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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 45 - Public Welfare |
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Subtitle A - Department of Health and Human Services |
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SubChapter B - Requirements Relating to Health Care Access |
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Part 155 - Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act |
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Subpart K - Exchange Functions: Certification of Qualified Health Plans |
§ 155.1055 - Service area of a QHP.
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§ 155.1055 Service area of a QHP.
The Exchange must have a process to establish or evaluate the service areas of QHPs to ensure such service areas meet the following minimum criteria:
(a) The service area of a QHP covers a minimum geographical area that is at least the entire geographic area of a county, or a group of counties defined by the Exchange, unless the Exchange determines that serving a smaller geographic area is necessary, nondiscriminatory, and in the best interest of the qualified individuals and employers.
(b) The service area of a QHP has been established without regard to racial, ethnic, language, health status-related factors specified under section 2705(a) of the PHS Act, or other factors that exclude specific high utilizing, high cost or medically-underserved populations.