Code of Federal Regulations (Last Updated: July 5, 2024) |
Title 45 - Public Welfare |
Subtitle A - Department of Health and Human Services |
SubChapter B - Requirements Relating to Health Care Access |
Part 154 - Health Insurance Issuer Rate Increases: Disclosure and Review Requirements |
Subpart B - Disclosure and Review Provisions |
§ 154.210 - Review of rate increases subject to review by CMS or by a State.
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§ 154.210 Review of rate increases subject to review by CMS or by a State.
(a) Except as provided in paragraph (b) of this section, CMS will review a rate increase subject to review to determine whether it is unreasonable, as required by this part.
(b) CMS will adopt a State's determination of whether a rate increase is an unreasonable rate increase, if the State:
(1) Has an Effective Rate Review Program as described in § 154.301; and
(2) The State provides to CMS, on a form and in a manner prescribed by the Secretary, its final determination of whether a rate increase is unreasonable, which must include a brief explanation of how its analysis of the relevant factors set forth in § 154.301(a)(3) caused it to arrive at that determination, within five business days following the State's final determination.
(c) CMS will post and maintain on its Web site a list of the States with market segments that meet the requirements of paragraph (b) of this section.