View all text of Subpart B [§ 600.100 - § 600.170]
§ 600.145 - State program administration and operation.
(a) Program operation. The State must implement its BHP in accordance with:
(1) The approved and fully certified State BHP Blueprint, any approved modifications to the State BHP Blueprint and the requirements of this chapter and applicable law; or
(2) The approved suspension application described in § 600.140.
(b) Eligibility. All persons have a right to apply for a determination of eligibility and, if eligible, to be enrolled into coverage that conforms to the regulations in this part.
(c) Statewide program operation. A state choosing to operate a BHP must operate it statewide.
(d) No caps on program enrollment. A State implementing a BHP must not be permitted to limit enrollment by setting an income level below the income standard prescribed in section 1331 of the Affordable Care Act, having a fixed enrollment cap or imposing waiting lists.
(e) Transition plan. States implementing in 2015 may identify a transition period following initial implementation during which the state may propose alternative enrollment strategies for approval. The transition plan is required to be submitted as part of the state's BHP Blueprint consistent with § 600.110.
(f) Core operations. A State operating a BHP must perform all of the following core operating functions:
(1) Eligibility determinations as specified in § 600.320.
(2) Eligibility and health services appeals as specified in 600.335.
(3) Contracting with standard health plan offerors as specified in § 600.410.
(4) Oversight and financial integrity including, but not limited to, operation of the Trust Fund specified at §§ 600.705 and 600.710, compliance with annual reporting at § 600.170, and providing data required by § 600.610 for Federal funding and reconciliation processes.
(5) Consumer assistance as required in § 600.150.
(6) Extending protections to American Indian/Alaska Natives specified at § 600.160, as well as comply with the Civil Rights and nondiscrimination provisions specified at § 600.165.
(7) Data collection and reporting as necessary for efficient and effective operation of the program and as specified by HHS to support program oversight.
(8) If necessary, program termination procedures at § 600.145.