United States. Congress

“ In general.— The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange. ”

“ There is no more than one Health Insurance Exchange operating with respect to any one State. (3) The State provides assurances satisfactory to the Commissioner that approval of such an Exchange will not result in any net increase in expenditures to the Federal Government. (4) The State provides for reporting of such information as the Commissioner determines and assurances satisfactory to the Commissioner that it will vigorously enforce violations of applicable requirements. ”

“ Enforcement of Network Adequacy.— In the case of a health benefits plan of a QHBP offering entity that uses a provider network, the contract under this section with the entity shall provide that if— (A) the Commissioner determines that such provider network does not meet such standards as the Commissioner shall establish under section 115; and (B) an individual enrolled in such plan receives an item or service from a provider that is not within such network ”