GroundRules
45 CFR 155.1055: Service area of a QHP.
Where this section sits in the code
- Title 45—Public Welfare
- SUBTITLE A—Department of Health and Human Services
- SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS
- PART 155—EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT
- Subpart K—Exchange Functions: Certification of Qualified Health Plans
The Exchange must have a process to establish or evaluate the service areas of QHPs to ensure such service areas meet the following minimum criteria:
(a) The service area of a QHP covers a minimum geographical area that is at least the entire geographic area of a county, or a group of counties defined by the Exchange, unless the Exchange determines that serving a smaller geographic area is necessary, nondiscriminatory, and in the best interest of the qualified individuals and employers.
(b) The service area of a QHP has been established without regard to racial, ethnic, language, health status-related factors specified under section 2705(a) of the PHS Act, or other factors that exclude specific high utilizing, high cost or medically-underserved populations.
Collected 2026-08-27T02:26:21Z. Source file · JSON