C.F.R. » Title 45 » 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

45 C.F.R. § 155.1090

Request for the reconsideration of a denial of certification

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(a) Request for the reconsideration of a denial of certification specific to a Federally-facilitated Exchange—(1) Request for reconsideration. The Federally-facilitated Exchanges will permit an issuer that has submitted a complete application to a Federally-facilitated Exchange for certification of a health plan as a QHP and is denied certification to request reconsideration of such action.

(2) Form and manner of request. An issuer submitting a request for reconsideration under paragraph (a)(1) of this section must submit a written request for reconsideration to HHS, in the form and manner specified by HHS, within 7 calendar days of the date of the written notice of denial of certification. The issuer must include any and all documentation the issuer wishes to provide in support of its request with its request for reconsideration. The request for reconsideration must provide clear and convincing evidence that HHS' determination that the plan does not meet the general certification criteria at § 155.1000(c) was in error.

(3) HHS reconsideration decision. HHS will review the reconsideration request to determine whether the issuer's reconsideration request provided clear and convincing evidence that HHS' determination that the plan does not meet the general certification criteria at § 155.1000(c) was in error. HHS will provide the issuer with a written notice of the reconsideration decision. The decision will constitute HHS' final determination.

(b) [Reserved]

[81 FR 94180, Dec. 22, 2016, as amended at 90 FR 4541, Jan. 15, 2025]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2024–2024 · leading case: Antidote Health Plan of Arizona, Inc. v. Becerra (D.D.C. 2024).
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Antidote Health Plan of Arizona, Inc. v. Becerra (D.D.C. 2024). · cites it 3× “45 C.F.R § 155.1090; 5 U.S.C. § 704 . But so far as Antidote tries to spin a substantive challenge to the Initial Denial into a critique of the reconsideration process writ large, that claim fails, too.”
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