{"description":"Documents matching 'income-based cost-sharing reduction plan variations'","count":65,"total_pages":4,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=income-based+cost-sharing+reduction+plan+variations&format=json&page=2","results":[{"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":"period and special enrollment periods; revises standards relating to failure to file and reconcile, income eligibility verifications for premium tax credits and <span class=\"match\">cost-sharing</span> <span class=\"match\">reductions</span>, annual eligibility redeterminations, de minimis thresholds for the actuarial value for <span class=\"match\">plans</span> subject to essential health benefits (EHB) requirements, and <span class=\"match\">income-based</span> <span class=\"match\">cost-sharing</span> <span class=\"match\">reduction</span> <span class=\"match\">plan</span> <span class=\"match\">variations</span>. This final rule also revises the premium adjustment percentage methodology and prohibits issuers of coverage subject to EHB requirements from providing coverage"},{"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":"potential noncompliance; failure to file and reconcile; income eligibility verifications for premium tax credits and <span class=\"match\">cost-sharing</span> <span class=\"match\">reductions</span>; annual eligibility redetermination; the automatic reenrollment hierarchy; the annual open enrollment period; special enrollment periods; de minimis thresholds for the actuarial value for <span class=\"match\">plans</span> subject to essential health benefits (EHB) requirements and for <span class=\"match\">income-based</span> <span class=\"match\">cost-sharing</span> <span class=\"match\">reduction</span> <span class=\"match\">plan</span> <span class=\"match\">variations</span>; and the premium adjustment percentage methodology; and prohibit issuers of coverage subject to EHB requirements"},{"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":"provisions related to the single risk pool. We codified that, for catastrophic <span class=\"match\">plans</span>, issuers may make a <span class=\"match\">plan</span>-specific adjustment to the market-wide index rate based on the expected impact of the specific eligibility categories for those <span class=\"match\">plans</span>. This <span class=\"match\">plan</span>-specific adjustment would be uniform across all of an issuer's catastrophic <span class=\"match\">plans</span> (that is, risk across all catastrophic <span class=\"match\">plans</span> must be pooled).\n \n In that rule, we also codified that a health <span class=\"match\">plan</span> is a catastrophic <span class=\"match\">plan</span> if it: (1) meets all applicable requirements for health insurance coverage in"},{"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":"satisfy their deductible or annual <span class=\"match\">cost-sharing</span> limitation. We also propose to amend § 156.130 to specify that, in the case of a catastrophic <span class=\"match\">plan</span> with a consecutive multi-year term, the annual limitation on <span class=\"match\">cost sharing</span> for the initial <span class=\"match\">plan</span> year of the contract may apply on an annual basis, or over the life of the contract. In the latter case, the limitation applicable to the specific <span class=\"match\">plan</span> year under each <span class=\"match\">plan</span> year of the coverage would be divided by 12 to determine the monthly limit on <span class=\"match\">cost sharing</span> under the <span class=\"match\">plan</span>. Further, we propose to amend § 156"},{"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":"Factors for the 2025 Benefit Year and Beyond \n \n <span class=\"match\">Plan</span> AV \n \n Current\n adjustment \n factors for the \n 2024 benefit year \n \n \n Adjustment\n factors for the \n 2025 benefit \n year and beyond \n \n \n \n \n Silver <span class=\"match\">Plan</span> Variant Recipients (and Enrollees in State wrap-around or Medicaid-expansion <span class=\"match\">plans</span> of any metal level, as applicable) \n \n \n \n <span class=\"match\">Plan</span> <span class=\"match\">Variation</span> 94% \n 1.12 \n 1.12 \n \n \n <span class=\"match\">Plan</span> <span class=\"match\">Variation</span> 87% \n 1.12 \n 1.12 \n \n \n <span class=\"match\">Plan</span> <span class=\"match\">Variation</span> 73% \n 1.00 \n 1.00 \n \n \n Standard <span class=\"match\">Plan</span> 70% \n 1.00 \n 1.00 \n \n \n \n \n Zero <span class=\"match\">Cost Sharing</span> <span class=\"match\">Plan</span> Variant Recipients (that is, AI/AN Recipients)"},{"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":"implications as a result of the unauthorized <span class=\"match\">plan</span> switch activity.