{"description":"Documents matching 'enroll through exchange advance premium'","count":819,"total_pages":41,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=enroll+through+exchange+advance+premium&format=json&page=2","results":[{"title":"Definition of the Term “Coverage Month” for Computing the Premium Tax Credit","type":"Rule","abstract":"This document contains final regulations that amend the definition of \"coverage month\" and amend certain other rules in existing income tax regulations regarding the computation of an individual taxpayer's premium tax credit. The coverage month amendment generally provides that, in computing a premium tax credit, a month may be a coverage month for an individual if the amount of the premium paid, including by advance payments of the premium tax credit, for the month for the individual's coverage is sufficient to avoid termination of the individual's coverage for that month. The final regulations also amend the existing regulations relating to the amount of enrollment premiums used in computing the taxpayer's monthly premium tax credit if a portion of the monthly enrollment premium for a coverage month is unpaid. Finally, the final regulations clarify when an individual is considered to be not eligible for coverage under a State's Basic Health Program. The final regulations affect taxpayers who enroll themselves, or enroll a family member, in individual health insurance coverage through a Health Insurance Exchange and may be allowed a premium tax credit for the coverage.","document_number":"2024-29651","html_url":"https://www.federalregister.gov/documents/2024/12/18/2024-29651/definition-of-the-term-coverage-month-for-computing-the-premium-tax-credit","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-12-18/pdf/2024-29651.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-29651.pdf?1734443143","publication_date":"2024-12-18","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"Internal Revenue Service","name":"Internal Revenue Service","id":254,"url":"https://www.federalregister.gov/agencies/internal-revenue-service","json_url":"https://www.federalregister.gov/api/v1/agencies/254","parent_id":497,"slug":"internal-revenue-service"}],"excerpts":"family <span class=\"match\">enrolls</span> in a qualified health plan (QHP) <span class=\"match\">through</span> a Health Insurance <span class=\"match\">Exchange</span> (<span class=\"match\">Exchange</span>) for one or more “coverage months.” \n Section 1.36B-3(c)(1) provides that a month is a coverage month for an individual if (i) as of the first day of the month, the individual is <span class=\"match\">enrolled</span> in a QHP <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>; (ii) the taxpayer pays the taxpayer's share of the <span class=\"match\">premium</span> for the individual's coverage under the plan for the month by the unextended due date for filing the taxpayer's income tax return for that taxable year, or the full <span class=\"match\">premium</span> for the"},{"title":"Definition of the Term “Coverage Month” for Computing the Premium Tax Credit","type":"Proposed Rule","abstract":"This document contains proposed regulations that would amend the definition of \"coverage month\" and amend certain other rules in existing income tax regulations regarding the computation of an individual taxpayer's premium tax credit (PTC). The proposed coverage month amendment generally would provide that, in computing a PTC, a month may be a coverage month for an individual if the amount of the premium paid, including by advance payments of the PTC (APTC), for the month for the individual's coverage is sufficient to avoid termination of the individual's coverage for that month. The proposal also would amend the existing regulations relating to the amount of enrollment premiums used in computing the taxpayer's monthly PTC if a portion of the monthly enrollment premium for a coverage month is unpaid. Finally, the proposed regulations would clarify when an individual is considered to be ineligible for coverage under a State's Basic Health Program (BHP). The proposed regulations would affect taxpayers who enroll themselves, or enroll a family member, in individual health insurance coverage through a Health Insurance Exchange (Exchange) and may be allowed a PTC for the coverage. This document also provides a notice of a public hearing on these proposed regulations.","document_number":"2024-20758","html_url":"https://www.federalregister.gov/documents/2024/09/17/2024-20758/definition-of-the-term-coverage-month-for-computing-the-premium-tax-credit","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-09-17/pdf/2024-20758.