reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.9 - Decertification

Current through June 14, 2024
DOA may, at any time after it has certified a VBE, withdraw
					 certification if the status of that firm's ownership, control, or management
					 make such action necessary, or it if fails to maintain its status as an ongoing
					 business, or it has violated the guidelines of an awarding authority or no
					 longer qualifies as a small business concern. A firm may be certified by the
					 DOA after being provided with an opportunity to be heard by the MBECO. Firms
					 decertified by the DOA may seek an appeal of the decertification determination
					 before the CRC.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.10 - Grounds for Complaint

Current through June 14, 2024
A. Any person,
				 including a DOA staff member or representative of an awarding authority, can,
				 in writing, make a complaint to DOA against any VBE if that person believes
				 that the VBE is abusing its certified status or failing to conduct itself as a
				 bona fide VBE. DOA reserves the right to investigate any and all
				 complaints.
B. If, after its
				 investigation, DOA finds that a VBE has:
1.
				 Submitted inaccurate or false information to DOA during the certification or
				 recertification process; or
2. Has
				 violated the guidelines of an awarding authority; or
3. Has changed its ownership, control, or
				 management without notifying DOA within thirty (30) days of such change;
				 or
4. Has failed to conduct itself
				 as a bona fide VBE or to maintain its status as an ongoing concern, it may seek
				 an information resolution to the problem, hold a hearing, or immediately
				 decertify the VBE.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.11 - Informal Resolution

Current through June 14, 2024
A. If DOA chooses to
				 seek an informal resolution to the problem, it will:
1. Advise the enterprise of the allegations
				 made against it, and
2. Inform the
				 enterprise of the findings of the representative who investigated its case,
				 and
3. Request that the VBE take
				 voluntary action to correct the problem within thirty (30) days of the
				 notification.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.12 - Annual Update

Current through June 14, 2024
A. All certified
				 firms shall update their business information on an annual basis. Failure to
				 furnish requested information may result in loss of certification, after being
				 provided with the opportunity to be heard by the MBECO.
B. DOA shall issue a Notice of Pending
				 Expiration of Certification or Notice of Annual Update Request to each VBE
				 approximately sixty (60) days before the experience of the certification period
				 or the annual update anniversary date. However, failure to DOA to issue the
				 notice or failure of the certified VBE firm to receive the notice shall not
				 extend the existing certification period nor relieve the VBE of the obligation
				 to submit a timely application for recertification or annual update in
				 accordance with this section.
C.
				 The application for Renewal of Certification or Annual Update shall be
				 submitted to DOA not less than thirty (30) days before the date of expiration
				 of the existing certification or the annual update anniversary date.
D. Applications for recertification and
				 annual updates shall meet all of the requirements for application for
				 certification set form in these regulations with all information and documents
				 updated to the date of the application for renewal or annual update anniversary
				 date.
E. Failure of a certified
				 firm to recertify or provide annual update submittals in a timely manner will
				 result in the firm not being recertified by DOA. A firm that fails to provide
				 all information required for recertification must submit a new certification
				 application, with all accompanying documents and this application will be
				 processed as prescribed in these regulations.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.13 - Effect of Prior VBE Certification by Another State or Federal Agency

Current through June 14, 2024
Prior VBE certification of the applicant by another state
					 or federal agency or a Unified Certification Program shall be considered by the
					 DOA, but in no case shall this prior certification be considered conclusive
					 proof that the applicant is eligible for certification. To the extent feasible,
					 DOA will confer with prior certifying agencies, but in no case shall prior
					 certification be considered grounds for reciprocity.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.14 - Judicial Review

Current through June 14, 2024
An applicant may seek judicial review of any final
					 administrative decision of the DOA and/or the CRC in accordance with R.I. Gen.
					 Laws Chapter 42-35.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.15 - Compliance with Regulations Governing Participation in State Purchases and Public Works Projects

