Part 153 - Standards Related to Reinsurance, Risk Corridors, and HHS Risk Adjustment Under the Affordable Care Act  


Subpart A - General Provisions
§ 153.10 - Basis and scope.
§ 153.20 - Definitions.
Subpart B - State Notice of Benefit and Payment Parameters
§ 153.100 - State notice of benefit and payment parameters.
§ 153.110 - Standards for the State notice of benefit and payment parameters.
Subpart C - State Standards Related to the Reinsurance Program
§ 153.200 - [Reserved]
§ 153.210 - State establishment of a reinsurance program.
§ 153.220 - Collection of reinsurance contribution funds.
§ 153.230 - Calculation of reinsurance payments made under the national contribution rate.
§ 153.232 - Calculation of reinsurance payments made under a State additional contribution rate.
§ 153.234 - Eligibility under health insurance market rules.
§ 153.235 - Allocation and distribution of reinsurance contributions
§ 153.240 - Disbursement of reinsurance payments.
§ 153.250 - Coordination with high-risk pools.
§ 153.260 - General oversight requirements for State-operated reinsurance programs.
§ 153.265 - Restrictions on use of reinsurance funds for administrative expenses.
§ 153.270 - HHS audits of State-operated reinsurance programs.
Subpart D - State Standards Related to the Risk Adjustment Program
§ 153.300 - [Reserved]
§ 153.310 - Risk adjustment administration.
§ 153.320 - Federally certified risk adjustment methodology.
§ 153.330 - State alternate risk adjustment methodology.
§ 153.340 - Data collection under risk adjustment.
§ 153.350 - Risk adjustment data validation standards.
§ 153.360 - Application of risk adjustment to the small group market.
§ 153.365 - General oversight requirements for State-operated risk adjustment programs.
Subpart E - Health Insurance Issuer and Group Health Plan Standards Related to the Reinsurance Program
§ 153.400 - Reinsurance contribution funds.
§ 153.405 - Calculation of reinsurance contributions.
§ 153.410 - Requests for reinsurance payment.
§ 153.420 - Data collection.
Subpart F - Health Insurance Issuer Standards Related to the Risk Corridors Program
§ 153.500 - Definitions.
§ 153.510 - Risk corridors establishment and payment methodology.
§ 153.520 - Attribution and allocation of revenue and expense items.
§ 153.530 - Risk corridors data requirements.
§ 153.540 - Compliance with risk corridors standards.
Subpart G - Health Insurance Issuer Standards Related to the Risk Adjustment Program
§ 153.600 - [Reserved]
§ 153.610 - Risk adjustment issuer requirements.
§ 153.620 - Compliance with HHS risk adjustment standards.
§ 153.630 - Data validation requirements when HHS operates risk adjustment.
Subpart H - Distributed Data Collection for HHS-Operated Programs
§ 153.700 - Distributed data environment.
§ 153.710 - Data requirements.
§ 153.720 - Establishment and usage of masked enrollee identification numbers.
§ 153.730 - Deadline for submission of data.
§ 153.740 - Failure to comply with HHS-operated risk adjustment and reinsurance data requirements.