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

What 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.

The Centers for Medicare & Medicaid Services's summary, as published in the Federal Register.

What changed in the regulation

4 parts of Title 42, 45 of the Code of Federal Regulations:

42 CFR 600, 45 CFR 150, 45 CFR 155, 45 CFR 156

Wording on eCFR: the day before it took effect and from the day it took effect (first part listed).

Compared with

The Centers for Medicare & Medicaid Services has published 24 final rules in 2026 so far, compared with 12 in all of 2025.

Counted by the Tribune from Federal Register records since Jan. 1, 2025.

Before this

2 earlier Federal Register documents under regulation identifier 0938-AV62 since Jan. 1, 2025.

• March 6, 2026 Proposed rule; correction. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
• Feb. 11, 2026 Proposed rule. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

Since then:

• July 21, 2026 Final rule; correction. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction

What happens next and when

These regulations are effective on July 20, 2026.

The agency's dates, word for word.

Check it yourself

• The document in the Federal Register
• Docket CMS-2026-0496 on Regulations.gov
• Title 42 on eCFR

The record as published

Source: the Federal Register (public domain). The document in the Federal Register