Data / Federal rules / 2025-11606
Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
The Health and Human Services Department published this final rule in the Federal Register on June 25, 2025. It took effect on August 25, 2025.
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What the agency says
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.
Key facts
- Document number
- 2025-11606
- Type
- Final rule
- Action
- Final rule
- Agency
- Health and Human Services Department
- Published
- June 25, 2025
- Takes effect
- August 25, 2025
- Dates
- Effective Date: These regulations are effective on August 25, 2025.
- Docket
- CMS-9884-F
- Regulation ID (RIN)
- 0938-AV61
- Code of Federal Regulations
- 45 CFR 147; 45 CFR 155; 45 CFR 156
- Topics
- Administrative practice and procedure; Advertising; Advisory committees; Aged; Brokers; Citizenship and naturalization; Civil rights; 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); Public assistance programs; Reporting and recordkeeping requirements; Sex discrimination; State and local governments; Sunshine Act; Taxes; Technical assistance; Women; Youth
- Pages
- 151
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 June 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.