The following abbreviations shall apply to this chapter:

ACO

Accountable Care Organization

APTC

Advance Payments of Premium Tax Credit

CAHPS

Consumer Assessment of Healthcare Providers and Systems

CalHEERS

California Healthcare Eligibility, Enrollment, and Retention System

CCR

California Code of Regulations

CCSB

Covered California for Small Business

CEC

Certified Enrollment Counselor

CFR

Code of Federal Regulations

CHIP

Children's Health Insurance Program

CMS

Centers for Medicare & Medicaid Services

CSR

Cost-Sharing Reduction

DHCS

Department of Health Care Services

DHS

U.S. Department of Homeland Security

EPO

Exclusive Provider Organization

FPL

Federal Poverty Level

FQHC

Federally-Qualified Health Center

HDHP

High Deductible Health Plan

HEDIS

Health Effectiveness Data and Information Set

HHS

U.S. Department of Health and Human Services

HIPAA

Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191)

HMO

Health Maintenance Organization

HSA

Health Savings Account

IAP

Insurance Affordability Program

IPA

Independent Practice Association

IRC

Internal Revenue Code of 1986

IRS

Internal Revenue Services

LEP

Limited English Proficient

MAGI

Modified Adjusted Gross Income

MEC

Minimum Essential Coverage

PBE

Certified Plan-Based Enroller

PBEE

Certified Plan-Based Enrollment Entity

POS

Point of Service

QDP

Qualified Dental Plan

QHP

Qualified Health Plan

SHOP

Small Business Health Options Program

SSA

Social Security Administration

SSN

Social Security Number

TIN

Taxpayer Identification Number

USC

United States Code

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100501, 100502 and 100503, Government Code; and 45 CFR Sections 155.20 and 155.300.

History

1. Amendment of article heading and new section filed 9-30-2013 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-30-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency language will be repealed by operation of law on the following day.

2. Amendment of article heading and new section refiled 4-1-2014 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency language will be repealed by operation of law on the following day.

3. Amendment of article heading and new section refiled 6-30-2014 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 6-30-2014 (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-29-2014 or emergency language will be repealed by operation of law on the following day.

4. Amendment of article heading and new section refiled 9-30-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-30-2014 (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

5. Editorial correction of History 4 (Register 2014, No. 45).

6. Editorial correction of History 4 (Register 2014, No. 50).

7. Amendment of article heading and new section refiled 12-12-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 12-12-2014 (Register 2014, No. 50). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

8. Amendment of article heading and new section refiled 5-11-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 5-11-2015 (Register 2015, No. 20). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

9. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 9-30-2016 or the language in the emergency order of 5-11-2015 will be repealed by operation of law on the following day (Register 2015, No. 38).

10. Amendment of article heading and new section refiled 9-17-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats. 2015, Ch. 18); operative 9-17-2015 (Register 2015, No. 38). A Certificate of Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code section 100504 or the language in the emergency order of 9-17-2015 will be repealed by operation of law on the following day.

11. Amendment of article heading and new section refiled 12-14-2015 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats. 2015, Ch. 18); operative 12-14-2015 (Register 2015, No. 51). A Certificate of Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code section 100504 or the language in the emergency order of 12-14-2015 will be repealed by operation of law on the following day.

12. Amendment of article heading and new section refiled 6-6-2016 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31) and Senate Bill 75 (Stats. 2015, Ch. 18); operative 6-6-2016 (Register 2016, No. 24). A Certificate of Compliance must be transmitted to OAL by 9-30-2016 pursuant to Government Code section 100504 or the language in the emergency order of 6-6-2016 will be repealed by operation of law on the following day.

13. Senate Bill 833 (Stats. 2016, c. 30) modified Government Code section 100504(a)(6) to extend the date upon which a Certificate of Compliance must be transmitted to OAL. Refiling of 6-6-2016 order on 9-30-2016 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-30-2016 (Register 2016, No. 40). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.

14. Amendment of article heading and new section refiled 2-16-2017 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c. 30), Senate Bill 75 (Stats. 2015, c. 18) and Senate Bill 857 (Stats. 2014, c. 31); operative 2-16-2017 (Register 2017, No. 7). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504(a)(6) or the language in the emergency order of 2-16-2017 will be repealed by operation of law on the following day.

15. Amendment of article heading and new section refiled, with further amendments, on 10-26-2017 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c. 30), Senate Bill 75 (Stats. 2015, c. 18) and Senate Bill 857 (Stats. 2014, c. 31); operative 10-26-2017 (Register 2017, No. 43). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504(a)(6) or the language in the emergency order of 10-26-2017 will be repealed by operation of law on the following day.

16. Certificate of Compliance as to 10-26-2017 order transmitted to OAL 8-10-2018 and filed 9-24-2018 (Register 2018, No. 39).

17. Amendment filed 10-7-2019 as a deemed emergency pursuant to Government Code section 100504; operative 10-7-2019 (Register 2019, No. 41). A Certificate of Compliance must be transmitted to OAL by 10-7-2024 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

18. Amendment refiled 9-9-2022 as a deemed emergency pursuant to Government Code section 100504; operative 9-9-2022 (Register 2022, No. 36). A Certificate of Compliance must be transmitted to OAL by 10-7-2024 pursuant to Government Code section 100504(a)(6) or the language in the emergency order of 10-7-2019 will be repealed by operation of law on the following day.

19. Amendment refiled 10-13-2023 as a deemed emergency pursuant to Government Code section 100504, including new CMS abbreviation; operative 10-13-2023 (Register 2023, No. 41). A Certificate of Compliance must be transmitted to OAL by 10-7-2024 pursuant to Government Code section 100504(a)(6) or the language in the emergency order of 10-7-2019 will be repealed by operation of law on the following day.

20. Certificate of Compliance as to 10-13-2023 order transmitted to OAL 6-11-2024 and filed 7-24-2024 (Register 2024, No. 30).

21. New definition of "CCSB" filed 12-16-2024 as a deemed emergency pursuant to Government Code section 100504; operative 12-16-2024 (Register 2024, No. 51). A Certificate of Compliance must be transmitted to OAL by 12-16-2029 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

22. New definition of “CCSB” refiled 12-12-2025 as a deemed emergency pursuant to Government Code section 100504; operative 12-12-2025 (Register 2025, No. 50). A Certificate of Compliance must be transmitted to OAL by 12-16-2029 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.