---
kind: "section"
citation: "45 C.F.R. § 150.203"
title: "45"
number: "150.203"
heading: "Circumstances requiring CMS enforcement."
url: "https://uscodex.org/cfr/45/150.203"
---

# §150.203. Circumstances requiring CMS enforcement.


CMS enforces PHS Act requirement to the extent warranted (as determined by CMS) in any of the following circumstances:

- (a) **Notification by State.** A State notifies CMS that it has not enacted legislation to enforce or that it is not otherwise enforcing PHS Act requirements.
- (b) **Determination by CMS.** If CMS receives or obtains information that a State may not be substantially enforcing PHS Act requirements, it may initiate the process described in this subchapter to determine whether the State is failing to substantially enforce these requirements.
- (c) **Special rule for guaranteed availability in the individual market.** If a State has notified CMS that it is implementing an acceptable alternative mechanism in accordance with [§ 148.128](/cfr/45/148.128.md) of this subchapter instead of complying with the guaranteed availability requirements of [§ 148.120](/cfr/45/148.120.md), CMS's determination focuses on the following:
  - (1) **Whether the State's mechanism meets the requirements for an acceptable alternative mechanism.**
  - (2) **Whether the State is implementing the acceptable alternative mechanism.**
- (d) **Consequence of a State not implementing an alternative mechanism.** If a State is not implementing an acceptable alternative mechanism, CMS determines whether the State is substantially enforcing the requirements of [§§ 148.101 through 148.126](/cfr/45/148.101..148.126.md) and [§ 148.170](/cfr/45/148.170.md) of this subchapter.

## Notes

### Amendments

[64 FR 45795, Aug. 20, 1999, as amended at 78 FR 13440, Feb. 27, 2013]

### Authority

Authority: 42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92, as amended.

### Source

Source: 64 FR 45795, Aug. 20, 1999, unless otherwise noted.

### Amendments

[64 FR 45795, Aug. 20, 1999, as amended at 78 FR 13440, Feb. 27, 2013]