Current through June 14, 2024
A. Scope
1. State Agencies as defined herein shall
				 comply with these regulations; provided, however, that pursuant to R.I. Gen.
				 Laws §§
											37-14.3-6 and
				  37-14.3-7 the Director of the Department of Transportation has received delegated
				 authority to adopt regulations consistent with R.I. Gen. Laws Chapter 37-14.3
				 thereby exempting the Department of Transportation from the requirements of
				 these Regulations.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.16 - Amendments

Current through June 14, 2024
The Regulations may be rescinded or amended from time to
					 time with the approval of the Director. Any amendments must be promulgated by
					 the Department of Administration on behalf of the Director in accordance with
					 the "Administrative Procedures Act", R.I. Gen. Laws Chapter
					 42-35.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 80 - Diversity, Equity and Opportunity › Subchapter 15 - Veteran Business Enterprise › Part 1 - Certification and Decertification of Veteran Business Enterprises by the State of Rhode Island and Participation by Veteran Business Enterprises in State Purchases of Goods and Services and Public Works Projects › Section 220-RICR-80-15-1.17 - Severability

Current through June 14, 2024
The provisions of this document are severable, and if any
					 of the provisions shall be held to be unconstitutional by any court of
					 competent jurisdiction, the decision of such court shall not affect or impair
					 any of the remaining provisions.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.1 - Purpose

Current through June 14, 2024
A. The purpose of these Regulations is to
				 establish certain Rules governing:
1.
				 Individual eligibility for enrollment in a Qualified Health Plan;
2. Individual eligibility for receipt of
				 advance payments of the premium tax credit and cost sharing
				 reductions;
3. Enrollment of
				 qualified individuals in a Qualified Health Plan;
4. Initial open enrollment, annual open
				 enrollment and special enrollment periods for qualified individuals;
5. Premium payments and termination of
				 coverage for qualified individuals;
6. Eligibility for Minimum Essential Coverage
				 exemptions;
7. The operation of a
				 SHOP Exchange, including enrollment of qualified employers and qualified
				 employees into Qualified Health Plans;
8. A mechanism for handling all Rhode Island
				 Health Benefits Exchange Appeals; and
9. Establishment of a trust to facilitate the
				 collection and payment of premiums to Qualified Health Plan issuers and the
				 receipt of payments for such products and services as may be offered by and/or
				 through the Exchange related to the goals of improving the health, wellbeing
				 and outcomes of all Rhode Islanders.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.2 - Authority

Current through June 14, 2024
A. This Part is promulgated pursuant to the
				 authority set forth in R.I. Gen. Laws Chapter 42-157; R.I. Gen. Laws
				 §§
										44-30-101; and 42-7.2-1
et seq.
; Pub. Law 111-148, the Patient Protection and Affordable Care Act (ACA), as amended by
				 Pub. Law 111-152, the Federal Health Care and Education Reconciliation Act of
				 2010, and any amendments to, or Regulations or guidance issued under those
				 Acts.
B.
										§1311 of the ACA
				 provides legal authority for States to establish health insurance exchanges.
				 Health insurance exchanges are designed to provide affordable health insurance
				 to eligible individuals and small businesses through Qualified Health Plans
				 (QHPs). The Exchange will operate a Small Business Health Options Program
				 (SHOP), which permits employers to obtain group health insurance coverage for
				 their employees. Certain employers that purchase coverage through a SHOP are
				 eligible for a Federal small business premium tax credit.
C. Pursuant to the provisions of R.I. Gen.
				 Laws §§
										42-35-3(a)(3)  and  42-35.1-4, consideration was given to:
				 alternative approaches to the Regulations; duplication or overlap with other
				 State Regulations; and significant economic impact on small business.
D. Based upon available information, no known
				 alternative approach, duplication or overlap was
				 identified.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.3 - Incorporated Materials

Current through June 14, 2024
These Regulations hereby adopt and incorporate 45 C.F.R. Parts 155, 156 and 157 (2022) and  26 C.F.R. §
											1.36B  (2022) by reference,
					 not including any further editions or amendments thereof and only to the extent
					 that the provisions therein are not inconsistent with these
					 Regulations.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.5 - Qualified Health Plan Eligibility and Enrollment

