{"identifier":"/us/usc/t42/s18041","title":42,"num":"\u00a7\u202f18041.","heading":"State flexibility in operation and enforcement of Exchanges and related requirements","text":"\u00a7\u202f18041.\nState flexibility in operation and enforcement of Exchanges and related requirements\n(a)\nEstablishment of standards\n(1)\nIn general\nThe Secretary shall, as soon as practicable after\n(A) the establishment and operation of Exchanges (including SHOP Exchanges);\n(B) the offering of qualified health plans through such Exchanges;\n(C) the establishment of the reinsurance and risk adjustment programs under part E; and\n(D) such other requirements as the Secretary determines appropriate.\nThe preceding sentence shall not apply to standards for requirements under subtitles A and C (and the amendments made by such subtitles) for which the Secretary issues regulations under the Public Health Service Act [\n42 U.S.C. 201\n(2)\nConsultation\nIn issuing the regulations under paragraph (1), the Secretary shall consult with the National Association of Insurance Commissioners and its members and with health insurance issuers, consumer organizations, and such other individuals as the Secretary selects in a manner designed to ensure balanced representation among interested parties.\n(b)\nState action\nEach State that elects, at such time and in such manner as the Secretary may prescribe, to apply the requirements described in subsection (a) shall, not later than\n(1) the Federal standards established under subsection (a); or\n(2) a State law or regulation that the Secretary determines implements the standards within the State.\n(c)\nFailure to establish Exchange or implement requirements\n(1)\nIn general\nIf\u2014\n(A) a State is not an electing State under subsection (b); or\n(B) the Secretary determines, on or before\n(i) will not have any required Exchange operational by\nJanuary 1, 2014\n(ii) has not taken the actions the Secretary determines necessary to implement\u2014\n(I) the other requirements set forth in the standards under subsection (a); or\n(II) the requirements set forth in subtitles A and C and the amendments made by such subtitles;\nthe Secretary shall (directly or through agreement with a not-for-profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.\n(2)\nEnforcement authority\nThe provisions of section 2736(b)\n1\n2\n2 So in original. Probably should be \u201cService\u201d.\n42 U.S.C. 300gg\u201322(b)\n(d)\nNo interference with State regulatory authority\nNothing in this title\n1\n1\n(e)\nPresumption for certain State-operated Exchanges\n(1)\nIn general\nIn the case of a State operating an Exchange before\nJanuary 1, 2010\n(2)\nProcess\nThe Secretary shall establish a process to work with a State described in paragraph (1) to provide assistance necessary to assist the State\u2019s Exchange in coming into compliance with the standards for approval under this section.","url":"https://projectusc.org/usc/t42/s18041.html","content":[{"t":"sec","id":"/us/usc/t42/s18041","children":[{"t":"num","text":"\u00a7\u202f18041."},{"t":"heading","text":"State flexibility in operation and enforcement of Exchanges and related requirements"},{"t":"subsec","id":"/us/usc/t42/s18041/a","children":[{"t":"num","text":"(a)"},{"t":"heading","text":"Establishment of standards"},{"t":"para","id":"/us/usc/t42/s18041/a/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"chapeau","text":"The Secretary shall, as soon as practicable after ","children":[{"t":"text","text":"March 23, 2010","tail":", issue regulations setting standards for meeting the requirements under this title,"},{"t":"ref","text":"1"},{"t":"num","text":"1","tail":"\u202fSee References in Text note below."},{"t":"text","text":"\u202fSee References in Text note below.","tail":" and the amendments made by this title,"},{"t":"ref","text":"1","tail":" with respect to\u2014"}]},{"t":"subpara","id":"/us/usc/t42/s18041/a/1/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" the establishment and operation of Exchanges (including SHOP Exchanges);","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s18041/a/1/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" the offering of qualified health plans through such Exchanges;","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s18041/a/1/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" the establishment of the reinsurance and risk adjustment programs under part E; and","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s18041/a/1/D","children":[{"t":"num","text":"(D)"},{"t":"content","text":" such other requirements as the Secretary determines appropriate.","tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"The preceding sentence shall not apply to standards for requirements under subtitles A and C (and the amendments made by such subtitles) for which the Secretary issues regulations under the Public Health Service Act [","children":[{"t":"ref","text":"42 U.S.C. 201","href":"/us/usc/t42/s201","tail":" et seq.]."}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s18041/a/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Consultation"},{"t":"content","children":[{"t":"p","text":"In issuing the regulations under paragraph (1), the Secretary shall consult with the National Association of Insurance Commissioners and its members and with health insurance issuers, consumer organizations, and such other individuals as the Secretary selects in a manner designed to ensure balanced representation among interested parties.