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-20758.pdf?1726490716","publication_date":"2024-09-17","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"Internal Revenue Service","name":"Internal Revenue Service","id":254,"url":"https://www.federalregister.gov/agencies/internal-revenue-service","json_url":"https://www.federalregister.gov/api/v1/agencies/254","parent_id":497,"slug":"internal-revenue-service"}],"excerpts":"the taxpayer's family <span class=\"match\">enrolls</span> in a qualified health plan (QHP) <span class=\"match\">through</span> an <span class=\"match\">Exchange</span> for one or more “coverage months.” \n Section 1.36B-3(c)(1) provides that a month is a coverage month for an individual if (i) as of the first day of the month, the individual is <span class=\"match\">enrolled</span> in a QHP <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>; (ii) the taxpayer pays the taxpayer's share of the <span class=\"match\">premium</span> for the individual's coverage under the plan for the month by the unextended due date for filing the taxpayer's income tax return for that taxable year, or the full <span class=\"match\">premium</span> for the month is paid"},{"title":"Clarifying the Eligibility of Deferred Action for Childhood Arrivals (DACA) Recipients and Certain Other Noncitizens for a Qualified Health Plan through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, and a Basic Health Program","type":"Rule","abstract":"This final rule makes several clarifications and updates the definitions currently used to determine whether a consumer is eligible to enroll in a Qualified Health Plan (QHP) through an Exchange; a Basic Health Program (BHP), in States that elect to operate a BHP; and for Medicaid and Children's Health Insurance Programs (CHIPs). Specifically, Deferred Action for Childhood Arrivals (DACA) recipients and certain other noncitizens will be included in the definitions of \"lawfully present\" that are used to determine eligibility to enroll in a QHP through an Exchange, for Advance Payments of the Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSRs), or for a BHP.","document_number":"2024-09661","html_url":"https://www.federalregister.gov/documents/2024/05/08/2024-09661/clarifying-the-eligibility-of-deferred-action-for-childhood-arrivals-daca-recipients-and-certain","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-05-08/pdf/2024-09661.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-09661.pdf?1714740321","publication_date":"2024-05-08","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"determine whether a consumer is eligible to <span class=\"match\">enroll</span> in a Qualified Health Plan (QHP) <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>; a Basic Health Program (BHP), in States that elect to operate a BHP; and for Medicaid and Children's Health Insurance Programs (CHIPs). Specifically, Deferred Action for Childhood Arrivals (DACA) recipients and certain other noncitizens will be included in the definitions of “lawfully present” that are used to determine eligibility to <span class=\"match\">enroll</span> in a QHP <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>, for <span class=\"match\">Advance</span> Payments of the <span class=\"match\">Premium</span> Tax Credit (APTC) and Cost-Sharing Reductions"},{"title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability","type":"Rule","abstract":"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.","document_number":"2025-11606","html_url":"https://www.federalregister.gov/documents/2025/06/25/2025-11606/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-06-25/pdf/2025-11606.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-11606.pdf?1750709712","publication_date":"2025-06-25","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"integrity and <span class=\"match\">premium</span> relief policies contained within these rules are necessary to respond to present-day challenges in the individual health insurance market. As a starting point, the ACA establishes American Health Benefit <span class=\"match\">Exchanges</span>, or “<span class=\"match\">Exchanges</span>,” to facilitate the purchase of QHPs. Many individuals who <span class=\"match\">enroll</span> in QHPs <span class=\"match\">through</span> individual market <span class=\"match\">Exchanges</span> are eligible to receive a <span class=\"match\">premium</span> tax credit (PTC) to reduce their costs for health insurance <span class=\"match\">premiums</span> and have their out-of-pocket expenses for health care services reduced <span class=\"match\">through</span> cost-sharing"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Rule","abstract":"This final rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); requirements related to defrayal for the cost of any State-required benefits in addition to the EHB; cost- sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive plan years; QHP issuer quality improvement strategies (QISs); and revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States. This final rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-10050","html_url":"https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-20/pdf/2026-10050.