Current through June 14, 2024
A. In
				 General - §1311 of the ACA establishes exchanges to facilitate the
				 purchase of Qualified Health Plans. §1311 and its implementing
				 regulations,  45 C.F.R. §§
											155.305 and  155.400, incorporated above at
				 §
										1.3     of this Part, respectively, establish eligibility requirements and
				 requirements for enrollment in a Qualified Health Plan.
B. Eligibility for Enrollment in a QHP
				 through the Exchange - The Exchange shall determine an applicant eligible for
				 enrollment in a Qualified Health Plan if he or she meets the requirements in  45 C.F.R. §
											155.305, incorporated above at §
										1.3     of this Part, including
				 the following requirements:
1. Citizenship,
				 status as a national, or lawful presence. Is a citizen, or national of the
				 United States, or is a non-citizen who is lawfully present in the United States
				 and is reasonably expected to be a citizen, national or a non-citizen who is
				 lawfully present for the entire period for which enrollment is
				 sought;
2. Incarceration. Is not
				 incarcerated, other than incarceration pending the disposition of
				 charges;
3. Residency. Meets the
				 applicable residency standards as defined in  45 C.F.R. §
												155.305(a)(3),
				 incorporated above at §
											1.3     of this Part.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.6 - Annual Open Enrollment and Special Enrollment Periods

Current through June 14, 2024
A.
				 In General - §1311 of the ACA and its implementing regulations,  45 C.F.R. §§
											155.410 and  155.420, incorporated above at §
										1.3     of this
				 Part, and R.I. Gen. Laws §
										42-157-12 establish requirements for annual
				 open enrollment, and special enrollment periods for Qualified Health
				 Plans.
B. Annual Open Enrollment
				 Period
1. The Exchange will establish the
				 annual open enrollment period and shall provide a minimum of one hundred twenty
				 (120) days advance public notice prior to its first
				 (1st) day.
2. Annual Open Enrollment Periods as
				 established by the Exchange shall last a minimum of thirty (30)
				 days.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.8 - Application and Renewal Process

Current through June 14, 2024
A. Integrated
				 Eligibility System - In September 2016, the State of Rhode Island implemented
				 its new Integrated Eligibility System (IES) which has the capacity to
				 cross-walk with the agency that administers the State's Medicaid program,
				 EOHHS, and, through a single application process, evaluate eligibility for QHP
				 and publicly financed health coverage. This section focuses on the application
				 and renewal processes that have been established in conjunction with the
				 implementation of the IES.
B.
				 Access Points - The State is committed to pursuing a "No Wrong Door" policy
				 that offers individuals multiple application and renewal access points which
				 all lead to the State's IES.
1. Self-Service
				 - Individuals seeking initial or continuing eligibility have the option of
				 accessing the eligibility system online using a self-service portal through
				 links on the HealthSource RI (healthsourceri.com) Executive Office of Health
				 and Human Services (eohhs.ri.gov) and Department of Human Services (dhs.ri.gov)
				 websites.
2. Assisted Service -
				 Individuals may also apply on paper and submit forms via mail to the address
				 specified thereon or deliver in person to HealthSource RI's walk-in
				 center.
3. Individuals may also
				 visit the HealthSource RI walk-in center or contact the HealthSource RI contact
				 center directly for assistance with an application.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.9 - Applying for Coverage

Current through June 14, 2024
A. In general, the
				 process of completing and submitting an application proceeds in accordance with
				 the following:
1. Account Creation - To
				 initiate the application process, an individual must create a login and
				 establish an account in the eligibility system. This can be done through the
				 self-service portal by the person alone or with the help of an eligibility
				 specialist or certified assister.
2. Identity Proofing - The applicant must
				 provide personally identifiable information for the purpose of creating an
				 online account as a form of identity proofing during the process of applying
				 for health coverage. Verification of this information is automated.
				 Documentation proving identity may be required if the automated verification
				 process is unsuccessful. Acceptable forms of identity proof include a driver's
				 license, school registration, voter registration card, etc. Documents may be
				 submitted via mail, online upload, or delivered to the HealthSource RI contact
				 center.
3. Account Matches - Once
				 identity is verified, account matches are conducted to determine whether the
				 applicant or members of the applicant's household have other accounts or are
				 currently receiving benefits.
4.
				 Application Submission - An Individual must submit a signed and completed
				 application in order to receive an eligibility determination for health
				 coverage. All signatures required from an applicant to complete an application
				 may be obtained electronically. Any such electronic signature is valid and the
				 legal equivalent of a signature obtained in another form. To submit an
				 application for health coverage, individuals must agree to the terms contained
				 therein.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.10 - Termination of Coverage and Grace Periods

