Health Reform CFR – Code of Federal Regulations on Rate Regulation

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

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Subpart A–GENERAL PROVISIONS

§154.101Basis and scope.§154.102

Definitions.§154.103Applicability.

Subpart B–DISCLOSURE AND REVIEW PROVISIONS

§154.200Rate increases subject to review.

§154.205Unreasonable rate increases.

§154.210Review of rate increases subject to review by CMS or by a State.

§154.215Submission of disclosure to CMS for rate increases subject to review.

§154.220Timing of providing the Preliminary Justification.

§154.225Determination by CMS or a State of an unreasonable rate increase.

§154.230Submission and posting of Final Justifications for unreasonable rate increases.

Subpart C–EFFECTIVE RATE REVIEW PROGRAMS

§154.301

CMS’s determinations of Effective Rate Review Programs.

TITLE 45–Public Welfare

SUBTITLE A–DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B–REQUIREMENTS RELATING TO HEALTH CARE ACCESS

PART 158–ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS

 

§158.101
Basis and scope.
§158.102
Applicability.
§158.103
Definitions.

Subpart A–DISCLOSURE AND REPORTING

§158.110
Reporting requirements related to premiums and expenditures.
§158.120
Aggregate reporting.
§158.121
Newer experience.
§158.130
Premium revenue.
§158.140
Reimbursement for clinical services provided to enrollees.
§158.150
Activities that improve health care quality.
§158.151
Expenditures related to Health Information Technology and meaningful use requirements.
§158.160
Other non-claims costs.
§158.161
Reporting of Federal and State licensing and regulatory fees.
§158.162
Reporting of Federal and State taxes.
§158.170
Allocation of expenses.

 

B – Calculating the Rebate

Subpart C–POTENTIAL ADJUSTMENT TO THE MLR FOR A STATE’S INDIVIDUAL MARKET

§158.301
Standard for adjustment to the medical loss ratio.
§158.310
Who may request adjustment to the medical loss ratio.
§158.311
Duration of adjustment to the medical loss ratio.
§158.320
Information supporting a request for adjustment to the medical loss ratio.
§158.321
Information regarding the State’s individual health insurance market.
§158.322
Proposal for adjusted medical loss ratio.
§158.323
State contact information.
§158.330
Criteria for assessing request for adjustment to the medical loss ratio.
§158.340
Process for submitting request for adjustment to the medical loss ratio.
§158.341
Treatment as a public document.
§158.342
Invitation for public comments.
§158.343
Optional State hearing.
§158.344
Secretary’s discretion to hold a hearing.
§158.345
Determination on a State’s request for adjustment to the medical loss ratio.
§158.346
Request for reconsideration.
§158.350
Subsequent requests for adjustment to the medical loss ratio.

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