\n \n \n Unauthorized <span class=\"match\">plan</span> changes may harm enrollees or applicants by removing them from their selected <span class=\"match\">plan</span> and placing them in another <span class=\"match\">plan</span> that may not provide coverage that meets their needs (for example, different <span class=\"match\">plans</span> can have different formularies and provider networks). Unauthorized enrollments can also involve situations where individuals are enrolled in an Exchange <span class=\"match\">plan</span> without having an existing Exchange <span class=\"match\">plan</span>. Being enrolled in an Exchange <span class=\"match\">plan</span>, including in the case of an unauthorized"},{"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":"Proposed Rule","abstract":"This proposed 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 proposed rule also includes proposed requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file and reconcile; non-standardized plan option limits and an exceptions process; standardized plan options; special enrollment periods (SEPs); direct enrollment (DE) entities; 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; State flexibility on the financial methodology used for Medicaid eligibility determinations for non- modified adjusted gross income (MAGI) populations; and State flexibility on the effective date of coverage in the Basic Health Program (BHP). A summary of this proposed rule may be found at https:// www.regulations.gov/.","document_number":"2023-25576","html_url":"https://www.federalregister.gov/documents/2023/11/24/2023-25576/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2025","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-11-24/pdf/2023-25576.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-25576.pdf?1700169608","publication_date":"2023-11-24","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":"s/MA-<span class=\"match\">Cost-Sharing</span>-Subsidies-in-ConnectorCare-Brief-083021.pdf. \n \n \n \n \n 65 \n  The structure of wrap-around <span class=\"match\">plans</span> in some States, such as Massachusetts, differs from the coverage in States who offer Medicaid expansion <span class=\"match\">plans</span> on the Exchange. For example, in Massachusetts, the higher <span class=\"match\">cost sharing</span> wrap-around <span class=\"match\">plans</span> are <span class=\"match\">variations</span> of lower <span class=\"match\">cost sharing</span> <span class=\"match\">plans</span>. As such, the Massachusetts wrap-around <span class=\"match\">plans</span> do not have the same AVs as their comparable <span class=\"match\">plans</span>. That is why we use a CSR adjustment factor of 1.12 for all Massachusetts wrap-around <span class=\"match\">plans</span> with"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as 2024 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 has requirements related to updating standardized plan options and reducing plan choice overload; the automatic re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers.","document_number":"2023-08368","html_url":"https://www.federalregister.gov/documents/2023/04/27/2023-08368/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2024","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-04-27/pdf/2023-08368.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-08368.pdf?1681935318","publication_date":"2023-04-27","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":"version of each of the three <span class=\"match\">income-based</span> silver CSR <span class=\"match\">plan</span> <span class=\"match\">variations</span>; one gold <span class=\"match\">plan</span>; and one platinum <span class=\"match\">plan</span>. \n \n We also will continue to differentially display standardized <span class=\"match\">plan</span> options, including those standardized <span class=\"match\">plan</span> options required under State action that took place on or before January 1, 2020, on \n HealthCare.gov, \n and continue enforcement of the standardized <span class=\"match\">plan</span> options display requirements for approved web-brokers and QHP issuers using a direct enrollment pathway to facilitate enrollment through an FFE or SBE–FP—including both the Classic"},{"title":"Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program","type":"Rule","abstract":"This major final rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to the Medicare Diabetes Prevention Program expanded model; updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; updates to policies for Rural Health Clinics and Federally Qualified Health Centers; update to the Ambulance Fee Schedule regulations; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; updates to the Medicare Promoting Interoperability Program.","document_number":"2025-19787","html_url":"https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-11-05/pdf/2025-19787.