Current through June 14, 2024
A. Termination of
				 Coverage
1. In General - §1412(c)(2) of
				 the ACA, and its implementing regulation,  45 C.F.R. §
												156.270,
				 incorporated above at §
											1.3     of this Part, establish a three (3) month
				 grace period for non-payment of premium before coverage will be terminated for
				 a qualified individual who is receiving advance payment of premium tax credits
				 and has made at least one (1) full month's premium payment during the Benefit
				 Year.  45 C.F.R. §
												155.430, incorporated above at §
											1.3     of this Part,
				 establishes procedures for termination of QHP coverage.
2. Termination of Coverage Due to Non-Payment
				 of Premium - The Exchange shall establish a standard policy for the termination
				 of coverage of enrollees due to non-payment of premiums. This policy for the
				 termination of coverage:
a. Must include the
				 grace period for enrollees receiving advance payments of the premium tax
				 credits; and
b. Must be applied
				 uniformly to enrollees in similar circumstances.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.11 - Minimum Essential Coverage Exemptions

Current through June 14, 2024
A. In General -
				 §5000A of the Internal Revenue Code of 1986,  26 U.S.C. §
											5000A, as
				 added by the ACA, and R.I. Gen. Laws §
										44-30-101 require that for each
				 month during the taxable year, a non-exempt individual must have minimum
				 essential coverage, as defined under the law, or pay a Federal individual
				 responsibility penalty or State shared responsibility payment penalty,
				 respectively.
1. The Exchange is authorized
				 to issue exemptions from the individual responsibility penalty and the shared
				 responsibility payment penalty.
2.
				 With regard to exemptions from the individual responsibility penalty, the
				 Exchange may rely on HHS for this purpose.
3. The Exchange must determine an
				 individual's eligibility for an exemption from the shared responsibility
				 payment penalty in accordance with the applicable standards specified in  45 C.F.R. §
												155.605, incorporated above at §§
											1.3  and   1.11(B)(5)     of
				 this Part.
4. The Exchange will
				 develop an application that applicants will be required to complete to apply
				 for an exemption from the shared responsibility payment penalty. The
				 application will request the minimum information necessary for the purposes of
				 determining the applicant's eligibility for an exemption.
5. Applicants requesting an exemption from
				 the shared responsibility payment penalty must submit the application developed
				 by the Exchange under §
											1.11(A)(4)     of this Part in a manner specified by
				 the Exchange.
6. The Exchange
				 contact center and web site shall provide information to consumers regarding
				 the exemption eligibility process.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.12 - Agreements with Issuers

Current through June 14, 2024
A. In General - The
				 Exchange shall establish a certification process for all participating QHP
				 Issuers.
B. Issuer Agreements - All
				 QHP Issuers must enter an Issuer Agreement with the Exchange describing the
				 issuer's obligations with regard to offering products and/or services on the
				 Exchange.
1. Issuer Agreements shall be
				 negotiated on an annual basis and formed in advance of the annual open
				 enrollment period for the upcoming Benefit Year.
2. QHPs offered through the Exchange pursuant
				 to an Issuer Agreement may vary from year to year.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.13 - SHOP Exchange

