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Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary

Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

Published May 20, 2026. Takes effect July 20, 2026, printed at 91 FR 29526, amending 42 CFR 600, 45 CFR 150, 45 CFR 155, 45 CFR 156. 359,178 words.

In plain English

This changes how the health law is carried out. It covers plans sold to the public.

Read it at the Federal Register →

What the Rule Says It Does

This final rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 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 provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); requirements related to defrayal for the cost of any State-required benefits in addition to the EHB; cost- sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive plan years; QHP issuer quality improvement strategies (QISs); and revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States. This final rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.

This is the rule's own summary, as the Federal Register prints it.

The Order It Names

The rule names this order itself. What it does about it is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 91, Number 97 (Wednesday, May 20, 2026)] [Rules and Regulations] [Pages 29526-29877] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2026-10050]

Vol. 91

Wednesday,

No. 97

May 20, 2026

Part II

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Part 600

Office of the Secretary

45 CFR Parts 150, 155, and 156

Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 600

Office of the Secretary

45 CFR Parts 150, 155, and 156

[CMS-9883-F] RIN 0938-AV62

Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Final rule.

DATES

These regulations are effective on July 20, 2026.

FOR FURTHER INFORMATION CONTACT

Jeff Wu, (301) 492-4305, Rogelyn McLean, (410) 786-1524, Grace Bristol, (410) 786-8437, for general information.

Ayesha Anwar, (301) 448-3625, or Joshua Paul, (301) 492-4347, for matters related to HHS-operated risk adjustment and HHS-operated risk adjustment data validation.

Aaron Franz, (410) 786-8027 for matters related to user fees.

Brian Gubin, (410) 786-1659, for matters related to agent, broker, and web-broker guidelines.

Zarin Ahmed, (301) 492-4400, for matters related to enrollment of qualified individuals into QHPs and termination of Exchange enrollment or coverage for qualified individuals.

Hannah Armbruster Hill, (301) 492-4343, for matters related to certification standards for QHPs, cost-sharing requirements, and the Actuarial Value Calculator.

Kelly Carda, (312) 886-5210, or Cassandra Thompson, (667) 414-0870, for matters related to Provider Access standards.

Ariana Koenitzer, (410) 786-0724, or Samantha Nguyen Kella, (816) 426-6339, for matters related to Essential Community Provider Standards.

Ariana Koenitzer, (410) 786-0724, or Cassandra Thompson, (667) 414- 0870, for matters related to QHP Certification of Non-Network Plans.

Nikolas Berkobien, (667) 290-9903, for matters related to standardized plan options, non-standardized plan option limits and exceptions.

Jenny Chen, (301) 492-5156, or Shilpa Gogna, (301) 492-4257, for matters related to State Exchange and State Exchange Blueprint requirements.

Rebecca Braun-Harrison, (667) 290-8846, or Nia Blasingame, (470) 890-4178, for matters related to civil money penalties of issuers and non-Federal governmental group health plans.

Preeti Hans, (301) 492-5144, for matters related to the Quality Improvement Strategy.

Mary Beth Hance, 410-786-4299, for matters related to the Basic Health Program.

Christina Whitefield, (301) 492-4172, for matters related to the medical loss ratio (MLR) program.

David Mlawsky, (410) 786-6851, for matters related to catastrophic plans with multi-year plan terms.

Jessica Veffer, (301) 492-4827, for matters related to expanding hardship exemptions for individuals ineligible for APTC or CSRs due to projected household income.

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

I. Executive Summary

We are finalizing changes to the provisions and parameters implemented through prior rulemaking to implement the Patient Protection and Affordable Care Act and are also finalizing updates to implement new provisions.\1\ These requirements are published under the authority granted to the Secretary of HHS (the Secretary) by the Affordable Care Act and the Public Health Service (PHS) Act.\2\ In this document, we are finalizing changes related to some of the Affordable Care Act provisions and parameters we previously implemented under the authority granted to the Secretary by Public Law (Pub. L.) 119-21, which CMS refers to as the Working Families Tax Cut (WFTC) legislation.\3\ Our goal with these requirements is providing quality, more affordable coverage to consumers while minimizing administrative burden and ensuring program integrity. The changes finalized in this rule are also intended to enhance the role of States in these programs, provide issuers and States with additional flexibilities, reduce unnecessary regulatory burden on interested parties, and improve affordability.

