Federal Register #CMS-9873-P

CMS proposed rule on Exchange eligibility verification and enrollment

CMS proposes regulatory changes to Affordable Care Act Exchange eligibility and enrollment verification; this notice is not a request to buy products or services. - Government buyer: No purchasing agency is identified. The issuing agency is the Centers for Medicare & Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS). - Proposal scope: Changes would address eligibility data-matching issues, residency verification, annual and in-plan-year eligibility redeterminations, enrollment while verification is underway, coverage effective dates, and State Exchange readiness before open enrollment. - Notable requirements under consideration: CMS proposes limits on authorizing advance premium tax credits and cost-sharing reductions while specified data-matching issues remain unresolved. The proposal also seeks input on improving residency verification while protecting consumers. - Organizations mentioned: LexisNexis is cited as a provider used in a prior residency-verification pilot. The Internal Revenue Service (IRS) and data brokers are discussed as possible verification approaches, not as selected vendors. - Procurement status: No products, services, quantities, part numbers, or contract value are identified.

Description

This proposed rule would implement Working Families Tax Cut legislation requirements related to Exchange eligibility and verification. It proposes updates to inconsistency periods and verification procedures, annual and in-plan-year eligibility redeterminations, and enrollment methods during the verification process. It also proposes new coverage effective dates and includes proposals concerning State Exchange pre-open enrollment verification and related eligibility rules. Comments must be received by November 27, 2026.

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