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-19787.pdf?1761945018","publication_date":"2025-11-05","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":"Apply the phase-in of significant RVU <span class=\"match\">reductions</span> and its associated adjustment. Section 1848(c)(7) of the Act specifies that for services that are not new or revised codes, if the total RVUs for a service for a year would otherwise be decreased by an estimated 20 percent or more as compared to the total RVUs for the previous year, the applicable adjustments in work, PE, and MP RVUs shall be phased in over a 2-year period. In implementing the phase-in, we consider a 19 percent <span class=\"match\">reduction</span> as the maximum 1-year <span class=\"match\">reduction</span> for any service not described by"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024","type":"Proposed Rule","abstract":"This proposed rule includes proposed payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as proposed 2024 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 proposes requirements related to updating standardized plan options and reducing plan choice overload; re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers.","document_number":"2022-27206","html_url":"https://www.federalregister.gov/documents/2022/12/21/2022-27206/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2024","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-12-21/pdf/2022-27206.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-27206.pdf?1671052525","publication_date":"2022-12-21","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":"percent standard, as specified in § 156.140(c) (known as an expanded bronze <span class=\"match\">plan</span>); one standard silver <span class=\"match\">plan</span>; one version of each of the three <span class=\"match\">income-based</span> silver CSR <span class=\"match\">plan</span> <span class=\"match\">variations</span>; one gold <span class=\"match\">plan</span>; and one platinum <span class=\"match\">plan</span>. We would continue to differentially display standardized <span class=\"match\">plan</span> options, including those standardized <span class=\"match\">plan</span> options required under State action that took place on or before January 1, 2020, on \n HealthCare.gov, \n and would continue enforcement of the standardized <span class=\"match\">plan</span> options display requirements for approved web-brokers and QHP issuers"},{"title":"Medicaid Program; Community Engagement Requirement for Certain Individuals","type":"Rule","abstract":"This interim final rule with comment period (IFC) interprets and implements the community engagement requirement in Medicaid under section 1902(xx) of the Social Security Act. States are required to implement the new requirement no later than January 1, 2027. This IFC specifies the requirements and expectations for States, including the Medicaid applicants and beneficiaries who must demonstrate community engagement as a condition of their eligibility, the types of qualifying activities that satisfy the community engagement requirement, the criteria to meet an exception from the requirement (that is, be deemed compliant), and the criteria to meet a specified exclusion from the requirement. It also specifies requirements for verification of qualifying activities, outreach to affected populations, steps States must take if they determine individuals are noncompliant, and additional operational considerations for States. Finally, this IFC specifies implementation timing and establishes new State reporting requirements.","document_number":"2026-11094","html_url":"https://www.federalregister.gov/documents/2026/06/03/2026-11094/medicaid-program-community-engagement-requirement-for-certain-individuals","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-06-03/pdf/2026-11094.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-11094.pdf?1780346707","publication_date":"2026-06-03","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":"Indians are exempt from <span class=\"match\">cost sharing</span> in Medicaid and CHIP and may receive special types of income that are not included in the MAGI calculation. They may also be eligible for special enrollment periods and <span class=\"match\">cost sharing</span> <span class=\"match\">reductions</span> for qualified health <span class=\"match\">plans</span> purchased on the Health Insurance Exchange. State Medicaid applications ask questions to identify who might be eligible for these protections (that is, <span class=\"match\">cost sharing</span> exemptions and deductions from income for Medicaid and CHIP and special enrollment periods and <span class=\"match\">cost sharing</span> <span class=\"match\">reductions</span> on the Health Insurance"},{"title":"Guidance for Federal Financial Assistance","type":"Rule","abstract":"The Office of Management and Budget (OMB) is revising the OMB Guidance for Grants and Agreements, which is now called the OMB Guidance for Federal Financial Assistance. The final guidance reflects public comments received in response to the OMB Notification of Proposed Guidance published in October 2023 and comments received from Federal agencies. In response to comments, OMB is revising and updating the guidance to incorporate recent OMB policy priorities related to Federal financial assistance and to reduce agency and recipient burden. OMB is also incorporating certain statutory requirements and clarifying certain sections of the prior version of the guidance that recipients or agencies have interpreted in different ways. OMB is also making revisions to use plain language, improve flow, and address inconsistent use of terms within the guidance text. Finally, OMB is making revisions to improve Federal financial assistance management, transparency, and oversight through more accessible and readily comprehensible guidance.","document_number":"2024-07496","html_url":"https://www.federalregister.gov/documents/2024/04/22/2024-07496/guidance-for-federal-financial-assistance","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-22/pdf/2024-07496.