\1\ The Patient Protection and Affordable Care Act (Pub. L. 111- 148) was enacted on March 23, 2010. The Healthcare and Education Reconciliation Act of 2010 (Pub. L. 111-152), which amended and revised several provisions of the Patient Protection and Affordable Care Act, was enacted on March 30, 2010. In this rulemaking, the two statutes are referred to collectively as the “Patient Protection and Affordable Care Act” or “Affordable Care Act.”

\2\ See sections 1301, 1302, 1311, 1312, 1313, 1321, 1331, and 1343 of the Affordable Care Act and section 2792 of the PHS Act.

\3\ The WFTC legislation (Pub. L. 119-21) was enacted on July 4, 2025.

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 73 headings, 359,178 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 3 words
  3. SUMMARYOn its face · 216 words
  4. DATESOn its face · 9 words
  5. FOR FURTHER INFORMATION CONTACTOn its face · 297 words
  6. SUPPLEMENTARY INFORMATIONPreamble · 2 words
  7. I. Executive SummaryPreamble · 271 words
  8. II. BackgroundPreamble · 2 words
  9. A. Legislative and Regulatory OverviewPreamble · 4,621 words
  10. 3. Market RulesPreamble · 2,327 words
  11. B. Summary of Major ProvisionsPreamble · 4,374 words
  12. III. Summary of the Proposed Provisions, Public Comments, and Responses to Comments on the Proposed RulePreamble · 16 words
  13. A. Part 150--CMS Enforcement in Group and Individual Insurance MarketsPreamble · 10 words
  14. 1. Factors CMS Uses To Determine the Amount of a Civil Money Penalty (CMP) (Sec. 150.317)Preamble · 249 words
  15. B. Part 153--Standards Related to Reinsurance, Risk Corridors, and Risk AdjustmentPreamble · 172 words
  16. 1. SequestrationPreamble · 1,586 words
  17. a. Data for HHS Risk Adjustment Model Recalibration for the 2027 Benefit YearPreamble · 3,283 words
  18. b. List of Factors To Be Employed in the HHS Risk Adjustment Models (Sec. 153.320)Preamble · 4,069 words
  19. c. Model Performance StatisticsPreamble · 511 words
  20. 3. Overview of the HHS Risk Adjustment Methodology (Sec. 153.320)Preamble · 1,231 words
  21. a. HHS-RADV Error Estimation Modification To Incorporate IVA Sampling ChangesPreamble · 1,781 words
  22. 5. HHS Risk Adjustment User Fee for the 2027 Benefit Year (Sec. 153.610(f))Preamble · 6,809 words
  23. D. Part 155--Exchange Establishment Standards and Other Related StandardsPreamble · 67,696 words
  24. 16. Special Enrollment Period Verification (Sec. 155.420(g))Preamble · 14,948 words
  25. 18. Amending Exchange Network Adequacy Standards (Sec. 155.1050)Preamble · 7,800 words
  26. a. Purpose and Scope (Sec. 155.1600)Preamble · 14,218 words
  27. k. Failure To Comply (Sec. 155.1650)Preamble · 1,369 words
  28. E. Part 156--Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to ExchangesPreamble · 16 words
  29. 1. FFE and SBE-FP User Fee Rates for the 2027 Benefit Year (Sec. 156.50)Preamble · 261 words
  30. a. FFE User Fee Rate for the 2027 Benefit YearPreamble · 102,452 words
  31. a. Previous Rulemaking Related to Non-Network PlansPreamble · 721 words
  32. b. The Basis for Reconsidering Our Existing Prohibition on Non-Network Plans as QHPsPreamble · 46,415 words
  33. H. Comments Regarding the Public Comment PeriodPreamble · 669 words
  34. I. SeverabilityPreamble · 325 words
  35. IV. Collection of Information RequirementsPreamble · 179 words
  36. A. Wage EstimatesPreamble · 435 words
  37. B. ICRs Regarding Rate Filing Justification--OMB Control Number 0938- 1141 (Sec. 154.215)Preamble · 12 words
  38. 1. ICR Regarding Estimating CSR Load Factor Using the Standard MethodologyPreamble · 1,278 words
  39. 3. ICR Related to the Submission of Actuarial MemorandumPreamble · 472 words
  40. 4. Cost to Federal Government Related to Review of URRT Reporting Requirements Related to CSR EstimatesPreamble · 164 words