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s18041/b","children":[{"t":"num","text":"(b)"},{"t":"heading","text":"State action"},{"t":"chapeau","text":"Each State that elects, at such time and in such manner as the Secretary may prescribe, to apply the requirements described in subsection (a) shall, not later than ","children":[{"t":"text","text":"January 1, 2014","tail":", adopt and have in effect\u2014"}]},{"t":"para","id":"/us/usc/t42/s18041/b/1","children":[{"t":"num","text":"(1)"},{"t":"content","text":" the Federal standards established under subsection (a); or","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s18041/b/2","children":[{"t":"num","text":"(2)"},{"t":"content","text":" a State law or regulation that the Secretary determines implements the standards within the State.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s18041/c","children":[{"t":"num","text":"(c)"},{"t":"heading","text":"Failure to establish Exchange or implement requirements"},{"t":"para","id":"/us/usc/t42/s18041/c/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"chapeau","text":"If\u2014"},{"t":"subpara","id":"/us/usc/t42/s18041/c/1/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" a State is not an electing State under subsection (b); or","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s18041/c/1/B","children":[{"t":"num","text":"(B)"},{"t":"chapeau","text":" the Secretary determines, on or before ","children":[{"t":"text","text":"January 1, 2013","tail":", that an electing State\u2014"}]},{"t":"clause","id":"/us/usc/t42/s18041/c/1/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" will not have any required Exchange operational by ","children":[{"t":"text","text":"January 1, 2014","tail":"; or"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s18041/c/1/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"chapeau","text":" has not taken the actions the Secretary determines necessary to implement\u2014"},{"t":"subclause","id":"/us/usc/t42/s18041/c/1/B/ii/I","children":[{"t":"num","text":"(I)"},{"t":"content","text":" the other requirements set forth in the standards under subsection (a); or","tail":"\n"}],"tail":"\n"},{"t":"subclause","id":"/us/usc/t42/s18041/c/1/B/ii/II","children":[{"t":"num","text":"(II)"},{"t":"content","text":" the requirements set forth in subtitles A and C and the amendments made by such subtitles;","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n\n"},{"t":"continuation","text":"the Secretary shall (directly or through agreement with a not-for-profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements.","tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s18041/c/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Enforcement authority"},{"t":"content","children":[{"t":"p","text":"The provisions of section 2736(b)\u202f","children":[{"t":"text","text":"1","tail":" of the Public Health Services\u202f"},{"t":"ref","text":"2"},{"t":"num","text":"2","tail":"\u202fSo in original. Probably should be \u201cService\u201d."},{"t":"text","text":"\u202fSo in original. Probably should be \u201cService\u201d.","tail":" Act ["},{"t":"ref","text":"42 U.S.C. 300gg\u201322(b)","href":"/us/usc/t42/s300gg\u201322/b","tail":"] shall apply to the enforcement under paragraph (1) of requirements of subsection (a)(1) (without regard to any limitation on the application of those provisions to group health plans)."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s18041/d","children":[{"t":"num","text":"(d)"},{"t":"heading","text":"No interference with State regulatory authority"},{"t":"content","children":[{"t":"p","text":"Nothing in this title\u202f","children":[{"t":"text","text":"1","tail":" shall be construed to preempt any State law that does not prevent the application of the provisions of this title."},{"t":"text","text":"1"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subsec","id":"/us/usc/t42/s18041/e","children":[{"t":"num","text":"(e)"},{"t":"heading","text":"Presumption for certain State-operated Exchanges"},{"t":"para","id":"/us/usc/t42/s18041/e/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"In general"},{"t":"content","children":[{"t":"p","text":"In the case of a State operating an Exchange before ","children":[{"t":"text","text":"January 1, 2010","tail":", and which has insured a percentage of its population not less than the percentage of the population projected to be covered nationally after the implementation of this Act, that seeks to operate an Exchange under this section, the Secretary shall presume that such Exchange meets the standards under this section unless the Secretary determines, after completion of the process established under paragraph (2), that the Exchange does not comply with such standards."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s18041/e/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Process"},{"t":"content","children":[{"t":"p","text":"The Secretary shall establish a process to work with a State described in paragraph (1) to provide assistance necessary to assist the State\u2019s Exchange in coming into compliance with the standards for approval under this section.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"},{"t":"text","text":"\n"}]}]}