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10050.pdf?1779135308","publication_date":"2026-05-20","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"agents or brokers to (1) <span class=\"match\">enroll</span> qualified individuals and qualified employers in QHPs offered <span class=\"match\">through</span> <span class=\"match\">Exchanges</span> and (2) assist individuals in applying for <span class=\"match\">advance</span> payments of the <span class=\"match\">premium</span> tax credit (APTC) and cost-sharing reductions (CSRs) for QHPs sold <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>. \n Sections 1313 and 1321 of the Affordable Care Act provide the Secretary with the authority to oversee the financial integrity of State <span class=\"match\">Exchanges</span>, their compliance with HHS standards, and the efficient and non-discriminatory administration of State <span class=\"match\">Exchange</span> activities. Section 1313(a)(5)(A)"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also includes provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); cost-sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive years; QHP issuer quality improvement strategies (QISs); revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States; and seeks comment on potential adjustments to other Federal standards, including the Federal medical loss ratio (MLR) standard in the individual market. This proposed rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-02769","html_url":"https://www.federalregister.gov/documents/2026/02/11/2026-02769/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-02-11/pdf/2026-02769.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-02769.pdf?1770671709","publication_date":"2026-02-11","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"agents or brokers to (1) <span class=\"match\">enroll</span> qualified individuals and qualified employers in QHPs offered <span class=\"match\">through</span> <span class=\"match\">Exchanges</span> and (2) assist individuals in applying for <span class=\"match\">advance</span> payments of the <span class=\"match\">premium</span> tax credit (APTC) and cost sharing reductions (CSRs) for QHPs sold <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>. \n Sections 1313 and 1321 of the Affordable Care Act provide the Secretary with the authority to oversee the financial integrity of State <span class=\"match\">Exchanges</span>, their compliance with HHS standards, and the efficient and non-discriminatory administration of State <span class=\"match\">Exchange</span> activities. Section 1313(a)(5)(A)"},{"title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability","type":"Proposed Rule","abstract":"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.","document_number":"2025-04083","html_url":"https://www.federalregister.gov/documents/2025/03/19/2025-04083/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-03-19/pdf/2025-04083.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-04083.pdf?1741810509","publication_date":"2025-03-19","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"integrity and <span class=\"match\">premium</span> relief policies contained within these proposed rules are necessary to improve the individual health insurance market. As a starting point, the ACA establishes American Health Benefit <span class=\"match\">Exchanges</span>, or “<span class=\"match\">Exchanges</span>” to facilitate the purchase of qualified health plans (QHPs). Many individuals who <span class=\"match\">enroll</span> in QHPs <span class=\"match\">through</span> individual market <span class=\"match\">Exchanges</span> are eligible to receive a <span class=\"match\">premium</span> tax credit (PTC) to reduce their costs for health insurance <span class=\"match\">premiums</span> and have their out-of-pocket expenses for health care services reduced <span class=\"match\">through</span> cost-sharing"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS-RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; permissible plan-level adjustment to the index rate to account for cost-sharing reductions (CSRs); reconsideration standards for certification denials; changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a policy to publicly share aggregated, summary- level Quality Improvement Strategy (QIS) information on an annual basis; and revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2025-00640","html_url":"https://www.federalregister.gov/documents/2025/01/15/2025-00640/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-15/pdf/2025-00640.