Je veux savoir à propos de…

khammond on DSKJM1Z7X2PROD with PROPOSALS2

Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules Section 1303 of the ACA, as implemented in 45 CFR 156.280, specifies standards for issuers of QHPs through the Exchanges that cover abortion services for which federal funding is prohibited. The statute and regulation establish that, unless otherwise prohibited by state law, a QHP issuer may elect to cover such abortion services. If an issuer elects to cover such services under a QHP sold through an individual market Exchange, the issuer must take certain steps to ensure that no PTC or CSR funds are used to pay for abortion services for which public funding is prohibited.
As specified in section 1303b2 of the ACA, one such step is that individual market Exchange issuers must determine the amount of, and collect, from each enrollee, a separate payment for an amount equal to the actuarial value of the coverage for abortions for which public funding is prohibited, which must be no less than $1 per enrollee, per month. QHP issuers must also segregate funds for abortion services for which federal funds are prohibited collected through this payment into a separate allocation account used to pay for such abortion services.
Sections 1311b and 1321b of the ACA provide that each state has the opportunity to establish an individual market Exchange that facilitates the purchase of insurance coverage by qualified individuals through QHPs and meets other standards specified in the ACA. Section 1321c1 of the ACA
directs the Secretary to establish and operate such Exchange within states that do not elect to establish an Exchange or, as determined by the Secretary on or before January 1, 2013, will not have an Exchange operable by January 1, 2014.
Section 1311c1 of the ACA
provides the Secretary the authority to issue regulations to establish criteria for the certification of QHPs, including network adequacy standards at section 1311c1B of the ACA. Section 1311d of the ACA describes the minimum functions of an Exchange.
Section 1311e1 of the ACA grants the Exchange the authority to certify a health plan as a QHP if the health plan meets the Secretarys requirements for certification issued under section 1311c1 of the ACA, and the Exchange determines that making the plan available through the Exchange is in the interests of qualified individuals and qualified employers in the state. Section 1311c6 of the ACA establishes authority for the Secretary to require Exchanges to provide enrollment periods, including special enrollment
VerDate Sep<11>2014

19:24 Jun 30, 2021

Jkt 253001

periods, including the monthly enrollment period for Indians, as defined by section 4 of the Indian Healthcare Improvement Act, per section 1311c6D of the ACA.13
Sections 1311d4K and 1311i of the ACA require each Exchange to establish a Navigator program under which it awards grants to entities to carry out certain Navigator duties.
Section 1312c of the ACA generally requires a health insurance issuer to consider all enrollees in all health plans except grandfathered health plans offered by such issuer to be members of a single risk pool for each of its individual and small group markets.
States have the option to merge the individual and small group market risk pools under section 1312c3 of the ACA.
Section 1312e of the ACA directs the Secretary to establish procedures under which a state may permit agents and brokers to enroll qualified individuals and qualified employers in QHPs through an Exchange and to assist individuals in applying for financial assistance for QHPs sold through an Exchange.
Sections 1313 and 1321 of the ACA
provide the Secretary with the authority to oversee the financial integrity of State Exchanges, their compliance with HHS
standards, and the efficient and nondiscriminatory administration of State Exchange activities. Section 1321 of the ACA provides for state flexibility in the operation and enforcement of Exchanges and related requirements.
Section 1321a1 of the ACA directs the Secretary to issue regulations that set standards for meeting the requirements of title I of the ACA for, among other things, the establishment and operation of Exchanges. When operating an FFE under section 1321c1 of the ACA, HHS has the authority under sections 1321c1 and 1311d5A of the ACA to collect and spend user fees. Office of Management and Budget OMB Circular A25
establishes federal policy regarding user fees and specifies that a user charge will be assessed against each identifiable recipient for special benefits derived from federal activities beyond those received by the general public.
Section 1321d of the ACA provides that nothing in title I of the ACA must be construed to preempt any state law that does not prevent the application of title I of the ACA. Section 1311k of the 13 The Indian Healthcare Improvement Act IHCIA, the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives, was made permanent when President Obama signed the bill on March 23, 2010, as part of the ACA.

PO 00000

Frm 00005

Fmt 4701

Sfmt 4702

35159

ACA specifies that Exchanges may not establish rules that conflict with or prevent the application of regulations issued by the Secretary.
Section 1332 of the ACA provides the Secretary of HHS and the Secretary of the Treasury collectively, the Secretaries with the discretion to approve a states proposal to waive specific provisions of the ACA, provided the states section 1332 waiver plan meets certain requirements.
Section 1332a4B of the ACA
requires the Secretaries to issue regulations regarding procedures for section 1332 waivers.
Section 1402 of the ACA provides for, among other things, reductions in cost sharing for EHB for qualified lowand moderate-income enrollees in silver level QHPs offered through the individual market Exchanges. This section also provides for reductions in cost sharing for American Indians enrolled in QHPs at any metal level.
Section 1411c of the ACA requires the Secretary to submit certain information provided by applicants under section 1411b of the ACA to other federal officials for verification, including income and family size information to the Secretary of the Treasury.
Section 1411d of the ACA provides that the Secretary must verify the accuracy of information provided by applicants under section 1411b of the ACA for which section 1411c of the ACA does not prescribe a specific verification procedure, in such manner as the Secretary determines appropriate.
Section 1411f of the ACA requires the Secretary, in consultation with the Secretary of the Treasury, the Secretary of Homeland Security, and the Commissioner of Social Security, to establish procedures for hearing and making decisions governing appeals of Exchange eligibility determinations.
Section 1411f1B of the ACA
requires the Secretary to establish procedures to redetermine eligibility on a periodic basis, in appropriate circumstances, including eligibility to purchase a QHP through the Exchange and for APTC and CSRs.
Section 1411g of the ACA allows the use or disclosure of applicant information only for the limited purposes of, and to the extent necessary to, ensure the efficient operation of the Exchange, including by verifying eligibility to enroll through the Exchange and for APTC and CSRs.
Section 5000A of the Internal Revenue Code the Code, as added by section 1501b of the ACA, requires individuals to have minimum essential coverage MEC for each month, qualify
E:FRFM01JYP2.SGM

01JYP2