WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:     | 1 |   ...   | 49 | 50 || 52 | 53 |   ...   | 55 |

«Department of Health and Human Services has submitted this rule to the Office of the Federal Register. The official version of the rule will be ...»

-- [ Page 51 ] --

(iii) The benefits are paid in a fixed dollar amount per period of hospitalization or illness and/or per service (for example, $100/day or $50/visit) regardless of the amount of expenses incurred and without regard to the amount of benefits provided with respect to the event or service under any other health coverage.

(iv) A notice is displayed prominently in the application materials in at least 14 point type that has the following language: “THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND

IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL

COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN

ADDITIONAL PAYMENT WITH YOUR TAXES.”

(v) The requirement of paragraph (b)(4)(iv) of this section applies to all hospital or other fixed indemnity insurance policy years beginning on or after January 1, 2015, and the requirement of paragraph (b)(4)(i) of this section applies to hospital or other fixed indemnity insurance policies issued on or after January 1, 2015, and to hospital or other fixed indemnity policies issued before that date, upon their first renewal occurring on or after October 1, 2016.

* * * * *

PART 153 – STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND

RISK ADJUSTMENT UNDER THE AFFORDABLE CARE ACT

19. The authority citation for part 153 continues to read as follows:

Authority: Secs. 1311, 1321, 1341–1343, Pub. L. 111–148, 24 Stat. 119.

–  –  –

Adjustment percentage means, with respect to a QHP:

(1) For benefit year 2014, for a QHP offered by a health insurance issuer with allowable costs of at least 80 percent of after-tax premium in a transitional State, the percentage specified by HHS for such QHPs in the transitional State; and otherwise zero percent.

(2) For benefit year 2015, for a QHP offered by a health insurance issuer in any State, two percent.

* * * * *

PART 154 – HEALTH INSURANCE ISSUER RATE INCREASES: DISCLOSURE AND

REVIEW REQUIREMENTS

21. The authority citation for part 154 continues to read as follows:

Authority: Section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94).

–  –  –

follows:

§154.102 Definitions.

* * * * * Product means a package of health insurance coverage benefits with a discrete set of rating and pricing methodologies that a health insurance issuer offers in a State. The term product includes any product that is discontinued and newly filed within a 12-month period when the changes to the product meet the standards of §147.106(e)(2) or (3) of this subchapter (relating to uniform modification of coverage).

* * * * *

PART 155 – EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED

–  –  –

23. The authority citation for part 155 continues to read as follows:

Authority: Title I of the Affordable Care Act, sections 1301, 1302, 1303, 1304, 1311, 1312, 1313, 1321, 1322, 1331, 1332, 1334, 1402, 1411, 1412, 1413, Pub. L. 111-148, 124 Stat.

119 (42 U.S.C. 18021-18024, 18031-18033, 18041-18042, 18051, 18054, 18071, and 18081Section 155.120 is amended by revising paragraph (c) to read as follows:

§155.120 Non-interference with Federal law and non-discrimination standards.

* * * * * (c) Non-discrimination.

(1) In carrying out the requirements of this part, the State and the Exchange must:

(i) Comply with applicable non-discrimination statutes; and (ii) Not discriminate based on race, color, national origin, disability, age, sex, gender identity or sexual orientation.

(2) Notwithstanding the provisions of paragraph (c)(1)(ii) of this section, an organization that receives Federal funds to provide services to a defined population under the terms of Federal legal authorities that participates in the certified application counselor program under §155.225 may limit its provision of certified application counselor services to the same defined population, but must comply with paragraph (c)(1)(ii) of this section with respect to the provision of certified application counselor services to that defined population. If the organization limits its provision of certified application counselor services pursuant to this exception, but is approached for certified application counselor services by an individual who is not included in the defined population that the organization serves, the organization must refer

–  –  –

organization does not limit its provision of certified application counselor services pursuant to this exception, the organization must comply with paragraph (c)(1)(ii) of this section.

–  –  –

§155.206 Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.

(a) Enforcement actions. If an individual or entity specified in paragraph (b) of this section engages in activity specified in paragraph (c) of this section, the Department of Health

and Human Services (HHS) may impose the following sanctions:





(1) Civil money penalties (CMPs), subject to the provisions of this section.

