Regulatory Updates
Regulatory Updates provide quick access to employee benefit regulations, rulings and other guidance released by governmental agencies in the U.S. and Canada.
New updates to this page may be included in Today’s Headlines which is emailed to International Foundation members each business day. Inquiries regarding these updates should be directed to the Benefits Knowledge Center at the International Foundation at (888) 334-3327, option 5 or [email protected].
Search Regulatory Updates
ACA Implementation FAQs Part 71 Addresses the No Surprises Act and Cost Sharing Under ACA
Jul 31, 2025, 05:00
by
Amanda Wilke
The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) released Consolidated Appropriations Act, 2021 and Affordable Care Act (ACA) Implementation Frequently Asked Questions (FAQs) Part 71 on calculating Qualifying Payment Amounts (QPAs) under the No Surprises Act and limitations on cost sharing under ACA.
FAQs address implementation of the No Surprises Act as a result of the Fifth Circuit Court of Appeals' decision in Texas Medical Association et al. v. U.S. Department of Health and Human Services et al. (TMA III) to grant a rehearing en banc and vacate the Fifth Circuit's October 30, 2024, panel opinion. As a result, the district court's decision from August 24, 2023, continues to bind the Departments pending the Fifth Circuit's en banc decision.
Until the Fifth Circuit issues its en banc decision, plans and issuers must calculate QPAs using a good faith, reasonable interpretation of the 2023 methodology.
FAQs specifically discuss how plans and issuers should:
- Calculate a QPA for purposes of patient cost sharing, disclosures with an initial payment or notice of denial of payment, and disclosures and submissions required under the Federal IDR process following the Fifth Circuit’s order of May 30, 2025 in TMA III.
- Make disclosures about the QPA to nonparticipating providers, facilities, and providers of air ambulance services with an initial payment or notice of denial of payment, and in a timely manner upon request of the provider or facility.
In the ACA Marketplace Integrity and Affordability final rule, HHS finalized revisions to the premium adjustment percentage methodology as well as new values for, among other things, the premium adjustment percentage and maximum annual limitation on cost sharing for the 2026 plan year.
FAQs state:
- The premium adjustment percentage for the 2026 plan year will be 1.6726771319.
- The maximum annual limitation on cost sharing for the 2026 plan year will be $10,600 for self-only coverage, and $21,200 for other than self-only coverage.