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07496.pdf?1713271514","publication_date":"2024-04-22","agencies":[{"raw_name":"OFFICE OF MANAGEMENT AND BUDGET","name":"Management and Budget Office","id":280,"url":"https://www.federalregister.gov/agencies/management-and-budget-office","json_url":"https://www.federalregister.gov/api/v1/agencies/280","parent_id":null,"slug":"management-and-budget-office"}],"excerpts":"the submitting organization, individual investigator or program director, or both. \n \n (ii) \n <span class=\"match\">Cost Sharing</span>. \n This subsection must state:\n \n (A) Whether there is required <span class=\"match\">cost sharing</span>. This statement must be clear that not committing to the required <span class=\"match\">cost sharing</span> will make the application ineligible. If <span class=\"match\">cost sharing</span> is not required, the announcement must say so. \n \n (B) An explanation of the calculation for the required <span class=\"match\">cost sharing</span>. Required <span class=\"match\">cost sharing</span> may be a certain percentage or amount or in the form of contributions of specified items or activities"},{"title":"Older Americans Act: Grants to State and Community Programs on Aging; Grants to Indian Tribes and Native Hawaiian Grantees for Supportive, Nutrition, and Caregiver Services; Grants for Supportive and Nutritional Services to Older Hawaiian Natives; and Allotments for Vulnerable Elder Rights Protection Activities","type":"Rule","abstract":"ACL is issuing this final rule to modernize the implementing regulations of the Older Americans Act of 1965 (\"the Act\" or OAA). These changes advance the policy goals of the Act as articulated by Congress, including equity in service delivery, accountability for funds expended, and clarity of administration for ACL and its grantees. This final rule ultimately facilitates improved service delivery and enhanced benefits for OAA participants, particularly those in greatest economic need and greatest social need consistent with the statute.","document_number":"2024-01913","html_url":"https://www.federalregister.gov/documents/2024/02/14/2024-01913/older-americans-act-grants-to-state-and-community-programs-on-aging-grants-to-indian-tribes-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-14/pdf/2024-01913.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-01913.pdf?1707227113","publication_date":"2024-02-14","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":"Administration for Community Living","name":"Community Living Administration","id":587,"url":"https://www.federalregister.gov/agencies/community-living-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/587","parent_id":221,"slug":"community-living-administration"}],"excerpts":"to <span class=\"match\">Planning</span> and Service Areas \n 6. § 1321.15 Interstate <span class=\"match\">Planning</span> and Service Area \n 7. § 1321.17 Appeal to the Departmental Appeals Board on <span class=\"match\">Planning</span> and Service Area Designation \n 8. § 1321.19 Designation of and Designation Changes to Area Agencies \n 9. § 1321.21 Withdrawal of Area Agency Designation \n 10. § 1321.25 Duration, Format, and Effective Date of the State <span class=\"match\">Plan</span> \n 11. § 1321.27 Content of State <span class=\"match\">Plan</span> \n 12. § 1321.29 Public Participation \n 13. § 1321.31 Amendments to the State <span class=\"match\">Plan</span> \n 14. § 1321.33 Submission of the State <span class=\"match\">Plan</span> or <span class=\"match\">Plan</span> Amendment"},{"title":"Introduction to the Unified Agenda of Federal Regulatory and Deregulatory Actions-Fall 2023","type":"Proposed Rule","abstract":"Publication of the Fall 2023 Unified Agenda of Federal Regulatory and Deregulatory Actions represents a key component of the regulatory planning mechanism prescribed in Executive Order (\"E.O.