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Rule 25 Jun 2025 healthcare, regulation, consumer protection, administrative practice and procedure, reporting and recordkeeping requirements, sunshine act, intergovernmental relations, health care, conflict of interests, indians, medicaid, youth, civil rights, insurance, brokers, health records, health insurance, hospitals, technical assistance, individuals with disabilities, aged, organization and functions (government agencies), advertising, grant programs-health, taxes, sex discrimination, citizenship and naturalization, advisory committees, public assistance programs, grants administration, women, loan programs-health, state and local governments, enrollment, health maintenance organizations (hmo), aca, premium tax credit

🏥Marketplace Integrity and Affordability Regulations Overview

This final rule revises standards relating to denial of coverage for failure to pay past-due premium; excludes Deferred Action for Childhood Arrivals recipients from the definition of "lawfully present;" establishes the evidentiary standard HHS uses to assess an agent's, broker's, or web-broker's potential noncompliance; revises the Exchange automatic reenrollment hierarchy; revises standards related to the annual open enrollment period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and cost-sharing reductions, annual eligibility redeterminations, de minimis thresholds for the actuarial value for plans subject to essential health benefits (EHB) requirements, and income-based cost-sharing reduction plan variations. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage for specified sex-trait modification procedures as an EHB.

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