CMS finalizes 2027 ACA exchange rule, expands catastrophic plan access and strengthens state fraud oversight

CMS published the final 2027 Notice of Benefit and Payment Parameters for the Affordable Care Act exchanges. The rule expands access to catastrophic health plans for all consumers, not just those under 30, which could increase patient volume with high-deductible plans. It also grants states enhanced authority to combat fraud and abuse in the individual market, likely leading to more aggressive referral patterns and stricter network adequacy reviews. For practices with a significant exchange-plan patient mix, expect shifts in patient financial responsibility and more scrutiny of referral patterns starting in the 2027 plan year.