
Settlement.
§156.915
Intervention.
§156.917
Issues to be heard and decided by ALJ.
§156.919
Forms of hearing.
§156.921
Appearance of counsel.
§156.923
Communications with the ALJ.
§156.925
Motions.
§156.927
Form and service of submissions.
§156.929
Computation of time and extensions of time.
§156.931
Acknowledgment of request for hearing.
§156.935
Discovery.
§156.937
Submission of briefs and proposed hearing exhibits.
§156.939
Effect of submission of proposed hearing exhibits.
§156.941
Prehearing conferences.
§156.943
Standard of proof.
§156.945
Evidence.
§156.947
The record.
§156.951
Posthearing briefs.
§156.953
ALJ decision.
§156.955
Sanctions.
§156.957
Review by Administrator.
§156.959
Judicial review.
§156.961
Failure to pay assessment.
§156.963
Final order not subject to review.
rule

Subpart K—CASES FORWARDED TO QUALIFIED HEALTH PLANS AND QUALIFIED HEALTH PLAN ISSUERS IN FEDERALLY-FACILITATED EXCHANGES

§156.1010
Standards.
rule

Subpart L—QUALITY STANDARDS

§156.1105
Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges.
§156.1110
Establishment of patient safety standards for QHP issuers.
§156.1120
Quality rating system.
§156.1125
Enrollee satisfaction survey system.
§156.1130
Quality improvement strategy.
rule

Subpart M—QUALIFIED HEALTH PLAN ISSUER RESPONSIBILITIES

§156.1210
Confirmation of HHS payment and collections reports.
§156.1215
Payment and collections processes.
§156.1220
Administrative appeals.
§156.1230
Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.
§156.1240
Enrollment process for qualified individuals.
§156.1250
Acceptance of certain third party payments.
§156.1255
Renewal and re-enrollment notices.
§156.1256
Other notices.

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