🏥Proposed Rule for Marketplace Integrity Under the ACA
Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
Summary
This proposed rule would revise standards relating to past-due premium payments; exclude Deferred Action for Childhood Arrivals recipients from the definition of "lawfully present"; the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; failure to file and reconcile; income eligibility verifications for premium tax credits and cost-sharing reductions; annual eligibility redetermination; the automatic reenrollment hierarchy; the annual open enrollment period; special enrollment periods; de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements and for income-based cost-sharing reduction plan variations; and the premium adjustment percentage methodology; and prohibit issuers of coverage subject to EHB requirements from providing coverage for sex-trait modification as an EHB.
Agencies
- Health and Human Services Department
Business Impact
$$$ - High
The proposed rule directly impacts business owners and executives in the healthcare and insurance sectors by revising compliance standards for premium payments and eligibility verifications, potentially affecting enrollment procedures and premium costs. This may lead to increased scrutiny and operational adjustments as businesses align with new regulatory expectations.