CMS Publishes Patient Protection and Affordable Care Act Marketplace Affordability Final Rule
CMS published a Final Rule to revise the standard for Health Insurance Marketplaces, to finalize additional safeguards to protect consumers from improper enrollment, and to establish standards pertaining to the integrity of the Affordable Care Act (ACA) Exchanges. The Final Rule, among other things, revises the standards related to the denial of coverage for failure to pay past-due premiums; excludes Deferred Action for Childhood Arrival (“DACA”) recipients from the definition of “lawfully present”; revises the standards related to the annual open enrollment and special enrollment periods; and revises standards relating to failure to file and reconcile income eligibility verification for premium tax credits and cost-sharing reductions, annual eligibility determinations, and income-based cost sharing reduction plan variations. The Final Rule includes temporary measures set to sunset at the end of 2026.
HHS-OIG Publishes Semiannual Report to Congress
HHS-OIG published its Semiannual Report to Congress summarizing its activities between October 1, 2025 to March 31, 2025. According to the report, HHS-OIG’s total monetary impact during the reporting period was $16.61 billion. $3.51 billion derived from investigations, $451 million derived from audits, and $12.65 billion attributed to potential cost saving initiatives. HHS‑OIG executed 395 civil actions and 349 criminal actions. It identified and excluded 1,503 bad actors from participating in federally funded healthcare programs. It published 78 reports, including audit reports, evaluation reports, and reports of finding in response to Office of Special Counsel whistleblower disclosures.
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