Appendix F - Data Elements for 156 Subpart J

Appendix F: Data Elements for Administrative Review of QHP Issuer Sanctions in
Federally-facilitated Exchanges (Part 156, Subpart J)
The data elements for the collections of information included in Part 156, Subpart J –
Administrative Review in Federally-facilitated Exchanges (FFE), are as follows:
Form and Content of Request for Hearing (§156.907)
As proposed in §156.905, an issuer has the right to hearing before an administrative law judge if
it files a request for a hearing that complies with proposed §156.907(a) within 30 days of the
issuance of a notice of proposed assessment from HHS under proposed §156.805. In addition to
identifying the relevant notice of assessment or decertification by date and attaching a copy of
the notice to the request for hearing, the request for a hearing must:
1. Identify any factual or legal bases for the assessment or decertification with which the
issuer disagrees; and
2. Describe with reasonable specificity the basis for the disagreement, including any
affirmative facts or legal arguments on which the respondent is relying.
We assume the request for a hearing will contain basic administrative information about the
issuer as well as all evidence needed to meet the standards listed above; therefore, we assume the
request may include the following information:
1.
2.
3.
4.
5.
6.

Issuer name
Issuer address
Date of receipt of notice from HHS
Date of submission of request for hearing
Type of notice received
Factual or legal bases used by HHS in their assessment or decertification with which the
issuer disagrees
7. The basis for the issuer’s disagreement (including facts or legal arguments to support its
argument)
8. Evidence to counteract any specific details specified in the notice from HHS that give
grounds for its assessment or decertificaiton
9. Evidence that shows the issuer’s overall financial and regulatory good standing as proof
against the assessment or decertification

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