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Proposed Rule

Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability

Proposed rule.

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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.

Key Dates
Citation: 90 FR 12942
To be assured consideration, comments must be received by April 11, 2025.
Comments closed: April 11, 2025
Public Participation
Topics:
Administrative practice and procedure Advertising Advisory committees Aged Brokers Citizenship and naturalization Civil rights Conflict of interests Consumer protection Grant programs-health Grants administration Health care Health insurance Health maintenance organizations (HMO) Health maintenance organizations (HMO) Health records Hospitals Indians Individuals with disabilities Intergovernmental relations Loan programs-health Medicaid Organization and functions (Government agencies) Public assistance programs Reporting and recordkeeping requirements Reporting and recordkeeping requirements Reporting and recordkeeping requirements Sex discrimination State and local governments Sunshine Act Taxes Technical assistance Women Youth

Document Details

Document Number2025-04083
FR Citation90 FR 12942
TypeProposed Rule
PublishedMar 19, 2025
Effective Date-
RIN0938-AV61
Docket IDCMS-9884-P
Pages12942–13032 (91 pages)
Text FetchedNo

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Related Documents (by RIN/Docket)

Doc #TypeTitlePublished
2025-11606 Final Rule Patient Protection and Affordable Care A... Jun 25, 2025

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