\") 12866, \"Regulatory Planning and Review,\" (58 FR 51735, as amended) and reaffirmed in E.O. 13563, \"Improving Regulation and Regulatory Review,\" (76 FR 3821) and E.O. 14094, \"Modernizing Regulatory Review,\" (88 FR 21879). The Regulatory Flexibility Act requires that agencies publish semiannual regulatory agendas in the Federal Register describing regulatory actions they are developing that may have a significant economic impact on a substantial number of small entities (5 U.S.C. 602). The Unified Agenda of Federal Regulatory and Deregulatory Actions (Unified Agenda), published in the fall and spring, helps agencies fulfill all of these requirements. All Federal regulatory agencies have chosen to publish their regulatory agendas as part of this publication. The complete publication of the Fall 2023 Unified Agenda contains the Regulatory Plans of 29 Federal agencies and 69 Federal agency regulatory agendas available to the public at www.reginfo.gov. The Fall 2023 Unified Agenda publication appearing in the Federal Register includes the Regulatory Plan and agency Regulatory Flexibility Agendas, in accordance with the publication requirements of the Regulatory Flexibility Act. Agency Regulatory Flexibility Agendas contain only those Agenda entries for rules that are likely to have a significant economic impact on a substantial number of small entities and entries that have been selected for periodic review under section 610 of the Regulatory Flexibility Act.","document_number":"2024-00476","html_url":"https://www.federalregister.gov/documents/2024/02/09/2024-00476/introduction-to-the-unified-agenda-of-federal-regulatory-and-deregulatory-actions-fall-2023","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-09/pdf/2024-00476.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-00476.pdf?1707399919","publication_date":"2024-02-09","agencies":[{"raw_name":"REGULATORY INFORMATION SERVICE CENTER","name":"Regulatory Information Service Center","id":449,"url":"https://www.federalregister.gov/agencies/regulatory-information-service-center","json_url":"https://www.federalregister.gov/api/v1/agencies/449","parent_id":null,"slug":"regulatory-information-service-center"}],"excerpts":"Contents \n \n Introduction to the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda of Federal Regulatory and Deregulatory Actions \n I. What are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda? \n II. Why are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda published? \n III. How are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda organized? \n IV. What information appears for each entry? \n V. Abbreviations \n VI. How can users get copies of the <span class=\"match\">Plan</span> and the Agenda? \n Introduction to the Fall 2023 Regulatory <span class=\"match\">Plan</span> \n Agency Regulatory <span class=\"match\">Plans</span> \n Cabinet Departments \n Department of Agriculture"},{"title":"Coronavirus State and Local Fiscal Recovery Funds","type":"Rule","abstract":"The Secretary of the Treasury is issuing an interim final rule to implement the amendments made by the Consolidated Appropriations Act, 2023 with respect to the Coronavirus State Fiscal Recovery Fund and the Coronavirus Local Fiscal Recovery Fund established under the American Rescue Plan Act.","document_number":"2023-17446","html_url":"https://www.federalregister.gov/documents/2023/09/20/2023-17446/coronavirus-state-and-local-fiscal-recovery-funds","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-09-20/pdf/2023-17446.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-17446.pdf?1695127514","publication_date":"2023-09-20","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"}],"excerpts":"outlined in <span class=\"match\">planning</span> documents submitted to HUD, these <span class=\"match\">planning</span> documents cover a grantee's programmatic <span class=\"match\">plans</span> for all HUD awards (not just those authorized under Title I) on an annual basis with respect to action <span class=\"match\">plans</span> and a multi-year basis with respect to consolidated <span class=\"match\">plans</span>. Based on the structure of the SLFRF program, certification and approval requirements associated with these <span class=\"match\">plans</span> are irrelevant for the SLFRF program. In any event, HUD does not affirmatively approve CDBG grantees' <span class=\"match\">planning</span> documents, but the agency may disapprove <span class=\"match\">plans</span> as necessary"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as 2023 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 guaranteed availability; the offering of QHP standardized plan options through Exchanges on the Federal platform; requirements for agents, brokers, and web-brokers; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; and re-enrollment. This final rule also responds to comments on how the Department of Health and Human Services (HHS) can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.","document_number":"2022-09438","html_url":"https://www.federalregister.gov/documents/2022/05/06/2022-09438/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2023","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-05-06/pdf/2022-09438.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-09438.pdf?1651522516","publication_date":"2022-05-06","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"}],"excerpts":"provisions of part A of title XXVII of the PHS Act relating to group health <span class=\"match\">plans</span> and health insurance \n \n issuers in the group and individual markets. The term “group health <span class=\"match\">plan</span>” includes both insured and self-insured group health <span class=\"match\">plans</span>.