# Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability
> **US Department of Health and Human Services** · Final rule. · Published 2025-06-25 · Effective 2025-08-25 · 90 FR 27074
## Document
- **Document number:** 2025-11606
- **Category:** other
- **Sub-agency:** US Department of Health and Human Services
- **Federal Register citation:** 90 FR 27074
- **CFR reference:** 45 CFR 147
- **Publication date:** 2025-06-25
- **Effective date:** 2025-08-25
- **HHS docket:** CMS-9884-F
## Abstract

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.

## Source
- [Federal Register document](https://www.federalregister.gov/documents/2025/06/25/2025-11606/patient-protection-and-affordable-care-act-marketplace-integrity-and-affordability)
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