Current through June 14, 2024
A. In General -
				 §1311(b)(1)(B) of the ACA and its implementing regulation,  45 C.F.R. Part 155  Subpart H, incorporated above at §
										1.3     of this Part, provide for the
				 establishment of a Small Business Health Options Program (SHOP) Exchange that
				 is designed to assist qualified employers and to facilitate the enrollment of
				 qualified employees into Qualified Health Plans.
B. Terms and Conditions - To participate in
				 the SHOP Exchange, a qualified employer or a qualified employee must register
				 with the Exchange and accept the terms and conditions for participation. The
				 SHOP Exchange may from time to time modify such terms and conditions for
				 participation in the SHOP Exchange.
C. SHOP Enrollment - A qualified employer or
				 a qualified employee shall submit a signed application for coverage prior to
				 receiving coverage through the SHOP Exchange. All signatures required from a
				 qualified employer or a qualified employee to complete an enrollment
				 application may be obtained electronically. Any such electronic signature is
				 valid and the legal equivalent of a signature obtained in another
				 form.
D. Agents and Brokers - The
				 SHOP Exchange shall establish a process by which a qualified employer or
				 qualified employee may designate an insurance agent or broker to act on his or
				 her behalf in interactions with the SHOP Exchange.
1. In order to enroll qualified employers and
				 qualified employees through the SHOP Exchange, the agent or broker must be
				 certified to participate in the SHOP Exchange and must have established an
				 account with the SHOP Exchange.
2.
				 A qualified employer or qualified employee may designate an agent or broker
				 electronically.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.14 - Appeals

Current through June 14, 2024
A. Designation of Exchange Appeals Entity -
				 Any Exchange appeals other than Large Employer Appeals may be accepted,
				 processed and adjudicated by EOHHS if, at such time as the appeal is filed, the
				 Exchange has in effect a Memorandum of Agreement (MOA) designating EOHHS as the
				 entity responsible for such appeals.
B. Procedures for Appeals Delegated to EOHHS
				 by MOA - Specific requirements relating to the acceptance, processing, and
				 adjudication of appeals by EOHHS shall be as set forth in 210-RICR- 10-05-2,
				 Appeals Process and Procedures for EOHHS Agencies and Programs.
C. Exchange appeals must be filed within
				 thirty (30) days of the contested agency action. The thirty (30) days begins
				 five (5) days after the mailing date of the notice of an agency
				 action.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.15 - Exchange Trust Payments

Current through June 14, 2024
A. Establishment of
				 Trust - The Exchange shall establish the Trust for the following purposes:
1. Collecting health and dental insurance
				 premium payments from qualified employers and qualified individuals;
2. Remitting premium payments to QHP issuers
				 on behalf of enrollees who participate in QHPs offered through the
				 Exchange;
3. Performing functions
				 ancillary to the collection and payment of premiums to Qualified Health Plan
				 issuers and the receipt of payments for such products and services as may be
				 offered through the Exchange; and
4. Carrying out any other functions that are
				 reasonably necessary in furtherance of the foregoing and in accordance with the
				 establishment and maintenance of the Trust.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.16 - Request for the Promulgation of a Rule

Current through June 14, 2024
A. The purpose
				 of this section and §
										1.17     of this Part is to prescribe the form of a
				 Petition for Promulgation of Rules pursuant to R.I. Gen. Laws §
										42-35-6 and the procedure for its submission, consideration, and disposition.
B. For purposes of this section and §
										1.17     of this Part only, the following definitions shall apply:
1. "Department" means HealthSource
				 RI.
2. "Petition" means a request
				 for the promulgation of a Rule.
3.
				 "Petitioner" means a person requesting the promulgation of a Rule.
4. "Promulgate", with respect to a Rule,
				 means the process of writing a new Rule, or amending or repealing an existing
				 Rule.
5. "Rule" means the whole or
				 a part of an agency statement of general applicability that implements,
				 interprets, or prescribes law or policy or the organization, procedure, or
				 practice requirements of an agency and has the force of law. The term includes
				 the amendment or repeal of an existing Rule. The term is used interchangeably
				 with the term "regulation." The term does not include the exceptions listed in
				 R.I. Gen. Laws §§
											42-35-1(19)(i) through (vi).
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.17 - Consideration and Disposition of Request for the Promulgation of a Rule