\n 13 \n \n \n \n \n 13 \n  The term “group health <span class=\"match\">plan</span>” is used in title XXVII of the PHS Act and is distinct from the term “health <span class=\"match\">plan</span>” as used in other provisions of title I of ACA. The term “health <span class=\"match\">plan</span>” does not include self-insured group health <span class=\"match\">plans</span>.\n \n \n Section 2702 of the PHS Act, as added by the ACA, establishes requirements"},{"title":"Basic Health Program; Federal Funding Methodology for Program Year 2023 and Changes to the Basic Health Program Payment Notice Process","type":"Rule","abstract":"This rule finalizes the methodology and data sources necessary to determine Federal payment amounts to be made for program year 2023 to States that elect to establish a Basic Health Program under the Patient Protection and Affordable Care Act to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Health Insurance Exchanges.","document_number":"2022-27211","html_url":"https://www.federalregister.gov/documents/2022/12/20/2022-27211/basic-health-program-federal-funding-methodology-for-program-year-2023-and-changes-to-the-basic","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-12-20/pdf/2022-27211.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-27211.pdf?1671207319","publication_date":"2022-12-20","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":"to potentially coordinate standard health <span class=\"match\">plans</span> in the BHP with their Medicaid managed care <span class=\"match\">plans</span>, or to potentially reduce the costs to individuals by lowering premiums or <span class=\"match\">cost-sharing</span> requirements. \n Federal funding for a BHP under section 1331(d)(3)(A) of the ACA is based on the amount of the Federal premium tax credit (PTC) allowed and payments to cover required <span class=\"match\">cost-sharing</span> <span class=\"match\">reductions</span> (CSRs) that would have been provided for the fiscal year to eligible individuals enrolled in BHP standard health <span class=\"match\">plans</span> in the State if such eligible individuals"},{"title":"Small Business Development Centers","type":"Rule","abstract":"The U.S. Small Business Administration (SBA or the Agency) issues this final rule to update its regulations for the Small Business Development Centers Program (the SBDC Program or the Program). The Office of Small Business Development Centers has not comprehensively updated its regulations since 1995. This final rule updates and clarifies the regulations, making them more efficient, effective, transparent, and comprehensive, and puts them in alignment with current SBA policy and guidance. This final rule also includes policy and procedural changes identified by the Agency as necessary to preserve the integrity and legislative intent of the Program. Finally, it incorporates updates to conform with administrative requirements, cost principles, and audit requirements for Federal awards (Uniform Guidance).","document_number":"2023-22164","html_url":"https://www.federalregister.gov/documents/2023/11/07/2023-22164/small-business-development-centers","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-11-07/pdf/2023-22164.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-22164.pdf?1699278316","publication_date":"2023-11-07","agencies":[{"raw_name":"SMALL BUSINESS ADMINISTRATION","name":"Small Business Administration","id":468,"url":"https://www.federalregister.gov/agencies/small-business-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/468","parent_id":null,"slug":"small-business-administration"}],"excerpts":"paragraph (b) regarding the use of program <span class=\"match\">income based</span> on the Small Business Act section 21(a)(4)(A) which requires the recipient to match 100 percent Federal grant funding not less than 50 percent cash and not more than 50 percent of indirect costs and in-kind contributions. SBA interprets this paragraph to mean that program income, which are fees collected from recipients of assistance, is excluded to be used as matching funds. Further, SBA requests the sources of match to ensure that the NFE's <span class=\"match\">cost sharing</span> and matching are not paid by the Federal"},{"title":"Introduction to the Unified Agenda of Federal Regulatory and Deregulatory Actions-Fall 2022","type":"Proposed Rule","abstract":"Publication of the Fall 2022 Unified Agenda of Federal Regulatory and Deregulatory Actions represents a key component of the regulatory planning mechanism prescribed in Executive Order (\"E.O.