{"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).","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"},{"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"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2024/04/15/2024-07274.html","cfr_references":[{"chapter":null,"citation_url":null,"part":"33","title":31},{"chapter":null,"citation_url":null,"part":"600","title":42},{"chapter":null,"citation_url":null,"part":"153","title":45},{"chapter":null,"citation_url":null,"part":"155","title":45},{"chapter":null,"citation_url":null,"part":"156","title":45}],"citation":"89 FR 26218","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"These regulations are effective on June 4, 2024.","disposition_notes":null,"docket_ids":["CMS-9895-F"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":null,"comment_start_date":null,"updated_at":"2024-04-16T12:56:38.256-04:00","comment_url":"https://www.regulations.gov/commenton/CMS-2023-0191-0223","allow_late_comments":null,"id":"CMS-2023-0191-0223","comment_end_date":null,"regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS-2023-0191","title":"Patient Protection and Affordable Care Act, Notice of Benefit and Payment Parameters for 2025; 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Anti-Money Laundering Programs; Special Due Diligence Programs for Certain Foreign Accounts  RULES"}],"document_number":"2024-07274","effective_on":"2024-06-04","end_page":26426,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2024/04/15/2024-07274.xml","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","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2024-07274?publication_date=2024-04-15","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2024-04-15/2024-07274/mods.xml","not_received_for_publication":null,"page_length":209,"page_views":{"count":11248,"last_updated":"2026-07-27 22:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-15/pdf/2024-07274.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07274.pdf?1712351231","publication_date":"2024-04-15","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2024/04/15/2024-07274.txt","regulation_id_number_info":{"0938-AV22":{"issue":"202310","html_url":"https://www.federalregister.gov/regulations/0938-AV22/hhs-notice-of-benefit-and-payment-parameters-for-2025-cms-9895-","title":"HHS Notice of Benefit and Payment Parameters for 2025 (CMS-9895)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202310&RIN=0938-AV22&operation=OPERATION_EXPORT_XML","priority_category":"Section 3(f)(1) Significant"}},"regulation_id_numbers":["0938-AV22"],"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-2024-0002","supporting_documents_count":0,"docket_id":"HHS-OS-2024-0002","document_id":"HHS-OS-2024-0002-0016","regulation_id_number":null,"title":"HHS 2024 Publications","checked_regulationsdotgov_at":"2024-04-20T16:00:07Z"},"regulations_dot_gov_url":null,"significant":false,"signing_date":null,"start_page":26218,"subtype":null,"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","toc_doc":"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 Program; and Basic Health Program","toc_subject":null,"topics":["Administrative practice and procedure","Advertising","Advisory committees","Brokers","Consumer protection","Grant programs-health","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)","Penalties","Public assistance programs","Reporting and recordkeeping requirements","State and local governments","Sunshine Act","Technical assistance","Women","Youth"],"type":"Rule","volume":89}