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-00640.pdf?1736802922","publication_date":"2025-01-15","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"days after a State <span class=\"match\">Exchange</span> receives a data inaccuracy from an issuer operating in an State <span class=\"match\">Exchange</span> that includes a description of an inaccuracy that meets the requirements at § 156.1210(a) <span class=\"match\">through</span> (c) and all the information that the State <span class=\"match\">Exchange</span> requires or requests to properly assess the inaccuracy, State <span class=\"match\">Exchanges</span> must review and resolve the State <span class=\"match\">Exchange</span> issuer's enrollment data inaccuracies and submit to HHS a description of the resolution of any inaccuracies described by the State <span class=\"match\">Exchange</span> issuer that the State <span class=\"match\">Exchange</span> confirms to be inaccuracies"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also includes proposed requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS- RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; proposed reconsideration standards for certification denials; proposed changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a proposal to publicly share aggregated, summary-level Quality Improvement Strategy (QIS) information on an annual basis; and proposed revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2024-23103","html_url":"https://www.federalregister.gov/documents/2024/10/10/2024-23103/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-10/pdf/2024-23103.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-23103.pdf?1728072923","publication_date":"2024-10-10","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"proposing one change to the methodology regarding the <span class=\"match\">premium</span> adjustment factor (PAF). \n The PAF is used to calculate the adjusted reference <span class=\"match\">premium</span> (ARP) that is used to calculate the BHP payment. The adjusted reference <span class=\"match\">premium</span> (ARP) is used to calculate the estimated PTC that would be allowed if BHP-eligible individuals <span class=\"match\">enrolled</span> in QHPs <span class=\"match\">through</span> an <span class=\"match\">Exchange</span> and is based on the <span class=\"match\">premiums</span> for the applicable second lowest cost silver plan during the applicable plan year. The PAF considers the <span class=\"match\">premium</span> increases in other States that took effect after we"},{"title":"Accountability in Higher Education and Access Through Demand-Driven Workforce Pell: Pell Grant Exclusion Relating to Other Grant Aid; and Workforce Pell Grants","type":"Rule","abstract":"The Secretary of Education (Secretary) amends the regulations governing institutional eligibility, general provisions, and the Federal Pell Grant (Pell Grant) Program under title IV of the Higher Education Act (HEA) of 1965, as amended (the title IV, HEA programs). The final regulations implement statutory changes to the title IV, HEA programs included in the Working Families Tax Cuts Act (WFTCA), signed into law by President Trump on July 4, 2025. In the NPRM, we referenced the WFTCA as the \"One Big Beautiful Bill\"; however, for clarity and consistency in this final rule, we will instead use WFTCA. The WFTCA made numerous changes to the HEA, including changes to student eligibility requirements for the Pell Grant Program and the establishment of Workforce Pell Grants for students who enroll in a new type of eligible program called an \"eligible workforce program,\" intended to be a high-quality, performance-based, short-term program that supports America's workforce needs.","document_number":"2026-10013","html_url":"https://www.federalregister.gov/documents/2026/05/19/2026-10013/accountability-in-higher-education-and-access-through-demand-driven-workforce-pell-pell-grant","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-19/pdf/2026-10013.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10013.pdf?1779108315","publication_date":"2026-05-19","agencies":[{"raw_name":"DEPARTMENT OF EDUCATION","name":"Education Department","id":126,"url":"https://www.federalregister.gov/agencies/education-department","json_url":"https://www.federalregister.gov/api/v1/agencies/126","parent_id":null,"slug":"education-department"}],"excerpts":"None.\n \n \n Comments: \n One commenter was concerned that institutions will try and game completion rates <span class=\"match\">through</span> selective enrollment and institutions would try to improve completion rates by refusing to <span class=\"match\">enroll</span> students likely to drop out and instead concentrate on <span class=\"match\">enrolling</span> the most motivated students while turning away the most economically vulnerable applicants. The commenter was also concerned that job placement rates could be gamed <span class=\"match\">through</span> temporary employment. Institutions could count any paid employment in the placement rate, including a graduate's"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment program, as well as 2025 user fee rates for issuers offering qualified health plans (QHPs) through federally facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file Federal income taxes to reconcile advance payments of the premium tax credit (APTC); non- standardized plan option limits in the FFEs and SBE-FPs and a related exceptions process; standardized plan options in the FFEs and SBE-FPs; special enrollment periods (SEPs); direct enrollment (DE) entities supporting Exchange applications and enrollments; the Insurance Affordability Program enrollment eligibility verification process; requirements for agents, brokers, web-brokers, and DE entities assisting Exchange consumers; network adequacy; public notice procedures for section 1332 waivers; prescription drug benefits; updates to the Consumer Operated and Oriented Plan (CO-OP) Program; and State flexibility on the effective date of coverage in the Basic Health Program (BHP).","document_number":"2024-07274","html_url":"https://www.federalregister.gov/documents/2024/04/15/2024-07274/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2025","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-15/pdf/2024-07274.