Federal Register #2026-10050

HHS Final Rule: Benefit and Payment Parameters for 2027 under the Affordable Care Act

This final rule from the Health and Human Services Department (HHS), via the Centers for Medicare & Medicaid Services (CMS) and the Office of the Secretary, updates regulatory provisions for the Affordable Care Act: - No procurement of products or services; no OEMs or vendors are named - Addresses payment parameters, risk adjustment, and validation programs - Sets user fee rates for issuers of qualified health plans (QHPs) - Establishes civil money penalties for noncompliant issuers - Updates standards for agents, brokers, and web-brokers - Revises hardship exemption eligibility and provider access standards - Modifies essential community provider standards and QHP certification - Includes amendments related to the Working Families Tax Cut legislation - Implements requirements for state exchanges and eligibility verification for noncitizens - Updates marketing and documentation standards for agents and brokers - No quantities, part numbers, or specific products/services are listed

Description

This final rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to risk adjustment, civil money penalties, standards for agents, brokers, and web-brokers, and other related provisions. It includes updates on the HHS-operated risk adjustment and risk adjustment data validation programs, user fee rates for issuers offering qualified health plans, and standards for qualified health plan certification. The rule also addresses hardship exemption eligibility, provider access standards, and amendments related to the Working Families Tax Cut legislation. The regulation is effective on July 20, 2026.

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