(2) Corrective action plans. In the notice of assessment of CMPs specified in paragraph (l) of this section, HHS may provide an individual or entity specified in paragraph (b) of this section the opportunity to enter into a corrective action plan to correct the violation instead of paying the CMP, based on evaluation of the factors set forth in paragraph (h) of this section. In the event that the individual or entity does not follow such a corrective action plan, HHS could require payment of the CMP.

(b) Consumer assistance entities. CMPs may be assessed under this section against the

following consumer assistance entities:

(1) Individual Navigators and Navigator entities in a Federally-facilitated Exchange, including grantees, sub-grantees, and all personnel carrying out Navigator duties on behalf of a grantee or sub-grantee;

(2) Non-Navigator assistance personnel authorized under §155.205(d) and (e) and non

–  –  –

limited to individuals and entities under contract with HHS to facilitate consumer enrollment in QHPs in a Federally-facilitated Exchange; and (3) Organizations that a Federally-facilitated Exchange has designated as certified application counselor organizations and individual certified application counselors carrying out certified application counselor duties in a Federally-facilitated Exchange.

(c) Grounds for assessing CMPs. HHS may assess CMPs against a consumer assistance entity if, based on the outcome of the investigative process outlined in paragraphs (d) through (i) of this section, HHS has reasonably determined that the consumer assistance entity has failed to comply with the Federal regulatory requirements applicable to the consumer assistance entity that have been implemented pursuant to section 1321(a)(1) of the Affordable Care Act, including provisions of any agreements, contracts, and grant terms and conditions between HHS and the consumer assistance entity that interpret those Federal regulatory requirements or establish procedures for compliance with them, unless a CMP has been assessed for the same conduct under 45 CFR 155.285.

(d) Basis for initiating an investigation of a potential violation. (1) Information. Any information received or learned by HHS that indicates that a consumer assistance entity may have engaged or may be engaging in activity specified in paragraph (c) of this section may warrant an investigation. Information that might trigger an investigation includes, but is not

limited to, the following:

(i) Complaints from the general public;

(ii) Reports from State regulatory agencies, and other Federal and State agencies; or (iii) Any other information that indicates that a consumer assistance entity may have

–  –  –

(2) Who may file a complaint. Any entity or individual, or the legally authorized representative of an entity or individual, may file a complaint with HHS alleging that a consumer assistance entity has engaged or is engaging in an activity specified in paragraph (c) of this section.

(e) Notice of investigation. When HHS performs an investigation under this section, it must provide a written notice to the consumer assistance entity of its investigation. This notice

must include the following:

(1) Description of the activity that is being investigated.

(2) Explanation that the consumer assistance entity has 30 days from the date of the notice to respond with additional information or documentation, including information or documentation to refute an alleged violation.

(3) State that a CMP might be assessed if the allegations are not, as determined by HHS, refuted within 30 days from the date of the notice.

(f) Request for extension. In circumstances in which a consumer assistance entity cannot prepare a response to HHS within the 30 days provided in the notice of investigation described in (e) of this section, the entity may make a written request for an extension from HHS detailing the reason for the extension request and showing good cause. If HHS grants the extension, the consumer assistance entity must respond to the notice within the time frame specified in HHS’s letter granting the extension of time. Failure to respond within 30 days, or, if applicable, within an extended time frame, may result in HHS’s imposition of a CMP depending upon the outcome of HHS’s investigation of the alleged violation.

(g) Responses to allegations of noncompliance. In determining whether to impose a

–  –  –

accordance with paragraph (d)(1) of this section, as well as additional documents or information provided by the consumer assistance entity in response to receiving a notice of investigation in accordance with paragraph (e)(2) of this section. HHS may also conduct an independent investigation into the alleged violation, which may include site visits and interviews, if applicable, and may consider the results of this investigation in its determination.

(h) Factors in determining noncompliance and amount of CMPs, if any. In determining whether there has been noncompliance by the consumer assistance entity, and whether CMPs are appropriate, (1) HHS must take into account the following:

(i) The consumer assistance entity’s previous or ongoing record of compliance, including but not limited to compliance or noncompliance with any corrective action plan.