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07274.pdf?1712351231","publication_date":"2024-04-15","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":" \n Section 1312(e) of the ACA provides the Secretary with the authority to establish procedures under which a State may allow agents or brokers to (1) <span class=\"match\">enroll</span> qualified individuals and qualified employers in QHPs offered <span class=\"match\">through</span> <span class=\"match\">Exchanges</span> and (2) assist individuals in applying for <span class=\"match\">advance</span> payments of the <span class=\"match\">premium</span> tax credit (APTC) and cost-sharing reductions (CSRs) for QHPs sold <span class=\"match\">through</span> an <span class=\"match\">Exchange</span>. \n Section 1312(f)(1)(B) of the ACA provides that an individual shall not be treated as a qualified individual for enrollment in a QHP if, at the time"},{"title":"Accountability in Higher Education and Access Through Demand- Driven Workforce Pell: Student Tuition and Transparency System (STATS) and Earnings Accountability","type":"Rule","abstract":"The Secretary of Education (Secretary) amends the regulations governing institutional eligibility, general provisions, and the William D. Ford Direct Loan (Direct Loan) Program under title IV of the Higher Education Act (HEA) of 1965, as amended (the title IV, HEA programs) to implement statutory changes to the title IV, HEA programs included in the Working Families Tax Cuts Act (WFTCA) signed into law by President Trump on July 4, 2025. These changes include revisions to program eligibility requirements for the Direct Loan program and the introduction of an earnings accountability framework that limits Direct Loan eligibility to programs whose graduates meet certain earnings benchmarks. This action finalizes regulations to implement the provisions of the WFTCA related to low-earning outcome programs and the Direct Loan program, and to harmonize those regulations with requirements for programs that are required to lead to gainful employment (GE programs).","document_number":"2026-13286","html_url":"https://www.federalregister.gov/documents/2026/07/01/2026-13286/accountability-in-higher-education-and-access-through-demand--driven-workforce-pell-student-tuition","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-07-01/pdf/2026-13286.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-13286.pdf?1782823517","publication_date":"2026-07-01","agencies":[{"raw_name":"DEPARTMENT OF EDUCATION","name":"Education Department","id":126,"url":"https://www.federalregister.gov/agencies/education-department","json_url":"https://www.federalregister.gov/api/v1/agencies/126","parent_id":null,"slug":"education-department"}],"excerpts":"believes that all of these authorities work in tandem and authorize us, independent from the amendments made by the WFTCA related to accountability, require an earnings <span class=\"match\">premium</span> measure for such GE programs. \n In practice, the proposed earnings <span class=\"match\">premium</span> measure under the WFTCA is the same as the earnings <span class=\"match\">premium</span> measure under GE. The only type of program not covered by the earnings <span class=\"match\">premium</span> measure under the WFTCA are certificate programs, which are covered by GE. As such, if a court disagrees with our assessment of the robust legal authority we have, the"},{"title":"Federal Employees Health Benefits Program: Verification Requirements for Family Member Coverage","type":"Rule","abstract":"The FEHB Protection Act of 2025 (FPA) requires OPM to issue regulations and implement a process to verify: The veracity of any qualifying life event (QLE) through which a health benefits plan enrollee seeks to add a member of family to their enrollment and that when an enrollee adds a family member to the health benefits plan, including during any open season, the individual is a qualified member of family. This final rule also clarifies responsibilities for initial family member eligibility determinations for the Postal Service Health Benefits (PSHB) Program.","document_number":"2026-11022","html_url":"https://www.federalregister.gov/documents/2026/06/02/2026-11022/federal-employees-health-benefits-program-verification-requirements-for-family-member-coverage","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-02/pdf/2026-11022.