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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
for an exemption, or make an individual shared responsibility payment. Under the Tax Cuts and Jobs Act Pub. L. 115
97, December 22, 2017 the individual shared responsibility payment has been reduced to $0, effective for months beginning after December 31, 2018.
Notwithstanding that reduction, certain exemptions are still relevant to determine whether individuals age 30
and above qualify to enroll in catastrophic coverage under 45 CFR
155.305h or 156.155.

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1. Program Integrity In the June 19, 2013 Federal Register 78 FR 37031, we published a proposed rule that proposed certain program integrity standards related to Exchanges and the premium stabilization programs proposed Program Integrity Rule. The provisions of that proposed rule were finalized in two rules, the first Program Integrity Rule published in the August 30, 2013 Federal Register 78 FR 54069
and the second Program Integrity Rule published in the October 30, 2013
Federal Register 78 FR 65045. In the December 27, 2019 Federal Register 84
FR 71674, we published a final rule that revised standards relating to oversight of Exchanges established by states and periodic data matching frequency. It also added new requirements for certain issuers related to the separate billing and collection of the separate payment for the premium portion attributable to coverage for certain abortion services. In the May 8, 2020 Federal Register 85 FR 27550, we published the Medicare and Medicaid Programs, Basic Health Programs and Exchanges interim final rule with public comment May 2020 IFC and postponed the implementation deadline for those separate billing and collection requirements by 60 days.
2. Market Rules An interim final rule relating to the HIPAA health insurance reforms was published in the April 8, 1997 Federal Register 62 FR 16894. A proposed rule relating to ACA health insurance market reforms that became effective in 2014
was published in the November 26, 2012 Federal Register 77 FR 70584. A
final rule implementing those provisions was published in the February 27, 2013 Federal Register 78
FR 13406 2014 Market Rules.
A proposed rule relating to Exchanges and Insurance Market Standards for 2015 and beyond was published in the March 21, 2014 Federal Register 79 FR
15808 2015 Market Standards Proposed Rule. A final rule implementing the Exchange and Insurance Market Standards for 2015

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and Beyond was published in the May 27, 2014 Federal Register 79 FR 30240
2015 Market Standards Rule. The 2018
Payment Notice final rule in the December 22, 2016 Federal Register 81
FR 94058 provided additional guidance on guaranteed availability and guaranteed renewability. In the Market Stabilization final rule that was published in the April 18, 2017 Federal Register 82 FR 18346, we released further guidance related to guaranteed availability. In the 2019 Payment Notice final rule in the April 17, 2018 Federal Register 83 FR 17058, we clarified that certain exceptions to the special enrollment periods only apply with respect to coverage offered outside of the Exchange in the individual market.
In part 2 of the 2022 Payment Notice final rule in the May 5, 2021 Federal Register 86 FR 24140, we made additional amendments to the guaranteed availability regulation regarding special enrollment periods and finalized new special enrollment periods related to untimely notice of triggering events, cessation of employer contributions or government subsidies to COBRA continuation coverage, and loss of APTC eligibility.
3. Exchanges We published a request for comment relating to Exchanges in the August 3, 2010 Federal Register 75 FR 45584.
We issued initial guidance to states on Exchanges on November 18, 2010. In the July 15, 2011 Federal Register 76 FR
41865, we published a proposed rule with proposals to implement components of the Exchanges, and a rule in the August 17, 2011 Federal Register 76 FR 51201 regarding Exchange functions in the individual market and Small Business Health Options Program SHOP, eligibility determinations, and Exchange standards for employers. A final rule implementing components of the Exchanges and setting forth standards for eligibility for Exchanges, including minimum network adequacy requirements, was published in the March 27, 2012 Federal Register 77 FR
18309 Exchange Establishment Rule.
In the 2014 Payment Notice and in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the March 11, 2013 Federal Register 78 FR
15541, we set forth standards related to Exchange user fees. We established an adjustment to the FFE user fee in the Coverage of Certain Preventive Services under the Affordable Care Act final rule, published in the July 2, 2013 Federal Register 78 FR 39869 Preventive Services Rule. In the 2016 Payment
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Notice in the February 27, 2015 Federal Register 80 FR 10750, we finalized changes related to network adequacy and provider directories.
In the 2017 Payment Notice in the March 8, 2016 Federal Register 81 FR
12204, we finalized six standardized plan options to simplify the plan selection process for consumers on the Exchanges. In the 2017 Payment Notice, we also finalized policies relating to network adequacy for QHPs on the FFEs. In the May 11, 2016 Federal Register 81 FR 29146, we published an interim final rule with amendments to the parameters of certain special enrollment periods 2016 Interim Final Rule. We finalized these in the 2018
Payment Notice final rule, published in the December 22, 2016 Federal Register 81 FR 94058. The 2018 Payment Notice also modified the standardized options finalized in the 2017 Payment Notice and included three new sets of standardized options. In the March 8, 2016 Federal Register 81 FR 12203, the final 2017 Payment Notice codified State-based Exchanges on the Federal platform SBEFPs along with relevant requirements.
In the April 18, 2017 Market Stabilization final rule Federal Register 82 FR 18346, we amended standards relating to special enrollment periods and QHP certification. In the 2019
Payment Notice final rule, published in the April 17, 2018 Federal Register 83
FR 16930, we modified parameters around certain special enrollment periods and discontinued the designation of standardized options. In the April 25, 2019 Federal Register 84
FR 17454, the final 2020 Payment Notice established a new special enrollment period. In the May 14, 2020
Federal Register 85 FR 29204, the 2021 Payment Notice final rule made certain changes to plan category limitations and special enrollment period coverage effective date rules, allowed individuals provided a noncalendar year qualified small employer health reimbursement arrangement QSEHRA to qualify for an existing special enrollment period, and discussed plans for future rulemaking for employer-sponsored coverage verification and non-enforcement discretion for Exchanges that do not conduct random sampling until plan year 2021.
In part 1 of the 2022 Payment Notice final rule, published in the January 19, 2021 Federal Register 85 FR 6138, we finalized a new Exchange Direct Enrollment DE option. In part 2 of the 2022 Payment Notice final rule in the May 5, 2021 Federal Register 86 FR
24140 we finalized new special
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