{"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.","action":"Final rule.","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"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2025/06/25/2025-11606.html","cfr_references":[{"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":"90 FR 27074","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Date: These regulations are effective on August 25, 2025.","disposition_notes":null,"docket_ids":["CMS-9884-F"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":0,"comment_start_date":"2025-06-25","updated_at":"2025-07-01T09:58:31.428-04:00","comment_url":"https://www.regulations.gov/commenton/CMS-2025-0020-25735","allow_late_comments":false,"id":"CMS-2025-0020-25735","comment_end_date":"2025-06-26","regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS-2025-0020","title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability CMS-9884-P"},{"supporting_documents":[],"agency_name":"HHS","documents":[{"comment_count":0,"comment_start_date":"2025-06-25","updated_at":"2025-06-25T08:56:47.809-04:00","comment_url":"https://www.regulations.gov/commenton/HHS_FRDOC_0001-1003","allow_late_comments":false,"id":"HHS_FRDOC_0001-1003","comment_end_date":null,"regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"HHS_FRDOC_0001","title":"Recently Posted HHS Rules and Notices."}],"document_number":"2025-11606","effective_on":"2025-08-25","end_page":27224,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2025/06/25/2025-11606.xml","html_url":"https://www.federalregister.gov/documents/2025/06/25/2025-11606/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2025-11606?publication_date=2025-06-25","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2025-06-25/2025-11606/mods.xml","not_received_for_publication":null,"page_length":151,"page_views":{"count":25550,"last_updated":"2026-04-30 10:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-06-25/pdf/2025-11606.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-11606.pdf?1750709712","publication_date":"2025-06-25","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2025/06/25/2025-11606.txt","regulation_id_number_info":{"0938-AV61":null},"regulation_id_numbers":["0938-AV61"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":0,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2025-0020","supporting_documents_count":0,"docket_id":"CMS-2025-0020","document_id":"CMS-2025-0020-25735","regulation_id_number":"0938-AV61","title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability CMS-9884-P","checked_regulationsdotgov_at":"2025-07-02T16:55:06Z"},"regulations_dot_gov_url":null,"significant":null,"signing_date":null,"start_page":27074,"subtype":null,"title":"Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability","toc_doc":"Marketplace Integrity and Affordability","toc_subject":"Patient Protection and Affordable Care Act","topics":["Administrative practice and procedure","Advertising","Advisory committees","Aged","Brokers","Citizenship and naturalization","Civil rights","Conflict of interests","Consumer protection","Grant programs-health","Grants administration","Health care","Health insurance","Health maintenance organizations (HMO)","Health maintenance organizations (HMO)","Health records","Hospitals","Indians","Individuals with disabilities","Intergovernmental relations","Loan programs-health","Medicaid","Organization and functions (Government agencies)","Public assistance programs","Reporting and recordkeeping requirements","Reporting and recordkeeping requirements","Reporting and recordkeeping requirements","Sex discrimination","State and local governments","Sunshine Act","Taxes","Technical assistance","Women","Youth"],"type":"Rule","volume":90}