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11022.pdf?1780085714","publication_date":"2026-06-02","agencies":[{"raw_name":"OFFICE OF PERSONNEL MANAGEMENT","name":"Personnel Management Office","id":406,"url":"https://www.federalregister.gov/agencies/personnel-management-office","json_url":"https://www.federalregister.gov/api/v1/agencies/406","parent_id":null,"slug":"personnel-management-office"}],"excerpts":"coverage. Some individuals who are not <span class=\"match\">enrolled</span> in FEHB coverage may be eligible for public insurance programs such as Medicaid, the Children's Health Insurance Program (CHIP), or Medicare. Some family members may be eligible to purchase coverage on the Affordable Care Act (ACA) <span class=\"match\">Exchanges</span> with federal <span class=\"match\">advance</span> <span class=\"match\">premium</span> tax credits that may cover all or a portion of an enrollee's <span class=\"match\">premiums</span>. That coverage would transfer costs from the FEHB Program to other publicly or privately funded health insurance coverage. \n <span class=\"match\">Premium</span> Savings \n The information reported"},{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges","type":"Proposed Rule","abstract":"These proposals are intended to improve the electronic exchange of health care data and streamline processes related to prior authorization by increasing the interoperability of systems used across the health care industry. We are proposing new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs), including issuers that offer small group market QHPs on the Federally-facilitated Small Business Health Options Program (FF- SHOP) Exchanges (hereinafter referred to as \"small group market QHP issuers on the FF-SHOPs\") (collectively \"impacted payers\"), to make available electronic prior authorization for drugs. We are also proposing to extend many existing interoperability requirements for the prior authorization of non-drug items and services to include prior authorizations for drugs to further reduce patient and provider burden. We are also proposing to require impacted payers to report their application programming interfaces (API) endpoints and related information for the Patient Access, Provider Directory, Provider Access, Payer-to-Payer, and Prior Authorization APIs to CMS. To help assess the impact of our policies, we are proposing to collect API usage metrics. In addition, we are proposing to apply the existing interoperability requirements to small group market QHP issuers on the FF-SHOPs as impacted payers. To improve impacted payers' ability to exchange health information while continuing CMS's drive toward interoperability, we are proposing to require certain Health Level Seven (HL7[supreg]) Fast Healthcare Interoperability Resources (FHIR[supreg]) implementation guides (IGs) that are currently recommended. In addition, HHS is proposing to adopt the HL7 FHIR base standard and certain associated specifications and IGs as the Health Insurance Portability and Accountability Act of 1996 (hereinafter referred to as \"HIPAA\") (Pub. L. 104-191, enacted Aug. 21, 1996) standards for dental, professional, and institutional \"referral certification and authorization\" transactions and \"eligibility for a health plan\" transactions associated with prior authorization. We are proposing to add a definition for \"failure to report,\" which would allow CMS to impose a civil monetary penalty (CMP) on applicable manufacturers or applicable group purchasing organizations (GPOs) if those entities fail to grant CMS timely access to documents for the purposes of an audit. Finally, ONC is using this rulemaking to propose to adopt updated versions of certain health information technology (health IT) standards and specifications for HHS use, such as CMS's interoperability requirements, to support a more robust health IT infrastructure.","document_number":"2026-07205","html_url":"https://www.federalregister.gov/documents/2026/04/14/2026-07205/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-standards","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-04-14/pdf/2026-07205.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-07205.pdf?1775852111","publication_date":"2026-04-14","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"The Creating Access to Real-time Information Now <span class=\"match\">through</span> Consumer Directed <span class=\"match\">Exchange</span> (CARIN) Alliance designed the HL7 FHIR CARIN Consumer Directed Payer Data <span class=\"match\">Exchange</span> (CARIN IG for Blue Button) IG \n 35 \n \n to meet the requirements in the 2020 CMS Interoperability and Patient Access final rule for impacted payers to make available adjudicated claims and encounter data, from a financial perspective, via a Patient Access API <span class=\"match\">through</span> consumer-directed <span class=\"match\">exchange</span> (85 FR 25532). Consumer-directed <span class=\"match\">exchange</span> occurs when a patient or an authorized personal representative"},{"title":"Agency Information Collection Activities: Submission for OMB Review; Comment Request","type":"Notice","abstract":"The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.","document_number":"2026-05743","html_url":"https://www.federalregister.gov/documents/2026/03/25/2026-05743/agency-information-collection-activities-submission-for-omb-review-comment-request","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-03-25/pdf/2026-05743.