Current through June 14, 2024
A. The Department shall promptly consider and
				 respond to the request for the promulgation of a Rule as provided in R.I. Gen.
				 Laws §
										42-35-6.
B. The
				 Department may, at its discretion and within the thirty (30) day period
				 prescribed by statute:
1. Hold a hearing for
				 further consideration and discussion on the petition; or
2. Request further information or documents
				 from the petitioner necessary for the full evaluation of his or her
				 petition.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.18 - Petition for Declaratory Order

Current through June 14, 2024
A. This section and
				 §
										1.19     of this Part state the requirements for submitting a request for a
				 Declaratory Order under R.I. Gen. Laws §
										42-35-8(b), and the procedure for
				 its consideration and prompt disposition.
B. The following definitions shall apply to
				 this section and §
										1.19     of this Part only:
1. "Declaratory Order" means an order issued
				 by the Department that:
a. Interprets or
				 applies a statute administered by the Department;
b. Clarifies whether a Rule, Guidance
				 Document, or Order issued by the Department applies to a petitioner;
				 or
c. Clarifies how a Rule,
				 Guidance Document, or Order issued by the Department applies to a
				 petitioner.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.19 - Consideration and Disposition of Request for Declaratory Order

Current through June 14, 2024
A. The Department shall promptly consider and
				 respond to the request for Declaratory Order as provided in R.I. Gen. Laws
				 §
										42-35-8(c).
1. Should the Department
				 schedule the matter for further consideration, the Department shall notify
				 petitioner in writing of the anticipated date on which the Department will
				 grant or deny the request for Declaratory Order.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 1 - Rules and Regulations Pertaining to HealthSource RI › Section 220-RICR-90-00-1.20 - Severability

Current through June 14, 2024
If any provisions of this Part or the application thereof
					 to any person or circumstance shall be held invalid, such invalidity shall not
					 affect the provisions or application of these Regulations which can be given
					 effect, and to this end the provisions of these Regulations are declared to be
					 severable.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.1 - Purpose

Current through June 14, 2024
A. The purpose of these Regulations is to
				 establish certain rules governing the Rhode Island Reinsurance Program
				 established by the Director pursuant to R.I. Gen. Laws §
										42-157.1-3 for the purposes of stabilizing health insurance rates and premiums in the
				 individual market and providing greater financial certainty to consumers of
				 health insurance in the state.
B.
				 Additional Guidance
1. Policies and procedures
				 for implementation of these regulations may be established in manuals and other
				 documents by the Director.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.2 - Authority

Current through June 14, 2024
A. This regulation is promulgated pursuant to
				 the authority granted in R.I. Gen. Laws §
										42-157.1-4.
B. Pursuant to the provisions of R.I. Gen.
				 Laws §§
										42-35-3(a)(3) 
				 and
				  42-35.1-4,
				 consideration was given to: alternative approaches to the regulations;
				 duplication or overlap with other state regulations; and significant economic
				 impact on small business.
C. Based
				 upon available information, no known alternative approach, duplication or
				 overlap was identified.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.4 - Information Reporting

