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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules enrollees with household incomes above 400 percent of the FPL.
Exchange regulations at 155.420d6 provide several special enrollment periods for enrollees and dependents based on a determination that they are newly eligible or newly ineligible for APTC. These special enrollment periods vary in terms of the details of their qualifying events, but all of them are dedicated to ensuring that current Exchange enrollees and other qualified individuals who become newly eligible or ineligible for APTC
have an opportunity to re-assess previous decisions about their QHP
enrollment, or their decision not to enroll in a QHP, based on gaining or losing eligibility for financial assistance available to them to help lower premiums. Ensuring that Exchanges consistently apply eligibility factors for these special enrollment periods is important under a variety of circumstances. For example, regulations at 155.420d6i and ii provide current Exchange enrollees with an opportunity to change to a different QHP if they are determined newly eligible or newly ineligible for APTC for themselves or their dependents or have a change in eligibility for CSRs, because such a change may impact the coverage they prefer or the type of coverage they can afford.
Section 155.420d6iv allows individuals to enroll in Exchange coverage if they either experience a change in household income or move to a different state, and as a result become newly eligible for APTC, after they were previously ineligible for APTC solely because of a household income below 100 percent of the FPL and, during the same timeframe, were ineligible for Medicaid because they lived in a nonMedicaid expansion state. Like the other qualifying events at 155.420d6, this special enrollment period benefits individuals because it allows them to take advantage of APTC for which they were previously ineligible, and we do not believe that it would benefit individuals who newly qualify for APTC but who are not entitled to an APTC amount greater than zero dollars.
We also believe that, regarding the group of potentially eligible individuals, increases from a household income of less than 100 percent of the FPL to a household income high enough to qualify for an APTC amount of zero dollars are relatively uncommon.
Finally, 155.420d6v provides a pathway for individuals who had MEC
for at least one of the past 60 days to enroll in Exchange coverage if they experience a decrease in household income and the Exchange newly
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determines them eligible for APTC. This special enrollment period was established in the 2020 Payment Notice, specifically to permit individuals enrolled in coverage outside of the Exchange to enroll in Exchange coverage based on newly being able to access APTC.68 Because this special enrollment period benefits qualified individuals by allowing them to obtain coverage that permits them to qualify for APTC, we do not believe that individuals who newly qualify for an APTC amount of zero dollars generally benefit from this special enrollment period, and they may even be harmed by changing plans mid-year because this would generally cause their deductible and other accumulators to be re-set.
We seek comment on this proposal, including from State Exchanges, regarding whether this definition of APTC eligibility reflects their current implementation of the special enrollment period qualifying events per 155.420d6, and if not, whether there are policy concerns about this clarification, or the burden of making related changes to Exchange operations.
We also seek comment on whether we should provide Exchanges with flexibility in terms of when they are required to ensure that their operations reflect this definition, and whether Exchanges should be permitted to adopt a more inclusive definition, for example, to consider an individual to be newly eligible or ineligible for APTC for purposes of the special enrollment periods at 155.420d6 based on a change from a zero-dollar maximum APTC amount to APTC ineligibility for another reason per regulations at 155.305f.
Additionally, we seek comment on whether the clarification that a qualified individual, enrollee, or his or her dependent is considered APTC
ineligible if they meet the requirements at 155.305f, but qualify for a maximum APTC amount of zero dollars, should be applied as proposed to all of the special enrollment period qualifying events at 155.420d6, or whether it should be limited to only apply to some of them. For example, we seek comment on whether we should only apply this clarification to the special enrollment periods at 155.420d6i and ii and iv and v, to permit individuals whose employer-sponsored coverage is no longer considered affordable or no longer meets the minimum value standard to qualify for a special enrollment period to enroll in Exchange coverage through 155.420d6iii regardless of whether they qualify for an 68 84

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APTC amount of greater than zero dollars.
C. Part 156Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges 1. User Fee Rates for the 2022 Benefit Year 156.50
In the December 4, 2020 Federal Register, we published the proposed 2022 Payment Notice that proposed to reduce fiscal and regulatory burdens across different program areas and to provide stakeholders with greater flexibility. In the January 19, 2021
Federal Register 86 FR 6138, we published part 1 of the 2022 Payment Notice final rule that addressed a subset of the policies proposed in the proposed rule. That final rule, among other things, finalized the user fee rates for issuers offering QHPs through the FFE at 2.25
percent of total monthly premiums, and the user fee rate for issuers offering QHPs through SBEFPs at 1.75 percent of total monthly premiums.
On January 28, 2021, President Biden issued E.O. 14009, Strengthening Medicaid and the Affordable Care Act, 69 directing HHS, and the heads of all other executive departments and agencies with authorities and responsibilities related to the ACA, to review all existing regulations, orders, guidance documents, policies, and any other similar agency actions to determine whether such agency actions are inconsistent with this Administrations policy to protect and strengthen the ACA and to make highquality health care accessible and affordable for every American. As part of this review, HHS examined policies and requirements under the proposed 2022 Payment Notice and part 1 of the 2022 Payment Notice final rule to analyze whether the policies under these rulemakings might undermine the Health Benefits Exchanges or the health insurance markets, and whether they may present unnecessary barriers to individuals and families attempting to access health coverage. HHS also considered whether to suspend, revise, or rescind any such actions through appropriate administrative action.
In compliance with E.O. 14009 and as a result of HHSs review of the proposed 2022 Payment Notice and part 1 of the 2022 Payment Notice final rule, we have reanalyzed the additional costs of expanded services, such as consumer outreach and education in the FFE and SBEFPs, and Navigators in the FFE in 2022. As explained in part 2 of the 2022
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