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-05743.pdf?1774356309","publication_date":"2026-03-25","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"Hearing and Appeal Processes, and <span class=\"match\">Premiums</span> and Cost Sharing; <span class=\"match\">Exchanges</span>: Eligibility and Enrollment; \n Use: \n Information collected \n \n by the <span class=\"match\">Exchanges</span>, Medicaid or CHIP agencies will be used to determine eligibility for coverage <span class=\"match\">through</span> the <span class=\"match\">Exchanges</span> and insurance affordability programs (\n i.e., \n Medicaid, CHIP, and <span class=\"match\">advance</span> payment of the <span class=\"match\">premium</span> tax credits), and to assist consumers in <span class=\"match\">enrolling</span> in a QHP if eligible. Applicants include anyone who may be eligible for coverage <span class=\"match\">through</span> any of these programs. The <span class=\"match\">Exchanges</span> verify the information provided"},{"title":"Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children's Health Insurance Programs","type":"Proposed Rule","abstract":"This proposed rule would make several clarifications and update the definitions currently used to determine whether a consumer is eligible to enroll in a Qualified Health Plan (QHP) through an Exchange; a Basic Health Program (BHP), in States that elect to operate a BHP; and for some State Medicaid and Children's Health Insurance Programs (CHIPs).","document_number":"2023-08635","html_url":"https://www.federalregister.gov/documents/2023/04/26/2023-08635/clarifying-eligibility-for-a-qualified-health-plan-through-an-exchange-advance-payments-of-the","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-04-26/pdf/2023-08635.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-08635.pdf?1682367317","publication_date":"2023-04-26","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"of determining eligibility to <span class=\"match\">enroll</span> in a QHP <span class=\"match\">through</span> an <span class=\"match\">Exchange</span> by cross-referencing the existing PCIP definition (77 FR 18309); and in 2014 to cross-reference the existing definition for purposes of determining eligibility to <span class=\"match\">enroll</span> in a BHP (79 FR 14111). In this proposed rule, we propose to amend these three regulations in order to update the definition of “lawfully present” at 45 CFR 152.2, which is used to determine whether a consumer is eligible to <span class=\"match\">enroll</span> in a QHP <span class=\"match\">through</span> an <span class=\"match\">Exchange</span> and for a BHP. <span class=\"match\">Exchange</span> regulations apply this definition"},{"title":"Privacy Act of 1974; Matching Program","type":"Notice","abstract":"In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of a new matching program between CMS and the Department of Veterans Affairs (VA), \"Verification of Eligibility for Insurance Affordability Programs Under the Patient Protection and Affordable Care Act.\"","document_number":"2026-13572","html_url":"https://www.federalregister.gov/documents/2026/07/06/2026-13572/privacy-act-of-1974-matching-program","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-07-06/pdf/2026-13572.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-13572.pdf?1782996320","publication_date":"2026-07-06","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare and Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"verifying whether an individual is <span class=\"match\">enrolled</span> in Minimum Essential Coverage (MEC) <span class=\"match\">through</span> a VHA Health Care Program. CMS makes the data provided by VHA available to the requesting AE <span class=\"match\">through</span> a data services hub (Hub) to verify an Applicant's enrollment in MEC to use in determining the enrollee's eligibility for financial assistance, Medicaid, the Children's Health Insurance Program (CHIP) and the Basic Health Program. CMS and AEs will use the VA's disability data for determining eligibility for <span class=\"match\">advance</span> payments of the <span class=\"match\">premium</span> tax credit (APTC) and cost-sharing"},{"title":"Medicaid Program; Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes","type":"Rule","abstract":"This is the second part of a two-part final rule that simplifies the eligibility and enrollment processes for Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). This rule aligns enrollment and renewal requirements for most individuals in Medicaid; establishes beneficiary protections related to returned mail; creates timeliness requirements for redeterminations of eligibility; makes transitions between programs easier; eliminates access barriers for children enrolled in CHIP by prohibiting premium lock-out periods, benefit limitations, and waiting periods; and modernizes recordkeeping requirements to ensure proper documentation of eligibility determinations.","document_number":"2024-06566","html_url":"https://www.federalregister.gov/documents/2024/04/02/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-02/pdf/2024-06566.