Current through June 14, 2024
A. As a condition of
				 receiving reinsurance payments from the program, a reinsurance eligible issuer
				 must provide the following information to the program in the form and manner
				 prescribed by the Director:
1. The name and
				 company code assigned to the reinsurance eligible issuer by the National
				 Association of Insurance Commissioners;
2. The identification number assigned to the
				 reinsurance eligible issuer by the Health Insurance Oversight System
				 (HIOS);
3. The total amount of the
				 reinsurance eligible issuer's reinsurance eligible claims for the benefit
				 year;
4. The portion of the
				 reinsurance eligible issuer's total reinsurance eligible claims for the benefit
				 year that fall between the attachment point and reinsurance cap;
5. A summary data file containing the
				 following information for each reinsurance eligible individual with claims for
				 which reinsurance payments are being requested:
a. An identification number assigned by the
				 reinsurance eligible issuer to the reinsurance eligible individual;
b. The start and end dates of coverage for
				 the reinsurance eligible individual;
c. The HIOS plan identification number for
				 the reinsurance eligible health benefit plan in which the reinsurance eligible
				 individual was enrolled;
d. The
				 total amount of reinsurance eligible claims for the reinsurance eligible
				 individual for the benefit year; and e. The total amount of reinsurance
				 eligible claims for the reinsurance eligible individual for the benefit year
				 that fall between the attachment point and reinsurance cap.
6. If requested by the Director,
				 in conjunction with the final year-end report or an audit, a detailed claims
				 file extracted from the reinsurance eligible issuer's claims processing system
				 that includes the issuer's complete record of all reinsurance eligible claims
				 for the benefit year.
7. An
				 attestation signed by an executive officer of the reinsurance eligible issuer
				 stating that the information is accurate as of the date of submission;
				 and
8. Any other information
				 requested by the Director that he or she deems necessary to administer the
				 program.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.5 - Reinsurance Parameters

Current through June 14, 2024
A. Annually, the
				 Director will set an attachment point, cap, and coinsurance rate for the
				 reinsurance program for the upcoming year based on anticipated revenue and
				 recently reported premium, enrollment, and claims data.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.6 - Reinsurance Payments

Current through June 14, 2024
A. A reinsurance
				 eligible issuer becomes eligible for a reinsurance payment when the claims
				 costs for at least one reinsurance eligible individual's covered benefits in a
				 calendar year exceed the attachment point.
B. The Director will calculate the total
				 reinsurance payment owed to each reinsurance eligible issuer.
1. Subject to §§
											2.6(B)(2)  and
				   2.6(B)(3)     of
				 this Part, the reinsurance payment made to each reinsurance eligible issuer for
				 a benefit year will be the product of the coinsurance rate and the portion of
				 the reinsurance eligible issuer's total reinsurance eligible claims for the
				 benefit year that fall between the attachment point and the reinsurance
				 cap.
2. The Director will uniformly
				 reduce or increase the coinsurance rate to the extent necessary, but at no time
				 shall the increase exceed 100%, to ensure that reinsurance payments equal the
				 total available funding for the benefit year, as determined by the Director in
				 his or her sole discretion.
3. In
				 making the calculation under §
											2.6(B)(1)     of
				 this Part, the Director in his or her sole discretion may disregard any or all
				 reinsurance eligible claims reported by a reinsurance eligible issuer under
				 §
											2.4     of this Part that cannot be verified as part of the audit described
				 under §
											2.7(A)(1)     of
				 this Part.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.7 - Duties of the Administrator

Current through June 14, 2024
A. The program shall
				 be administered by the Director. As administrator of the program, the Director
				 may:
1. Conduct an audit of the information
				 submitted under §
											2.4     of this Part.
2. Notify reinsurance eligible issuers of the
				 results of the calculation described in §
											2.6     of this Part, including any
				 modifications of the coinsurance rate.
3. Issue reinsurance payments to each
				 reinsurance eligible issuer in accordance with §
											2.6     of this
				 Part.
4. Assign the functions
				 vested in him or her by the Rhode Island Market Stability and Reinsurance Act
				 and these regulations to subordinate officers and employees as he or she deems
				 necessary. The assignee shall have the same power and authority that would be
				 afforded the Director.
5. Contract
				 with other state agencies and third parties as he or she deems
				 necessary.
6. Use, access, store,
				 and disclose the information submitted to the program under §
											2.4     of this
				 Part, including disclosing the information to the Office of the Health
				 Insurance Commissioner for the purposes of ensuring the efficient
				 administration of the program and to reduce the reporting burden on
				 issuers.
7. Perform other functions
				 he or she deems reasonably necessary to administer the program.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.8 - Document Retention and Audits

