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Enforcement

The Public Health Service Act (PHS Act) provides that States will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with the health insurance market reforms. If a state informs CMS that it does not have authority to enforce one or more of the applicable provisions of the PHS Act, and the state has not entered into a collaborative enforcement agreement (CEA), CMS has the responsibility to directly enforce the relevant provisions in the state with respect to health insurance issuers in the group and individual markets. Under a CEA, the state agrees to seek voluntary compliance from health insurance issuers and refer to CMS for possible enforcement action any potential violation for which the state is not able to obtain voluntary compliance.  The below chart captures the Transparency in Coverage Final Rule requirements that each state is enforcing either directly or through a CEA, and the requirements that CMS is enforcing.

State

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Alabama

CMS

CMS

Alaska

CMS

CMS

Arizona

CMS

CMS

Arkansas 

CMS

CMS

California 

CMS

CMS

Colorado

State

State

Connecticut

State (CEA)

State (CEA)

Delaware

CMS

CMS

District of Columbia

State

State

Florida

CMS

CMS

Hawaii

CMS

CMS

Idaho

State

State

Illinois

CMS

CMS

Indiana

CMS

CMS

Iowa

CMS

State

Kansas

State

State

Kentucky

CMS

State

Louisiana

CMS

CMS

Maine

State

State

Maryland 

State (CEA)

State (CEA)

Massachusetts

State (CEA)

State

Michigan 

CMS

State

Minnesota

CMS

CMS

Mississippi 

State (CEA)

State (CEA)

Missouri 

CMS

CMS

Montana 

CMS

CMS

Nebraska

CMS

CMS

Nevada

State

State

New Hampshire

State

State

New Jersey

State (CEA)

State (CEA)

New Mexico

CMS

CMS

New York

CMS

State

North Carolina

CMS

CMS

North Dakota

State

State

Ohio

CMS

CMS

Oklahoma

CMS

CMS

Oregon

CMS

CMS 

Pennsylvania

State (CEA)

State (CEA)

Rhode Island

CMS

CMS

South Carolina 

State (CEA)

State (CEA) 

South Dakota

State (CEA)

State (CEA)

Tennessee

CMS

CMS

Texas

CMS

CMS

Utah

State

State

Vermont

State

State

Virginia 

CMS

CMS

Washington

CMS

CMS

West Virginia

State

State

Wisconsin

CMS

State (CEA)

Wyoming 

CMS

CMS

Page Last Modified:
04/22/2026 10:20 AM