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-06566.pdf?1711543532","publication_date":"2024-04-02","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"individual re-<span class=\"match\">enrolls</span> in coverage). Further, as discussed in the September 2022 proposed rule, under the final rule, States cannot require families who were disenrolled to repay past-due <span class=\"match\">premiums</span> as a condition of reenrollment. Because States will no longer be able to require collection of past due <span class=\"match\">premiums</span> or enrollment fees as a condition of eligibility, a family could re-apply for coverage immediately following disenrollment, and could re-<span class=\"match\">enroll</span> without paying any past due <span class=\"match\">premiums</span>. However, the family could be required to pay a new <span class=\"match\">premium</span> or enrollment"},{"title":"Agency Information Collection Activities: Submission for OMB Review; Comment Request","type":"Notice","abstract":"The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.","document_number":"2025-20395","html_url":"https://www.federalregister.gov/documents/2025/11/20/2025-20395/agency-information-collection-activities-submission-for-omb-review-comment-request","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-11-20/pdf/2025-20395.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-20395.pdf?1763559918","publication_date":"2025-11-20","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"Options Program (SHOP).\n \n \n Section 1312(e) of the Affordable Care Act and 45 CFR 155.220(a)(1) expands the role of agents/brokers by permitting them to <span class=\"match\">enroll</span> qualified individuals or small employers/employees in qualified health plans (QHPs) <span class=\"match\">through</span> the <span class=\"match\">Exchanges</span>, and assist individuals in applying for <span class=\"match\">Advance</span> <span class=\"match\">Premium</span> Tax Credits (APTCs) and Cost Sharing Reductions (CSRs). To participate as facilitators to enrollment, agents/brokers must register with the FFE, complete a training course covering eligibility and enrollment criteria for assisting in"},{"title":"Postal Service Health Benefits Program: Additional Requirements and Clarifications","type":"Rule","abstract":"The Office of Personnel Management (OPM) is issuing this final rule to clarify and establish additional requirements regarding the Postal Service Health Benefits (PSHB) Program, which was established pursuant to the Postal Service Reform Act of 2022 (PSRA). This final rule expands on previous regulations concerning the PSHB Program and is intended to provide greater detail and clarity necessary to properly implement PSHB in 2025 and beyond. In particular, this final rule includes details on reconsideration of PSHB eligibility decisions, the Medicare Part B enrollment requirement, allocation of reserve credits, calendar year alignment of Government contribution requirements, financial reporting and actuarial calculations, premium payment prioritization from the Postal Service Retiree Health Benefits Fund, and Medicare Part D integration.","document_number":"2024-24796","html_url":"https://www.federalregister.gov/documents/2024/10/24/2024-24796/postal-service-health-benefits-program-additional-requirements-and-clarifications","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-24/pdf/2024-24796.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-24796.pdf?1729687549","publication_date":"2024-10-24","agencies":[{"raw_name":"OFFICE OF PERSONNEL MANAGEMENT","name":"Personnel Management Office","id":406,"url":"https://www.federalregister.gov/agencies/personnel-management-office","json_url":"https://www.federalregister.gov/api/v1/agencies/406","parent_id":null,"slug":"personnel-management-office"}],"excerpts":"required to pay Medicare Part B <span class=\"match\">premiums</span>. \n \n OPM appreciates this comment seeking clarity regarding the Part D <span class=\"match\">premium</span>. A Part D-eligible Postal Service annuitant and family member <span class=\"match\">enrolled</span> in the Part D EGWP will not pay an additional <span class=\"match\">premium</span> for Part D coverage. Part D coverage is included in the <span class=\"match\">premium</span> for PSHB coverage. The FEHB Program requires that all FEHB enrollees <span class=\"match\">enrolled</span> in the same plan and coverage level, as well as all PSHB enrollees <span class=\"match\">enrolled</span> in the same plan and coverage level, pay the same <span class=\"match\">premium</span> whether an eligible individual"}]}