Data / Federal rules / 2025-00640
Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program
The Health and Human Services Department published this final rule in the Federal Register on January 15, 2025. It took effect on January 15, 2025.
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What the agency says
This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year 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 modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS-RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; permissible plan-level adjustment to the index rate to account for cost-sharing reductions (CSRs); reconsideration standards for certification denials; changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a policy to publicly share aggregated, summary- level Quality Improvement Strategy (QIS) information on an annual basis; and revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.
Key facts
- Document number
- 2025-00640
- Type
- Final rule
- Action
- Final rule
- Agency
- Health and Human Services Department
- Published
- January 15, 2025
- Takes effect
- January 15, 2025
- Dates
- These regulations are effective on January 15, 2025.
- Docket
- CMS-9888-F
- Regulation ID (RIN)
- 0938-AV41
- Code of Federal Regulations
- 45 CFR 153; 45 CFR 155; 45 CFR 156; 45 CFR 158
- Topics
- Administrative practice and procedure; Advertising; Advisory committees; Brokers; Claims; 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
- Pages
- 119
Other documents from the Health and Human Services Department
Everything from the Health and Human Services Department · Rules on administrative practice and procedure · Rules on advertising · Rules on advisory committees · Published in January 2025
Read from the Federal Register API, last updated 2026-10-23. The document on federalregister.gov is the official record; dates and dockets can change through later corrections. Free to reuse with credit to SpecStream under CC BY 4.0.