(ii) The gravity of the violation, which may be determined in part by— (A) The frequency of the violation, taking into consideration whether any violation is an isolated occurrence, represents a pattern, or is widespread; and (B) Whether the violation caused, or could reasonably be expected to cause, financial or other adverse impacts on consumer(s), and the magnitude of those impacts;

(2) HHS may take into account the following:

(i) The degree of culpability of the consumer assistance entity, including but not limited to— (A) Whether the violation was beyond the direct control of the consumer assistance entity; and (B) The extent to which the consumer assistance entity received compensation—legal or

–  –  –

(ii) Aggravating or mitigating circumstances;

(iii) Whether other remedies or penalties have been assessed and/or imposed for the same conduct or occurrence; or (iv) Other such factors as justice may require.

(i) Maximum per-day penalty. The maximum amount of penalty imposed for each violation is $100 for each day for each consumer assistance entity for each individual directly affected by the consumer assistance entity’s noncompliance; and where the number of individuals cannot be determined, HHS may reasonably estimate the number of individuals directly affected by the violation.

(j) Settlement authority. Nothing in §155.206 limits the authority of HHS to settle any issue or case described in the notice furnished in accordance with paragraph (e) or to compromise on any penalty provided for in this section.

(k) Limitations on penalties. (1) Circumstances under which a CMP is not imposed.

HHS will not impose any CMP on:

(i) Any violation for the period of time during which none of the consumer assistance entities knew, or exercising reasonable diligence would have known, of the violation; or (ii) The period of time after any of the consumer assistance entities knew, or exercising reasonable diligence would have known, of the failure, if the violation was due to reasonable cause and not due to willful neglect and the violation was corrected within 30 days of the first day that any of the consumer assistance entities against whom the penalty would be imposed knew, or exercising reasonable diligence would have known, that the violation existed.

(2) Burden of establishing knowledge. The burden is on the consumer assistance entity

–  –  –

exercising reasonable diligence would have known, that the violation existed, as well as the period of time during which that limitation applies; or that the violation was due to reasonable cause and not due to willful neglect and was corrected pursuant to the elements in subparagraph (k)(1)(ii).

(3) Time limit for commencing action. No action under this section will be entertained unless commenced, in accordance with §155.206(l), within six years from the date on which the violation occurred.

(l) Notice of assessment of CMP. If HHS proposes to assess a CMP in accordance with this section, HHS will send a written notice of this decision to the consumer assistance entity

against whom the sanction is being imposed, which notice must include the following:

(1) A description of the basis for the determination;

–  –  –

(5) Whether HHS would permit the consumer assistance entity to enter into a corrective action plan in place of paying the CMP, and the terms of any such corrective action plan;



Pages:     | 1 |   ...   | 49 | 50 || 52 | 53 |   ...   | 55 |


Similar works:

«Package leaflet: Information for the patient KEYTRUDA® 50 mg powder for concentrate for solution for infusion pembrolizumab This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects. Read all of this leaflet carefully before you are given this medicine because it contains important information for you.Keep this leaflet. You may...»

«TRANSPORTATION BARRIERS TO HEALTH CARE: ASSESSING THE TEXAS MEDICAID PROGRAM A Dissertation by STEPHEN BOYCE BORDERS Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY May 2006 Major Subject: Urban and Regional Science TRANSPORTATION BARRIERS TO HEALTH CARE: ASSESSING THE TEXAS MEDICAID PROGRAM A Dissertation by STEPHEN BOYCE BORDERS Submitted to the Office of Graduate Studies of Texas A&M...»

«TMJ Disorders and Therapy (Including Night Guards) TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a clicking sound, you will be glad to know that these problems are more easily diagnosed and treated than they were in the past. Even clicking can lead to more serious problems, so early treatment is important. No one treatment can solve TMJ disorders completely and treatment takes time to be effective. But...»

«Molecular mechanism of natriuretic peptide secretion and adaptation to disease in animal model and clinical practice Doctoral dissertation Tímea Kováts, MD Semmelweis University Doctoral School of Theoretical Medical Sciences PhD supervisor: Miklós Tóth, MD, PhD, DSc Opponents: Barna Vásárhelyi, MD, PhD István Szokodi, MD, PhD Doctoral rigolosum, chairman: Zsolt Radák, PhD, DSc Doctoral rigolosum, members: Andrea Székely, MD, PhD Endre Zima, MD, PhD Budapest 2008 I. Abbreviations II....»

