Quiero saber acerca de...

khammond on DSKJM1Z7X2PROD with PROPOSALS2

Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules captured in the current section 1332
implementing regulations as finalized in part 1 of the 2022 Payment Notice final rule.
The Departments are of the view that rescinding the 2018 Guidance, repealing the previous codification of its guardrail interpretations in part 1 of the 2022
Payment Notice final rule, and proposing new policies and interpretations aligns with the Administrations goals to strengthen the ACA and increase enrollment in comprehensive, affordable health coverage among the remaining underinsured and uninsured. These proposals would further advance this Administrations goal to increase access to coverage in that it would empower states to develop innovative health coverage options, through section 1332
waivers, that best fit the states individual needs and provide coverage to their residents. The proposals are also intended to provide more information and clarity regarding the interpretations, processes and procedures the Departments would apply when reviewing new waiver applications and waiver amendment and extension requests, as well as making pass-through funding determinations for approved waivers. All of these proposals are designed to align with the Administrations commitment to protect and expand Americans access to highquality, comprehensive and affordable health care coverage and to ensure that systemic barriers to opportunities and benefits for people of color and other underserved groups are not perpetuated.
In addition, these proposals would further support the Administrations efforts to build on the ACA to meet the health care needs created by the COVID19 PHE, reduce individuals health care costs, and make our health care system less complex to navigate.
Through section 1332 waivers, the Departments aim to assist states with developing health insurance markets that expand coverage, lower costs, and make high-quality health care accessible for every American.101 In light of E.O.
13985, the Departments also encourage states to develop waiver proposals that diminish barriers to opportunities and benefits such as health insurance coverage for people of color and other underserved groups. For example, states may include waiver programs that increase plan options for comprehensive coverage, reduce premiums, improve 101 https www.whitehouse.gov/briefing-room/
statements-releases/2021/02/15/statement-bypresident-joe-biden-on-the-2021-special-healthinsurance-enrollment-period-through-healthcaregov/.

VerDate Sep<11>2014

19:24 Jun 30, 2021

Jkt 253001

affordability, as well as address social determinants of health.
As under similar waiver authorities,102 the Secretaries reserve the right to further evaluate an approved waiver and suspend or terminate an approved waiver, in whole or in part, any time before the date of expiration, if the Secretaries determine that the state materially has failed to comply with the terms and conditions of the waiver or the section 1332 guardrails,103
laws and regulations, unless specifically waived.104 And they must come into compliance with any changes in federal law or regulations affecting section 1332
waivers, unless the provision being changed is expressly waived.105
1. Coordinated Waiver Process 31 CFR
33.102 and 45 CFR 155.1302
Regulations at 31 CFR 33.102 and 45
CFR 155.1302 permit, but do not require, states to submit a single application for a section 1332 waiver and a waiver under one or more of the existing waiver processes applicable under titles XVIII, XIX, and XXI of the Social Security Act the Act, or under any other federal law relating to the provision of health care items or services, provided that the application is consistent with the procedures outlined in the 2012 Final Rule,106 the procedures for demonstrations under section 1115 of the Act, if applicable, and the procedures under any other applicable federal law or regulations under which the state seeks a waiver.
Similar to the policies outlined in the 2018 Guidance, as well as in guidance previously published in December 2015
2015 Guidance, the Departments determination of whether a section 1332
waiver proposal satisfies the statutory guardrails set forth in section 1332 takes into consideration the projected impact of waivers of certain ACA provisions made pursuant to the section 1332
waiver. The Departments also consider related changes to the states health care system that, under state law, are contingent only on the approval of the section 1332 waiver. For example, the Departments, in making their determination, would take into account the impact of a new, related state-run health benefits program that, under 102 Section 1115 Waiver Demonstrations have similar authority.
103 See 31 CFR 33.120d and 45 CFR 155.1320d and STC 16 at https www.cms.gov/CCIIO/
Programs-and-Initiatives/State-Innovation-Waivers/
Downloads/1332-NH-Approval-STCs.pdf.
104 See 31 CFR 33.120a1 and 45 CFR
155.1320a1.
105 Ibid.
106 See 77 FR 11700, https www.govinfo.gov/
content/pkg/FR-2012-02-27/pdf/2012-4395.pdf.

PO 00000

Frm 00027

Fmt 4701

Sfmt 4702

35181

legislation enacted by the state, would be implemented only if the section 1332
waiver were approved.
The Departments are not proposing any regulatory changes to 31 CFR 33.102
and 45 CFR 155.1302, but are reiterating through this preamble the proposed policy relating to the coordinated waiver process so states understand the process for submission and review of a coordinated waiver. The Departments are of the view that the policies outlined in this proposed rule, which are in line with both the 2018 and 2015 Guidance, further advance E.O. 14009 because these policies aim to protect and strengthen Medicaid and the ACA and to make high-quality health care accessible and affordable for every American by specifying how a state may submit a coordinated waiver.
Specifically, under this proposal the Departments would not consider the potential impact of policy changes that are contingent on further state action, such as state legislation that is proposed but not yet enacted that would be in effect during the timeframe for the section 1332 waiver. For example, the Departments would not consider the potential impact of state legislation to expand Medicaid that is not yet enacted.
The Departments would also not consider the impact of changes contingent on other federal determinations, including approval of federal waivers such as waivers under titles XVIII, XIX, or XXI of the Act pursuant to statutory provisions other than section 1332 of the ACA.
Therefore, under this proposal, the Departments would not take into account proposed changes to Medicaid or CHIP state plans that require separate federal approval, such as changes in coverage or federal Medicaid or CHIP
spending that would result from a proposed section 1115 demonstration, regardless of whether the section 1115
demonstration proposal is submitted as part of a coordinated waiver application with a section 1332 waiver. Savings accrued under either proposed or current Medicaid or CHIP section 1115
demonstrations would not be factored into the assessment of whether a proposed section 1332 waiver meets the deficit neutrality requirement. The Departments determination also would not take into account any proposed changes to the Medicaid or CHIP state plan that are subject to federal approval.
Under this proposal, the Departments would, however, take into account changes in Medicaid or CHIP coverage or in federal spending on Medicaid or CHIP that would result directly from the proposed waiver of ACA provisions pursuant to section 1332, holding state
E:FRFM01JYP2.SGM

01JYP2