45 CFR Part 155 — Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act

Contents

2,534 provisions, too many to show on one page. Open a part or section to read it with its history and connections, or search inside the text.

1. 155.10 · Basis and scope.
2. 155.100 · Establishment of a State Exchange.
3. 155.1000 · Certification standards for QHPs.
4. 155.1010 · Certification process for QHPs.
5. 155.1020 · QHP issuer rate and benefit information.
6. 155.1030 · QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions.
7. 155.1040 · Transparency in coverage.
8. 155.1045 · Accreditation timeline.
9. 155.105 · Approval of a State Exchange.
10. 155.1050 · Establishment of Exchange provider access standards.
11. 155.1051 · Effective Essential Community Provider Review Program.
12. 155.1055 · Service area of a QHP.
13. 155.106 · Election to operate an Exchange after 2014.
14. 155.1065 · Stand-alone dental plans.
15. 155.1075 · Recertification of QHPs.
16. 155.1080 · Decertification of QHPs.
17. 155.1090 · Request for the reconsideration of a denial of certification.
18. 155.110 · Entities eligible to carry out Exchange functions.
19. 155.120 · Non-interference with Federal law and non-discrimination standards.
20. 155.1200 · General program integrity and oversight requirements.
21. 155.1210 · Maintenance of records.
22. 155.130 · Stakeholder consultation.
23. 155.1300 · Basis and purpose.
24. 155.1302 · Coordinated waiver process.
25. 155.1304 · Definitions.
26. 155.1308 · Application procedures.
27. 155.1312 · State public notice requirements.
28. 155.1316 · Federal public notice and approval process.
29. 155.1318 · Modification from the normal public notice requirements during an emergent situation.
30. 155.1320 · Monitoring and compliance.
31. 155.1322 · Pass-through funding for approved waivers.
32. 155.1324 · State reporting requirements.
33. 155.1328 · Periodic evaluation requirements.
34. 155.1330 · Waiver amendment.
35. 155.1332 · Waiver extension.
36. 155.140 · Establishment of a regional Exchange or subsidiary Exchange.
37. 155.1400 · Quality rating system.
38. 155.1405 · Enrollee satisfaction survey system.
39. 155.150 · Transition process for existing State health insurance exchanges.
40. 155.1500 · Purpose and scope.
41. 155.1505 · Definitions.
42. 155.1510 · Data submission.
43. 155.1515 · Pre-testing and assessment procedures.
44. 155.160 · Financial support for continued operations.
45. 155.1600 · Purpose and scope.
46. 155.1605 · Applicability date and implementation.
47. 155.1610 · Definitions.
48. 155.1615 · Information submission.
49. 155.1620 · Sampling procedures.
50. 155.1625 · Determining payment errors.
51. 155.1630 · Difference Resolution and appeal process.
52. 155.1635 · Corrective action plan (CAP).
53. 155.1640 · SEIPM preparation phase.
54. 155.1645 · Minimizing potential duplicate audit requirements.
55. 155.1650 · Failure to comply.
56. 155.170 · Additional required benefits.
57. 155.20 · Definitions.
58. 155.200 · Functions of an Exchange.
59. 155.205 · Consumer assistance tools and programs of an Exchange.
60. 155.206 · Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.
61. 155.210 · Navigator program standards.
62. 155.215 · 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.
63. 155.220 · Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs.
64. 155.221 · Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities.
65. 155.225 · Certified application counselors.
66. 155.227 · Authorized representatives.
67. 155.230 · General standards for Exchange notices.
68. 155.240 · Payment of premiums.
69. 155.260 · Privacy and security of personally identifiable information.
70. 155.270 · Use of standards and protocols for electronic transactions.
71. 155.280 · Oversight and monitoring of privacy and security requirements.
72. 155.285 · Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information.
73. 155.30 · Severability.
74. 155.300 · Definitions and general standards for eligibility determinations.
75. 155.302 · Options for conducting eligibility determinations.
76. 155.305 · Eligibility standards.
77. 155.310 · Eligibility process.
78. 155.315 · Verification process related to eligibility for enrollment in a QHP through the Exchange.
79. 155.320 · Verification process related to eligibility for insurance affordability programs.
80. 155.330 · Eligibility redetermination during a benefit year.
81. 155.335 · Annual eligibility redetermination.
82. 155.340 · Administration of advance payments of the premium tax credit and cost-sharing reductions.
83. 155.345 · Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
84. 155.350 · Special eligibility standards and process for Indians.
85. 155.355 · Right to appeal.
86. 155.400 · Enrollment of qualified individuals into QHPs.
87. 155.405 · Single streamlined application.
88. 155.410 · Initial and annual open enrollment periods.
89. 155.415 · Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications.
90. 155.420 · Special enrollment periods.
91. 155.430 · Termination of Exchange enrollment or coverage.
92. 155.500 · Definitions.
93. 155.505 · General eligibility appeals requirements.
94. 155.510 · Appeals coordination.
95. 155.515 · Notice of appeal procedures.
96. 155.520 · Appeal requests.
97. 155.525 · Eligibility pending appeal.
98. 155.530 · Dismissals.
99. 155.535 · Informal resolution and hearing requirements.
100. 155.540 · Expedited appeals.
101. 155.545 · Appeal decisions.
102. 155.550 · Appeal record.
103. 155.555 · Employer appeals process.
104. 155.600 · Definitions and general requirements.
105. 155.605 · Eligibility standards for exemptions.
106. 155.610 · Eligibility process for exemptions.
107. 155.615 · Verification process related to eligibility for exemptions.
108. 155.620 · Eligibility redeterminations for exemptions during a calendar year.
109. 155.625 · Options for conducting eligibility determinations for exemptions.
110. 155.630 · Reporting.
111. 155.635 · Right to appeal.
112. 155.700 · Standards for the establishment of a SHOP.
113. 155.705 · Functions of a SHOP for plan years beginning prior to January 1, 2018.
114. 155.706 · Functions of a SHOP for plan years beginning on or after January 1, 2018.
115. 155.710 · Eligibility standards for SHOP.
116. 155.715 · Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018.
117. 155.716 · Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018.
118. 155.720 · Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018.
119. 155.721 · Record retention and IRS Reporting for plan years beginning on or after January 1, 2018.
120. 155.725 · Enrollment periods under SHOP for plan years beginning prior to January 1, 2018.
121. 155.726 · Enrollment periods under SHOP for plan years beginning on or after January 1, 2018.
122. 155.730 · Application standards for SHOP for plan year beginning prior to January 1, 2018.
123. 155.731 · Application standards for SHOP for plan years beginning on or after January 1, 2018.
124. 155.735 · Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018.
125. 155.740 · SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018.
126. 155.741 · SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018.