C.F.R. » Title 45 » SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS › PART 156—HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES › Subpart M—Qualified Health Plan Issuer Responsibilities

45 C.F.R. § 156.1215

Payment and collections processes

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar
Link to an amendment published at 91 FR 29877, May 20, 2026.

(a) Netting of payments and charges for 2014. In 2014, as part of its monthly payment and collections process, HHS will net payments owed to QHP issuers and their affiliates under the same taxpayer identification number against amounts due to the Federal government from the QHP issuers and their affiliates under the same taxpayer identification number for advance payments of the premium tax credit, advance payments of cost-sharing reductions, and payment of Federally-facilitated Exchange user fees.

(b) Netting of payments and charges for later years. As part of its payment and collections process, HHS may net payments owed to issuers and their affiliates operating under the same tax identification number against amounts due to the Federal Government from the issuers and their affiliates under the same taxpayer identification number for advance payments of the premium tax credit, advance payments of and reconciliation of cost-sharing reductions, payment of federally facilitated Exchange user fees, payment of State Exchanges utilizing the Federal platform user fees, HHS risk adjustment, reinsurance, and risk corridors payments and charges, and administrative fees for utilizing the Federal Independent Dispute Resolution process in accordance with § 149.510(d)(2) of this subchapter.

(c) Determination of debt. Any amount owed to the Federal Government by an issuer and its affiliates for advance payments of the premium tax credit, advance payments of and reconciliation of cost-sharing reductions, Federally-facilitated Exchange user fees, including any fees for State-based Exchanges utilizing the Federal platform, HHS risk adjustment, reinsurance, risk corridors, and unpaid administrative fees for utilizing the Federal Independent Dispute Resolution process in accordance with § 149.510(d)(2), after HHS nets amounts owed by the Federal Government under these programs, is a determination of a debt.

[79 FR 13841, Mar. 11, 2014, as amended at 81 FR 12351, Mar. 8, 2016; 86 FR 24294, May 5, 2021; 89 FR 26426, Apr. 15, 2024]
Notes of Decisions
Cited in 4 cases (2 in the last 5 years), 2018–2022 · leading case: Hammer v. U.S. Dep't of Health & Human Servs., 905 F.3d 517 (7th Cir. 2018).
Sort: Relevance Newest Treatment
Hammer v. U.S. Dep't of Health & Human Servs., 905 F.3d 517 (7th Cir. 2018). “Despite this order and the Director's protestations, HHS began to offset its overdue payments against Land of Lincoln's debt in the Risk Adjustment program, as its own regulations permitted, see 45 C.F.R. § 156.1215 (b). HHS has since withheld $27 million in payments that it put…”
Conway v. United States, 997 F.3d 1198 (Fed. Cir. 2021). · cites it 2× “UNITED STATES 45 C.F.R. § 156.1215 (b) (the “Netting Regulation”) (appli- cable after 2014).”
Health Repub. Ins. Co. v. United States (Fed. Cl. 2022). · cites it 4× “¶ 18 (citing 45 C.F.R. § 156.1215 ). In 2012, Colorado HealthOp received start-up and solvency loans under the CO-OP program.”
Conway v. United States (Fed. Cl. 2019). · cites it 3× “§ 18061 ; 45 C.F.R. § 156.1215 . ) THE UNITED STATES, ) ) Defendant.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.