Page:United States Statutes at Large Volume 124.djvu/212

124 STAT. 186 PUBLIC LAW 111–148—MAR. 23, 2010 PART III—STATE FLEXIBILITY RELATING TO EXCHANGES SEC. 1321. STATE FLEXIBILITY IN OPERATION AND ENFORCEMENT OF EXCHANGES AND RELATED REQUIREMENTS. (a) ESTABLISHMENT OF STANDARDS.— (1) IN GENERAL.—The Secretary shall, as soon as prac- ticable after the date of enactment of this Act, issue regulations setting standards for meeting the requirements under this title, and the amendments made by this title, with respect to— (A) the establishment and operation of Exchanges (including SHOP Exchanges); (B) the offering of qualified health plans through such Exchanges; (C) the establishment of the reinsurance and risk adjustment programs under part V; and (D) such other requirements as the Secretary deter- mines appropriate. The preceding sentence shall not apply to standards for require- ments under subtitles A and C (and the amendments made by such subtitles) for which the Secretary issues regulations under the Public Health Service Act. (2) CONSULTATION.—In issuing the regulations under para- graph (1), the Secretary shall consult with the National Associa- tion of Insurance Commissioners and its members and with health insurance issuers, consumer organizations, and such other individuals as the Secretary selects in a manner designed to ensure balanced representation among interested parties. (b) STATE ACTION.—Each State that elects, at such time and in such manner as the Secretary may prescribe, to apply the require- ments described in subsection (a) shall, not later than January 1, 2014, adopt and have in effect— (1) the Federal standards established under subsection (a); or (2) a State law or regulation that the Secretary determines implements the standards within the State. (c) FAILURE TO ESTABLISH EXCHANGE OR IMPLEMENT REQUIRE- MENTS.— (1) IN GENERAL.—If — (A) a State is not an electing State under subsection (b); or (B) the Secretary determines, on or before January 1, 2013, that an electing State— (i) will not have any required Exchange operational by January 1, 2014; or (ii) has not taken the actions the Secretary deter- mines necessary to implement— (I) the other requirements set forth in the standards under subsection (a); or (II) the requirements set forth in subtitles A and C and the amendments made by such sub- titles; the Secretary shall (directly or through agreement with a not- for-profit entity) establish and operate such Exchange within the State and the Secretary shall take such actions as are necessary to implement such other requirements. Determination. Deadline. Deadline. Regulations. 42 USC 18041.