«N I R A N L A DA M E D I S PA NIRANLADA MEDI-SPA W W W. C H I V A S O M. C O M / N I R A N L A D A M E D I S P A REJUVENATION FOR ETERNAL BEAUTY From Pali-Sanskrit, Niranlada means ‘eternal beauty’, and that is what we strive for in nurturing the Mind, Body and Spirit. Niranlada Medi-Spa complements our philosophy and traditional approach to overall wellness with the latest developments in both modern aesthetic treatments and micro-invasive cosmetic surgery, offering you a path to eternal...»

«IAEA-TECDOC-1597 Clinical Applications of SPECT/CT: New Hybrid Nuclear Medicine Imaging System August 2008 IAEA-TECDOC-1597 Clinical Applications of SPECT/CT: New Hybrid Nuclear Medicine Imaging System August 2008 The originating Section of this publication in the IAEA was: Nuclear Medicine Section International Atomic Energy Agency Wagramer Strasse 5 P.O. Box 100 A-1400 Vienna, Austria CLINICAL APPLICATIONS OF SPECT/CT: NEW HYBRID NUCLEAR MEDICINE IMAGING SYSTEM IAEA, VIENNA, 2008...»

«LEADERSHIP TRANSITIONS IN NOTES THE EPISCOPAL CHURCH IN ARKANSAS Guidelines for Calling a Rector (as of 12 December 2012) The Episcopal Church in Arkansas | episcopalarkansas.org 1 NOTES 2 GUIDELINES FOR CALLING A NEW RECTOR When your congregation is faced with the task of finding a new rector, many questions and concerns arise. It is time for exercising the interdependence that exists between congregations and diocesan leadership, a time for collaboration in a matter central to the health of...»

«Public Health Terminology (including descriptions of federal agencies that fund public health programs) Access Access is the potential for or actual entry of a population into the health system. Entry is dependent upon the wants, resources, and needs that individuals bring to the care-seeking process. The ability to obtain wanted or needed services may be influenced by many factors, including travel, distance, waiting time, available financial resources, and availability of a regular source of...»

«PROGRAM NEW HOPE NEW LIFE NEW ORLEANS FertilityCare and NaProTECHNOLOGY American Academy of FertilityCare Professionals 32nd Annual Meeting August 7-10, 2013 Hotel Monteleone French Quarter  New Orleans New Orleans, Louisiana Jointly sponsored by Creighton University Health Sciences Continuing Education American Academy of FertilityCare Professionals and the AAFCP lk kl The National Gianna Center for Women’s Health and Fertility would like to congratulate Karen Hemingway, CFCS on assuming...»

«PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT  WHITE TAIL PARK, INCORPORATED; AMERICAN ASSOCIATION FOR NUDE RECREATION-EASTERN REGION, INCORPORATED; K.H.; D.H., on behalf of themselves and their minor children, I.P. and B.P.; S.B.; J.B., on behalf of themselves and their minor child, C.B.; T.S.; J.S.,  No. 04-2002 on behalf of themselves and their minor children, T.J.S. and M.S., Plaintiffs-Appellants, v. ROBERT B. STROUBE, in his official capacity as Virginia State...»

«How (not) to inform patients about drug use: Use and effects of negations in Dutch patient information leaflets Christian Burgers*, Camiel J. Beukeboom Department of Communication Science, VU University Amsterdam, The Netherlands Lisa Sparks Department of Communication Studies, Wilkinson College of Humanities and Social Sciences, Chapman University, Orange, CA, USA/ Chao Family Comprehensive Cancer Center/NCI Designated, Public Health/Medicine, University of California, Irvine, USA Vera...»

«Elephant TB Guidelines 1 GUIDELINES FOR THE CONTROL OF TUBERCULOSIS IN ELEPHANTS 2012 UNITED STATES ANIMAL HEALTH ASSOCIATION (USAHA) ELEPHANT TUBERCULOSIS SUBCOMMITTEE 20 April 2012 DRAFT REVISION TABLE OF CONTENTS (topics are bookmarked) 1. Introduction 2. Definitions 3. Annual Testing 4. Culture Collection Procedure 5. ElephantTB STAT-PAK® and MAPIA™ Collection Procedure 6. Ancillary Diagnostic Tests 7. TB Management Groups 8. Principles of Anti-tuberculosis Therapy 9. Anti-tuberculosis...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.