  41. C. ICRs Regarding Mandating HHS-Approved and -Created Consumer Consent Form (Sec. 155.220)Preamble · 803 words
  42. D. ICRs Regarding Misleading Marketing (Sec. 155.220)Preamble · 515 words
  43. E. ICRs Regarding State Exchange Enhanced Direct Enrollment (SBE-EDE) Option (Sec. 155.221)Preamble · 184 words
  44. 1. Basic Health ProgramPreamble · 972 words
  45. 4. Ongoing Burden Related to New DMI Type for “Eligible Noncitizens”Preamble · 145 words
  46. 1. ExchangesPreamble · 217 words
  47. 2. Ongoing Burden Reduction--Medicaid Lawful Presence (MLP) and Annual Income (AI) Data Matching Issue (DMI) ProcessingPreamble · 351 words
  48. 4. Annual Income (AI) Data Matching Issue (DMI) ReductionPreamble · 311 words
  49. H. ICRs Regarding Failure To File and Reconcile (Sec. 155.305)Preamble · 464 words
  50. I. ICRs Regarding Income Verification When Data Sources Indicate Income Less Than 100 Percent of the FPL (Sec. 155.320(c)(3)(iii))Preamble · 733 words
  51. J. ICRs Regarding Removal of the Requirement To Accept Attestations of Household Income When Tax Data Is Unavailable (Sec. 155.320(c)(5))Preamble · 650 words
  52. K. ICRs Regarding Pre-Enrollment SEP Verification (Sec. 155.420(g))Preamble · 493 words
  53. L. ICRs Regarding Expansion of Hardship Exemption Eligibility (Sec. 155.605(d)(1))Preamble · 628 words
  54. M. ICRs Regarding Modification of Exchange Network Adequacy Standards (Sec. 155.1050)Preamble · 583 words
  55. N. ICRs Regarding General Program Integrity and Oversight Requirements (Sec. 155.1200)Preamble · 2,992 words
  56. Q. ICRs Regarding Non-Standardized Plan Option Limits (Sec. 156.202)Preamble · 142 words
  57. R. ICRs Regarding Provider Access Standards for Network Plans (Sec. 155.1050 and Sec. 156.230)Preamble · 611 words
  58. S. ICRs Regarding Essential Community Providers (Sec. 155.1051 and Sec. 156.235)Preamble · 2,909 words
  59. U. ICRs Regarding Quality Improvement Strategy (Sec. 156.1130)Preamble · 49 words
  60. V. Summary of Annual Burden Estimates for Finalized Requirements [GRAPHIC] [TIFF OMITTED] TR20MY26.037Preamble · 13 words
  61. W. Submission of PRA-Related CommentsPreamble · 71 words
  62. V. Regulatory Impact AnalysisPreamble · 4 words
  63. A. Statement of NeedPreamble · 267 words
  64. B. Overall ImpactPreamble · 350 words
  65. C. Impact Estimates of the Finalized Payment Notice Provisions and Accounting TablePreamble · 31,182 words
  66. D. Regulatory Alternatives ConsideredPreamble · 2,523 words
  67. E. Regulatory Flexibility Act (RFA)Preamble · 1,481 words
  68. 4. Regulatory Impacts and AlternativesPreamble · 1,620 words
  69. F. Unfunded Mandates Reform Act (UMRA)Preamble · 106 words
  70. G. FederalismPreamble · 1,275 words
  71. H. E.O. 14192, “Unleashing Prosperity Through Deregulation”Preamble · 73 words
  72. I. Congressional Review ActPreamble · 61 words
  73. List of SubjectsRegulatory text · 14,979 words

The Rest of the Text

This rule runs to 359,178 words. The rest of it is set out over 13 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, Office of the Secretary, “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program,” 91 FR 29526 (May 20, 2026). Effective July 20, 2026.
    https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and

  2. This page

    “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2026-10050/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 13 pages rather than one.

Two things the Register prints are not reproduced: the running head it repeats at every page break, and the tables it sets as pictures rather than as words. Its own marker for one of those tables, [GRAPHIC] [TIFF OMITTED], is left standing where the table was, so a reader can see that something is there and follow the link to the page it is on.

A heading with nothing quoted under it is one the rule prints on its own, with the words that follow it set under the headings beneath.