Regulatory updates for Q3 2026
These are the health care regulations, announcements and changes to keep on your radar for Q3 2026.
Staying on top of the legislative changes in an industry as complex and highly regulated as health care can be challenging. That’s why UnitedHealthcare is committed to easing that burden and keeping you updated on the legislative changes as they arise.
Here are some key regulatory deadlines for Q3, along with recent notices to be aware of.
Patient-Centered Outcomes Research Institute fee due to Internal Revenue Service by July 31
The Patient-Centered Outcomes Research Institute (PCORI) fee funds research comparing health outcomes, clinical effectiveness, and the risks and benefits of medical treatments. The fee applies to all covered lives — including employees, retirees, spouses and dependents — and is due to the Internal Revenue Service (IRS) by July 31 each year through 2030.
The IRS maintains a dedicated PCORI webpage for additional information.
Fee amounts: Most plans will use both amounts when calculating the total fee
- $3.84 per covered life for plan years beginning on or after Oct. 1, 2025, and ending before Oct. 1, 2026
- $3.47 per covered life for plan years beginning on or after Oct. 1, 2024, and ending before Oct. 1, 2025
Responsibilities by plan type:
- Fully insured groups: UnitedHealthcare files Form 720 and pays the fee. However, if a fully insured group also has a self-funded health reimbursement account (HRA) or flexible spending account (FSA), the employer is responsible for paying the fee on those accounts.
- Self-funded and level-funded groups: The employer is responsible for filing and paying the fee.
Due date: July 31
UnitedHealthcare also recently shared this information with clients, brokers and consultants, which can be referenced here.
Medical Loss Ratio rebate notification for fully insured employers
The ACA requires health insurers to spend a minimum percentage of premium dollars on medical care: 80% for small groups and 85% for large groups. When these thresholds are not met within a given aggregation set (by state, employer size and legal entity), insurers are required to issue a rebate or Medical Loss Ratio (MLR) to the customer. Note that some states may set higher MLR requirements.
How MLR is calculated: MLR is measured using the average total number of employees (ATNE), which includes full-time, part-time and seasonal workers. The goal is to ensure that premium dollars are directed toward care rather than administrative costs, overhead or profits.
Timing:
- Eligible fully insured employers will receive an MLR announcement letter along with a rebate check by Sept. 30, 2026
- Members whose employer receives a rebate will be notified 3–4 days after the employer's rebate is mailed
Gag clause confirmation of compliance
UnitedHealthcare is compliant with the Consolidated Appropriations Act (CAA) Gag Clause, which prohibits health plan sponsors and issuers from entering into agreements with providers, networks, third-party administrators or other service providers that restrict the disclosure of quality and cost of care information.
Annual compliance review: In early September, UnitedHealthcare will send self-funded employers a Confirmation of Compliance verify that the annual GCPCA review has been completed.
- Self-funded employers may use this confirmation to support their own attestation for any UnitedHealthcare-administered medical, behavioral and pharmacy business.
- For fully insured and level-funded groups, UnitedHealthcare submits the attestation on the employer's behalf.
Timing:
- Confirmation letters will be sent in early September
- Attestations due by Dec. 31, 2026
Prescription Drug Data Collection submission confirmation
UnitedHealthcare, including UMR, successfully submitted Prescription Drug Data Collection (RxDC) data to CMS on June 1, 2026, meeting the required deadline.
- Confirmation number for this submission: 46572
- Next RxDC submission deadline: June 1, 2027, for 2026 reference year
Independent Dispute Resolution final rule
The Departments of Health and Human Services, Labor and Treasury, along with the Office of Personnel Management, have finalized updates to the Federal Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA). The rule modernizes how plans, issuers, providers, facilities and certified IDR entities exchange information and resolve payment disputes for level-funded and self-funded groups.
Key areas addressed:
- Payer-provider communications
- Open negotiation and batching
- Eligibility review and portal functionality
- Administrative fees
Timing:
- June 2026: Administration fee reduced from $115 to $15 for new IDR requests
- August 2026: Additional operational changes take effect
- 2027: More complex provisions become effective
Nondiscrimination federal court decision
A federal court (Tennessee v. Kennedy, Oct. 22, 2025) vacated provisions of the 2024 "Nondiscrimination in Health Programs and Activities" final rule under Section 1557 of the Affordable Care Act.
What was vacated: The court invalidated provisions that expanded the definition of "sex discrimination" to include gender identity under Title IX. These provisions are legally void and unenforceable nationwide. Covered entities are no longer required to comply with the vacated gender identity-related provisions unless further legal or regulatory action occurs. All other nondiscrimination obligations remain in effect.
Notice of Nondiscrimination (NND): The language of UnitedHealthcare's NND has been updated to reflect the following: UnitedHealthcare complies with applicable civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with 45 CFR § 92.101(a)(2)). We do not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.
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