Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

HHS has issued its final Notice of Benefit and Payment Parameters for 2027, establishing updated rules for ACA marketplace plans that could affect PT patients' insurance coverage and access to care. Key provisions include revised provider access and essential community provider standards for qualified health plan certification, changes to cost-sharing structures for certain plan types, and a prohibition on including routine non-pediatric dental services as Essential Health Benefits. Physical therapists should note that provider network adequacy standards and cost-sharing rules directly influence patient out-of-pocket costs and access to outpatient rehabilitation services.

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