{"abstract":"This final rule sets forth revised 2022 user fee rates for issuers offering qualified health plans (QHPs) through federally- facilitated Exchanges and State-based Exchanges on the Federal platform; repeals separate billing requirements related to the collection of separate payments for the portion of QHP premiums attributable to coverage for certain abortion services; expands the annual open enrollment period and Navigator duties; implements a new monthly special enrollment period for qualified individuals or enrollees, or the dependents of a qualified individual or enrollee, who are eligible for advance payments of the premium tax credit (APTC) and whose household income does not exceed 150 percent of the Federal poverty level, available during periods of time during which APTC benefits are available such that certain applicable taxpayers' applicable percentage is set at zero, such as during tax years 2021 and 2022 under the section 9661 of the American Rescue Plan Act of 2021; repeals the recent establishment of a Direct Enrollment option for Exchanges; and modifies regulations and policies related to section 1332 waivers.","action":"Final rule.","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"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2021/09/27/2021-20509.html","cfr_references":[{"chapter":null,"citation_url":null,"part":33,"title":31},{"chapter":null,"citation_url":null,"part":147,"title":45},{"chapter":null,"citation_url":null,"part":155,"title":45},{"chapter":null,"citation_url":null,"part":156,"title":45}],"citation":"86 FR 53412","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"This final rule is effective on November 26, 2021.","disposition_notes":null,"docket_ids":["CMS-9906-F"],"dockets":[],"document_number":"2021-20509","effective_on":"2021-11-26","end_page":53506,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2021/09/27/2021-20509.xml","html_url":"https://www.federalregister.gov/documents/2021/09/27/2021-20509/patient-protection-and-affordable-care-act-updating-payment-parameters-section-1332-waiver","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2021-20509?publication_date=2021-09-27","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2021-09-27/2021-20509/mods.xml","not_received_for_publication":null,"page_length":95,"page_views":{"count":7160,"last_updated":"2026-04-18 02:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2021-09-27/pdf/2021-20509.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2021-20509.pdf?1632242893","publication_date":"2021-09-27","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2021/09/27/2021-20509.txt","regulation_id_number_info":{"0938-AU60":{"issue":"202104","html_url":"https://www.federalregister.gov/regulations/0938-AU60/patient-protection-and-affordable-care-act-updating-payment-parameters-and-improving-health-insuranc","title":"Patient Protection and Affordable Care Act; Updating Payment Parameters and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule (CMS-9906)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202104&RIN=0938-AU60&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"},"1505-AC78":{"issue":"202110","html_url":"https://www.federalregister.gov/regulations/1505-AC78/updating-payment-parameters-section-1332-waiver-implementing-regulations-and-improving-health-insura","title":"Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202110&RIN=1505-AC78&operation=OPERATION_EXPORT_XML","priority_category":"Other Significant"}},"regulation_id_numbers":["0938-AU60","1505-AC78"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":0,"agency_id":"HHS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=HHS-OS-2022-0008","supporting_documents_count":0,"docket_id":"HHS-OS-2022-0008","document_id":"HHS-OS-2022-0008-0629","regulation_id_number":null,"title":"HHS 2022 Archive","checked_regulationsdotgov_at":"2022-05-28T03:30:05Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":53412,"subtype":null,"title":"Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond","toc_doc":"Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond","toc_subject":"Patient Protection and Affordable Care Act:\n","topics":["Administrative practice and procedure","Advertising","Advisory committees","Alaska","Brokers","Citizenship and naturalization","Civil rights","Consumer protection","Grant programs-health","Grants administration","Health care","Health insurance","Health maintenance organizations (HMO)","Health records","Hospitals","Indians","Individuals with disabilities","Intergovernmental relations","Loan programs-health","Medicaid","Organization and functions (Government agencies)","Prescription drugs","Public assistance programs","Reporting and recordkeeping requirements","Sex discrimination","State and local governments","Sunshine Act","Taxes","Technical assistance","Women","Youth"],"type":"Rule","volume":86}