Part 155 - EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT  


Subparts I-J [Reserved]
Subpart A — General Provisions.
§ 155.10 Basis and scope.
§ 155.20 Definitions.
Subpart B — General Standards Related to the Establishment of an Exchange
§ 155.100 Establishment of a State Exchange.
§ 155.105 Approval of a State Exchange.
§ 155.106 Election to operate an Exchange after 2014.
§ 155.110 Entities eligible to carry out Exchange functions.
§ 155.120 Non-interference with Federal law and non-discrimination standards.
§ 155.130 Stakeholder consultation.
§ 155.140 Establishment of a regional Exchange or subsidiary Exchange.
§ 155.150 Transition process for existing State health insurance exchanges.
§ 155.160 Financial support for continued operations.
§ 155.170 Additional required benefits.
Subpart C — General Functions of an Exchange
§ 155.200 Functions of an Exchange.
§ 155.205 Consumer assistance tools and programs of an Exchange.
§ 155.206 Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.
§ 155.210 Navigator program standards.
§ 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.
§ 155.220 Ability of States to permit agents and brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs.
§ 155.221 Standards for HHS-approved vendors to perform audits of agents and brokers participating in direct enrollment.
§ 155.222 Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers.
§ 155.225 Certified application counselors.
§ 155.227 Authorized representatives.
§ 155.230 General standards for Exchange notices.
§ 155.240 Payment of premiums.
§ 155.260 Privacy and security of personally identifiable information.
§ 155.270 Use of standards and protocols for electronic transactions.
§ 155.280 Oversight and monitoring of privacy and security requirements.
§ 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.
Subpart D — Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs
§ 155.300 Definitions and general standards for eligibility determinations.
§ 155.302 Options for conducting eligibility determinations.
§ 155.305 Eligibility standards.
§ 155.310 Eligibility process.
§ 155.315 Verification process related to eligibility for enrollment in a QHP through the Exchange.
§ 155.320 Verification process related to eligibility for insurance affordability programs.
§ 155.330 Eligibility redetermination during a benefit year.
§ 155.335 Annual eligibility redetermination.
§ 155.340 Administration of advance payments of the premium tax credit and cost-sharing reductions.
§ 155.345 Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
§ 155.350 Special eligibility standards and process for Indians.
§ 155.355 Right to appeal.
Subpart E — Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans
§ 155.400 Enrollment of qualified individuals into QHPs.
§ 155.405 Single streamlined application.
§ 155.410 Initial and annual open enrollment periods.
§ 155.415 Allowing issuer application assisters to assist with eligibility applications.
§ 155.420 Special enrollment periods.
§ 155.430 Termination of Exchange enrollment or coverage.
Subpart F — Appeals of Eligibility Determinations for Exchange Participation and Insurance Affordability Programs
§ 155.500 Definitions.
§ 155.505 General eligibility appeals requirements.
§ 155.510 Appeals coordination.
§ 155.515 Notice of appeal procedures.
§ 155.520 Appeal requests.
§ 155.525 Eligibility pending appeal.
§ 155.530 Dismissals.
§ 155.535 Informal resolution and hearing requirements.
§ 155.540 Expedited appeals.
§ 155.545 Appeal decisions.
§ 155.550 Appeal record.
§ 155.555 Employer appeals process.
Subpart G — Exchange Functions in the Individual Market: Eligibility Determinations for Exemptions
§ 155.600 Definitions and general requirements.
§ 155.605 Eligibility standards for exemptions.
§ 155.610 Eligibility process for exemptions.
§ 155.615 Verification process related to eligibility for exemptions.
§ 155.620 Eligibility redeterminations for exemptions during a calendar year.
§ 155.625 Options for conducting eligibility determinations for exemptions.
§ 155.630 Reporting.
§ 155.635 Right to appeal.
Subpart H — Exchange Functions: Small Business Health Options Program (SHOP)
§ 155.700 Standards for the establishment of a SHOP.
§ 155.705 Functions of a SHOP.
§ 155.706 xxx
§ 155.710 Eligibility standards for SHOP.
§ 155.715 Eligibility determination process for SHOP.
§ 155.716 xxx
§ 155.720 Enrollment of employees into QHPs under SHOP.
§ 155.721 xxx
§ 155.725 Enrollment periods under SHOP.
§ 155.726 xxx
§ 155.730 Application standards for SHOP.
§ 155.731 xxx
§ 155.735 Termination of SHOP enrollment or coverage.
§ 155.740 SHOP employer and employee eligibility appeals requirements.
§ 155.741 xxx
Subpart K — Exchange Functions: Certification of Qualified Health Plans
§ 155.1000 Certification standards for QHPs.
§ 155.1010 Certification process for QHPs.
§ 155.1020 QHP issuer rate and benefit information.
§ 155.1030 QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions.
§ 155.1040 Transparency in coverage.
§ 155.1045 Accreditation timeline.
§ 155.1050 Establishment of Exchange network adequacy standards.
§ 155.1055 Service area of a QHP.
§ 155.1065 Stand-alone dental plans.
§ 155.1075 Recertification of QHPs.
§ 155.1080 Decertification of QHPs.
§ 155.1090 Request for reconsideration.
Subpart L [Reserved]
Subpart M — Oversight and Program Integrity Standards for State Exchanges
§ 155.1200 General program integrity and oversight requirements.
§ 155.1210 Maintenance of records.
Subpart N — State Flexibility
§ 155.1300 Basis and purpose.
§ 155.1302 Coordinated waiver process.
§ 155.1304 Definitions.
§ 155.1308 Application procedures.
§ 155.1312 State public notice requirements.
§ 155.1316 Federal public notice and approval process.
§ 155.1320 Monitoring and compliance.
§ 155.1324 State reporting requirements.
§ 155.1328 Periodic evaluation requirements.
Subpart O — Quality Reporting Standards for Exchanges
§ 155.1400 Quality rating system.
§ 155.1405 Enrollee satisfaction survey system.
Subparts B Through F [Reserved]
Subparts B Through G [Reserved]
Subparts A Through M [Reserved]
Subparts I-J [Reserved]
Subparts L-M [Reserved]

Authority

Title I of the Affordable Care Act, sections 1301, 1302, 1303, 1304, 1311, 1312, 1313, 1321, 1322, 1331, 1334, 1402, 1411, 1412, 1413.

Source

77 FR 11718, Feb. 27, 2012, unless otherwise noted.