Current through June 14, 2024
A. A reinsurance
				 eligible issuer must maintain documents and records, whether paper, electronic,
				 or in other media, sufficient to substantiate its requests for reinsurance
				 payments made pursuant to this Part for a minimum period of 10 years and must
				 make those documents and records available to the program upon request by the
				 Director for purposes of verification, investigation, or audit.
B. The Director may audit a reinsurance
				 eligible issuer to assess its compliance with the requirements of this Part.
				 The reinsurance eligible issuer must ensure that its relevant contractors,
				 subcontractors, or agents cooperate with any audit under this Part. If an audit
				 results in a finding of material weakness or significant deficiency with
				 respect to compliance with any requirement of this Part, the reinsurance
				 eligible issuer must complete all of the following:
1. Within 30 calendar days of the issuance of
				 the final audit report, provide a written corrective action plan to the program
				 for approval;
2. Implement that
				 plan; and
3. Provide to the program
				 written documentation of the corrective actions once taken.
Rhode Island Code of Regulations › Title 220 - Department of Administration › Chapter 90 - Health Benefits Exchange › Subchapter 00 - N/A › Part 2 - Rules and Regulations Pertaining to the Rhode Island Reinsurance Program › Section 220-RICR-90-00-2.9 - Severability

Current through June 14, 2024
A. If any provisions of this Part or the
				 application thereof to any person or circumstance shall be held invalid, such
				 invalidity shall not affect the provisions or application of these regulations
				 which can be given effect, and to this end the provisions of these regulations
				 are declared to be severable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.1 - Authority

Current through June 14, 2024
This Regulation is promulgated in accordance with R.I. Gen.
					 Laws §§
										38-2-3 and
					 42-14-17.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.2 - Purposes

Current through June 14, 2024
To provide procedures for public record
					 access.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.3 - Policy

Current through June 14, 2024
It is the policy of the Department that all files and
					 records of the Department that are required to be disclosed by state or federal
					 law, or otherwise ordered by a court of competent jurisdiction are available
					 for public inspection and copying. The Department shall not disclose files or
					 records that are (1) prohibited from disclosure by any state or federal law, or
					 (2) otherwise prohibited by order of a court of competent jurisdiction. Records
					 that are not deemed public under R.I. Gen. Laws §
										38-2-1 et seq. shall not be
					 disclosed by Department employees without the express written approval of the
					 Director of the Department.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.4 - Procedure for Requesting Public Records

Current through June 14, 2024
A. A person
				  requesting inspection or copying of public records shall contact the Department
				  of Business Regulation by email, regular mail or facsimile with the request.
				  The Department's preferred method of communication is email but all other forms
				  will be accepted. The request should indicate:
1. A complete description of the records
				  sought in a manner that will permit their identification and location by
				  Department personnel.
2. The method
				  by which the requestor would like delivery of the response. Please include all
				  information necessary for the Department to make that communication (e.g. email
				  address, facsimile number or street address).
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.5 - Fees

Current through June 14, 2024
A. The Department shall charge a fee for
				  copying and/or search and retrieval of requested documents consistent with
				  applicable state law.
B. All
				  persons requesting delivery of records shall be responsible for the actual cost
				  of delivery.
C. All payments for
				  copies of records shall be paid in advance of delivery, or, at the option of
				  the Department, at such later time as the Department may specify. All checks
				  shall be payable to the General Treasurer, State of Rhode Island.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.6 - Subpoenas

Current through June 14, 2024
Subpoenas issued pursuant to the rules of any Court will be
					 addressed in accordance with those rules. This regulation does not apply to
					 such subpoenas.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 1 - Access to Public Records (230-RICR-10-00-1) › Section 230-RICR-10-00-1.7 - Severability

Current through June 14, 2024
If any provision of these Rules and Regulations or the
					 application thereof to any person or circumstances shall be held invalid, such
					 invalidity shall not affect the provisions or application of the rules and
					 regulations which can be given effect, and to this end the provisions of these
					 rules and regulations are declared to be severable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 10 - Central Operations › Subchapter 00 - N/A › Part 2 - Rules of Procedure for Administrative Hearings › Section 230-RICR-10-00-2.1 - Authority

Current through June 14, 2024
A. This Regulation is promulgated pursuant to
				  R.I. Gen. Laws §§
										42-14-17, and  42-92-4.