CMS 2027 Notice of Benefit and Payment Parameters Proposal
On February 9, 2026, the Centers for Medicare & Medicaid Services (CMS) released the 2027 Notice of Benefit and Payment Parameters, impacting the implementation of the Patient Protection and Affordable Care Act (ACA) for the 2027 plan year. The proposal focuses on enhancing program integrity and consumer protection from enrollment fraud.
Stricter Marketing and Consumer Protection Practices
The rule enforces stricter marketing practices for insurers and brokers, prohibiting misleading tactics such as offering incentives or misrepresenting costs. Agents and brokers are required to use a standardized form from the Department of Health and Human Services (HHS) to ensure consistent consumer consent and eligibility verification.
Empowering State Exchanges and Provider Standards
The proposal grants states using Federally-facilitated Exchanges (FFE) autonomy to conduct their reviews for provider access and essential community provider (ECP) standards, provided they meet specified conditions. CMS will continue collecting provider and ECP data to ensure consumer access, offering technical assistance and intervention when state programs are insufficient.
Modifications to Network Adequacy Regulations
The proposed rule modifies network adequacy regulations for State-based Exchanges (SBEs) and State-based Exchanges on the Federal Platform (SBE-FPs) by eliminating strict time and distance requirements. Instead, non-network plans may qualify for Qualified Health Plan (QHP) certification by demonstrating comprehensive provider options, aiding consumers in leveraging price transparency.
Streamlining State Transitions and New Enrollment Models
CMS intends to streamline state transitions from FFE to SBE by removing interim requirements and introducing an optional Enhanced Direct Enrollment model for SBEs, allowing private web-brokers to manage eligibility and enrollment functions. Routine adult dental services are excluded from Essential Health Benefits, while states are mandated to cover costs for benefits required post-December 31, 2011.
Risk Adjustment, Penalties, and Public Feedback
Issuers will face increased scrutiny and potential penalties with enhanced CMS audit powers and a new administrative review process. The proposal invites feedback on numerous issues, including updates to risk adjustment models and aligning with the Working Families Tax Cut affecting premium assistance eligibility. Comments on the 2027 Proposed Rule are accepted until March 13, 2026.