🏥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.
Learn More❌Rescission of Obsolete Provisions in Summer EBT Program Regulations
This rule eliminates two time-limited state options in the Summer Electronic Benefits Transfer for Children (Summer EBT) program regulations that are now obsolete.
Learn More🍽️Deregulation of Summer Nutrition Program Requirements
This rule removes the Coordinated Services Plan (CSP) requirement for the Summer Food Service Program (SFSP) and Summer Electronic Benefits Transfer for Children (Summer EBT) Program under the "Implementing Provisions from the Consolidated Appropriations Act, 2023: Establishing the Summer EBT Program and Rural Non-Congregate Option in the Summer Meal Programs" interim final rule published December 29, 2023.
Learn More🏥Proposed Rule for Marketplace Integrity Under the ACA
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.
Learn More🏥Extension of Flexibility in Evaluating Healthcare Claims to 2029
We are extending the flexibility in the "close proximity of time" standard, as defined in two prior temporary final rules (TFR), through May 11, 2029. We issued a TFR providing the "close proximity of time" flexibility on July 23, 2021, because the COVID-19 national public health emergency (PHE) caused many individuals to experience barriers that prevented them from timely accessing in-person healthcare. On September 29, 2023, we extended the flexibility to evaluate evolving healthcare practices and consumption in a post-PHE environment. We determined that we need additional time to fully evaluate still-evolving healthcare practices after the PHE. We are therefore issuing this TFR to extend the "close proximity of time" flexibility until May 11, 2029, so we can continue to evaluate changes in healthcare practices and determine the proper "close proximity of time" standard for the musculoskeletal disorders listings.
Learn More