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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules which qualified individuals and qualified employers can purchase comprehensive health insurance coverage through qualified health plans QHPs. Many individuals who enroll in QHPs through individual market Exchanges are eligible to receive a premium tax credit PTC to reduce their costs for health insurance premiums and to receive reductions in required cost-sharing payments to reduce out-of-pocket expenses for health care services. This notice proposes rules and policies designed to promote greater access to comprehensive health insurance coverage through the Exchanges, consistent with applicable law and with the administrations policy priorities detailed in recent Presidential executive orders.
On January 28, 2021, the President issued Executive Order 14009, Executive Order on Strengthening Medicaid and the Affordable Care Act E.O. 14009, which stated the Administrations policy to protect and strengthen the ACA and to make highquality health care accessible and affordable for every American.2 This Executive Order instructed the Secretary of Health and Human Services hereinafter referred to as the Secretary, along with the Secretaries of the Departments of Labor and the Treasury, to review all existing regulations, guidance documents, and other agency actions to determine whether they are consistent with the aforementioned policy, and to consider whether to suspend, revise, or rescind any agency actions that are inconsistent with it.
On January 20, 2021, President Biden issued Executive Order 13985, On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government E.O. 13985,3
directing that as a policy matter, the federal government should pursue a comprehensive approach to advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality. E.O. 13985 also directs HHS to assess whether, and to what extent, its programs and policies perpetuate systemic barriers to opportunities and benefits for people of color and other underserved groups.
and Affordable Care Act, was enacted on March 30, 2010. In this proposed rule, we refer to the two statutes collectively as the Affordable Care Act or ACA.
2 86 FR 7793 Feb. 2, 2021.
3 86 FR 7009 Jan. 25, 2021.

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Today, of the 30 million uninsured, half are people of color.4 Of those that have insurance, there are frequently barriers to using insurance because of affordability concerns related to premiums, deductibles, copayments, and coinsurance, as well as challenges related to health literacy and the ability for the insured to find and access innetwork providers. These barriers to using insurance are particularly problematic for those with chronic conditions and individuals with social risk factors such as poverty, minority race and/or ethnicity, social isolation, and limited community resources,5
which also includes members of underserved communities, people of color, and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality. The COVID19
public health emergency PHE has highlighted the negative effects of these circumstances as COVID19 has unequally affected many racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID19.6
As part of its review of regulations and policies under the Executive Orders described in the preceding paragraphs, HHS examined certain policies and requirements addressed in this proposed rule to analyze whether they are consistent with policy goals outlined in the Executive Orders, including whether they might create or perpetuate systemic barriers to obtaining health insurance coverage. The results of our examinations and analyses led to the policies and rules proposed in this rule.
In previous rulemakings, HHS
established provisions and parameters to implement many ACA requirements and programs. In this proposed rule, we propose to amend and repeal some of these provisions and parameters, with a focus on making high-quality health care accessible and affordable for consumers. These proposed changes would provide consumers greater access to coverage through, for example, greater education and outreach, improve 4 Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, JanuaryJune 2020, National Center for Health Statistics, February 2021, available at https www.cdc.gov/nchs/data/nhis/earlyrelease/
insur202102-508.pdf.
5 See Social Risk Factors and Medicares ValueBased Purchasing Programs, HHS Office of the Secretary of Planning and Evaluation, available at https aspe.hhs.gov/social-risk-factors-andmedicares-value-based-purchasing-programs.
6 See Centers for Disease Control and Prevention, Health Equity Considerations and Racial and Ethnic Minority Groups, updated April 19, 2021, available at https www.cdc.gov/coronavirus/2019ncov/community/health-equity/raceethnicity.htmlprint.

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affordability for consumers, reduce administrative burden for issuers and consumers, and improve program integrity. As discussed more fully later in the preamble, each of these measures would strengthen the ACA or otherwise promote the policy goals outlined in the Executive Orders described above.7
We propose to amend 147.104b2
to specify that issuers are not required to provide a special enrollment period in the individual market with respect to coverage offered outside of an Exchange to qualifying individuals who would be eligible for the proposed special enrollment period triggering event at 155.420d16 described below.
We also propose to amend 155.210e9 to reinstitute previous requirements that Navigators in FFEs be required to provide consumers with information and assistance on certain post-enrollment topics, such as the Exchange eligibility appeals process, the Exchange-related components of the PTC reconciliation process, and the basic concepts and rights of health coverage and how to use it.
We also propose to remove 155.221j and repeal the Exchange Direct Enrollment option which establishes a process for State Exchanges, State-based Exchanges on the Federal platform, and Federallyfacilitated Exchanges to work directly with private sector entities including QHP issuers, web-brokers, and agents and brokers to operate enrollment websites through which consumers can apply for coverage, receive an eligibility determination from the Exchange, and purchase an individual market QHP
offered through the Exchange with APTC and cost-sharing reductions CSRs, if otherwise eligible.
For the 2022 coverage year and beyond, we propose to amend 155.410e to lengthen the annual open enrollment period for coverage through all Exchanges to November 1 through January 15, as compared to the current annual open enrollment period of November 1 through December 15.
We propose to add a new paragraph at 155.420d16 to establish a monthly special enrollment period for qualified individuals or enrollees, or the dependents of a qualified individual or enrollee, who are eligible for APTC, and whose household income does not exceed 150 percent of the FPL, in order to provide low-income individuals who generally will have access to a 7 Although many of the policies proposed in this rule support the goals outlined in recent Executive Orders, as described later in the preamble discussions related to individual proposals, each of the proposals is supported by statutory authority independent of the Executive Orders.

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