\") 12866, \"Regulatory Planning and Review,\" (58 FR 51735) and reaffirmed in E.O. 13563, \"Improving Regulation and Regulatory Review,\" (76 FR 3821). The Regulatory Flexibility Act requires that agencies publish semiannual regulatory agendas in the Federal Register describing regulatory actions they are developing that may have a significant economic impact on a substantial number of small entities (5 U.S.C. 602). The Unified Agenda of Regulatory and Deregulatory Actions (Unified Agenda), published in the fall and spring, helps agencies fulfill all of these requirements. All federal regulatory agencies have chosen to publish their regulatory agendas as part of this publication. The complete Unified Agenda and Regulatory Plan can be found online at www.reginfo.gov and a reduced print version can be found in the Federal Register. Information regarding obtaining printed copies can also be found on the Reginfo.gov website (or below, VI. How Can Users Get Copies of the Plan and the Agenda?). The Fall 2022 Unified Agenda publication appearing in the Federal Register includes the Regulatory Plan and agency regulatory flexibility agendas, in accordance with the publication requirements of the Regulatory Flexibility Act. Agency regulatory flexibility agendas contain only those Agenda entries for rules that are likely to have a significant economic impact on a substantial number of small entities and entries that have been selected for periodic review under section 610 of the Regulatory Flexibility Act. The complete Fall 2022 Unified Agenda contains the Regulatory Plans of 29 Federal agencies and 67 Federal agency regulatory agendas.","document_number":"2023-02113","html_url":"https://www.federalregister.gov/documents/2023/02/22/2023-02113/introduction-to-the-unified-agenda-of-federal-regulatory-and-deregulatory-actions-fall-2022","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-02-22/pdf/2023-02113.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-02113.pdf?1676987125","publication_date":"2023-02-22","agencies":[{"raw_name":"REGULATORY INFORMATION SERVICE CENTER","name":"Regulatory Information Service Center","id":449,"url":"https://www.federalregister.gov/agencies/regulatory-information-service-center","json_url":"https://www.federalregister.gov/api/v1/agencies/449","parent_id":null,"slug":"regulatory-information-service-center"}],"excerpts":"Contents \n Introduction to the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda of Federal Regulatory and Deregulatory Actions \n I. What are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda? \n II. Why are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda published? \n III. How are the Regulatory <span class=\"match\">Plan</span> and the Unified Agenda organized? \n IV. What information appears for each entry? \n V. Abbreviations \n VI. How can users get copies of the <span class=\"match\">Plan</span> and the Agenda? \n Introduction to the Fall 2022 Regulatory <span class=\"match\">Plan</span> \n Agency Regulatory <span class=\"match\">Plans</span> \n Cabinet Departments \n Department of Agriculture"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023","type":"Proposed Rule","abstract":"This proposed rule includes proposed payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as proposed 2023 user fee rates for issuers offering qualified health plans (QHPs) through federally- facilitated Exchanges and State-based Exchanges on the Federal platform. This proposed rule also proposes requirements related to prohibiting discrimination based on sexual orientation and gender identity; guaranteed availability; the offering of QHP standardized options through Exchanges on the Federal platform; requirements for agents, brokers, web-brokers, and issuers assisting consumers with enrollment through Exchanges that use the Federal platform; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; re-enrollment, and requirements related to a new State Exchange improper payment measurement program. This proposed rule also seeks comment on how HHS can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.","document_number":"2021-28317","html_url":"https://www.federalregister.gov/documents/2022/01/05/2021-28317/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2023","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-01-05/pdf/2021-28317.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2021-28317.pdf?1640726125","publication_date":"2022-01-05","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":"premiums, smaller networks, and worse <span class=\"match\">plan</span> options. Specifically, these commenters stated that reducing transfers to <span class=\"match\">plans</span> with higher-risk enrollees could create incentives for issuers to avoid enrolling high-risk enrollees in the future through distorting <span class=\"match\">plan</span> offering and designs, including by avoiding broad network <span class=\"match\">plans</span>, not offering platinum <span class=\"match\">plans</span> at all, and only offering limited gold <span class=\"match\">plans</span>. Commenters further stated that issuers could also distort <span class=\"match\">plan</span> designs by excluding coverage or imposing high <span class=\"match\">cost sharing</span> for certain drugs or services. Some"}]}