Code of Federal Regulations Title 45. Public Welfare § 45.150.101 Basis and scope

(1) Enforcement with respect to group health plans. The provisions of title XXVII of the PHS Act that apply to group health plans that are non–Federal governmental plans are enforced by CMS using the procedures described in § 150.301 et seq.

(2) Enforcement with respect to health insurance issuers. The states have primary enforcement authority with respect to the requirements of title XXVII of the PHS Act that apply to health insurance issuers offering coverage in the group or individual health insurance market. If CMS determines under subpart B of this part that a state is not substantially enforcing title XXVII of the PHS Act, including the implementing regulations in parts 146, 147, and 148 of this subchapter, CMS enforces them under subpart C of this part.