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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
proposed rule, the Departments propose that, consistent with the 2018 Guidance, these actuarial analyses and certifications should be conducted by a member of the American Academy of Actuaries.
The Departments analysis of whether a proposed section 1332 waiver meets the requirements under section 1332
would be based on state-specific estimates of the current level and distribution of population by the relevant economic and demographic characteristics, consistent with the 2015
and 2018 Guidance, including income and source of health coverage. It would generally use federal estimates of population growth, and economic growth as published in the Analytical Perspectives volume released as part of the Presidents Budget https
www.whitehouse.gov/omb/budget/
Analytical_Perspectives and health care cost growth https www.cms.gov/
Research-Statistics-Data-and-Systems/
Statistics-Trends-and-Reports/
NationalHealthExpendData/
index.html?redirect=/
NationalHealthExpendData/ to project the initial state variables through the 10year budget plan window. However, in limited circumstances where it is expected that a state will experience substantially different trends than the nation as a whole in the absence of a section 1332 waiver, the Secretaries may determine that state-specific assumptions will be used.
Consistent with the 2018 Guidance and largely similar to the 2015
Guidance, estimates of the effect of the section 1332 waiver would assume, in accordance with standard estimating conventions, that macroeconomic variables like population, output, and labor supply are not affected by the waiver. However, estimates would take into account, as appropriate, other changes in the behavior of individuals, employers, and other relevant entities induced by the section 1332 waiver where applicable, including employer decisions regarding what coverage and other compensation they offer and individual decisions regarding whether to take up coverage. The same statespecific and federal data, assumptions, and model are used to calculate comprehensiveness, affordability, and coverage, and relevant state components of federal taxes and spending under the section 1332 waiver and under current law.
The analysis and information submitted by the state as part of the section 1332 waiver application would conform to these standards as outlined in this proposed rule. Consistent with the 2015 and 2018 Guidance, the
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application would describe all modeling assumptions used, sources of statespecific data, and the rationale for any deviation from federal forecasts. A state may be required under 31 CFR
33.108f4vii and 45 CFR
155.1308f4vii to provide to the Secretaries copies of any data used for their section 1332 waiver analyses that are not publicly available so that the Secretaries can independently verify the analysis produced by the state.
In this proposed rule, the Departments propose that, consistent with the 2018 Guidance, for each of the guardrails, the state would clearly explain its estimates with and without the section 1332 waiver. The actuarial and economic analyses would be required to compare comprehensiveness, affordability, coverage, and deficit neutrality with and without the section 1332 waiver. The deficit neutrality analysis would specifically examine net federal spending and revenues under the section 1332 waiver to those measures absent the waiver the baseline for each year of the waiver. If the state is submitting a section 1332 waiver application for less than a 5-year period, the actuarial analysis could be submitted for the period of the waiver.
The Departments, in accordance with their regulations, could request additional information or data in order to conduct their assessments.
The state should also provide a description of the models used to produce these estimates, including data sources and quality of the data, key assumptions, and parameters for the section 1332 waiver. Consistent with the 2018 Guidance, the Departments are not proposing to prescribe any particular method of actuarial analysis to estimate the potential impact of a section 1332
waiver. However, the state should explain its modeling in sufficient detail to allow the Secretaries to evaluate the accuracy of the states modeling and the comprehensiveness and affordability of the coverage available under the states section 1332 waiver proposal. As permitted under 31 CFR 33.108g and 45 CFR 155.1308g, the state may be required to provide, upon request by the Secretaries, data or other information that it used to make its estimates, including an explanation of the assumptions used in the actuarial analysis.
The Departments seek comment on these proposals.

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b. Implementation Timeline and Operational Considerations 31 CFR
33.108f4iv and 45 CFR
155.1308f4iv As required under 31 CFR
33.108f4iv and 45 CFR
155.1308f4iv, states must include in their applications for initial approval of a section 1332 waiver a detailed draft timeline for the states implementation of the proposed waiver. In this proposed rule, the Departments are not proposing any regulatory changes to 31 CFR
33.108f4iv and 45 CFR
155.1308f4iv. Rather, the Departments are proposing the operational considerations in preamble that states should take into account when developing their waiver application, waiver plan, and implementation timeline. Specifically, the Departments are proposing these operational considerations to provide additional information regarding how HHS and the IRS may be able to support a state in implementing a section 1332
waiver plan so states can take this information into consideration as it relates to their implementation timeline.
These proposals would help to ensure that the Departments have the appropriate and necessary information to measure the impact of proposed waivers on the statutory guardrails, particularly related to coverage. This information is especially important in light of the goal of E.O. 14009 to provide more comprehensive affordable coverage to consumers. In addition, the Departments encourage states to include in their analysis whether the proposed section 1332 waiver would increase health equity in line with E.O. 13985.
Upon consideration, the approach proposed with regard to operational considerations is revised from the 2018
Guidance with regard to the use of the Exchange information technology platform the federal platform and IRS
operational considerations to maintain smooth operations of the Exchange consistent with E.O. 14009 and this Administrations goals to protect and strengthen Medicaid and the ACA and to make high-quality health care accessible and affordable for every American.
The Departments seek comment on these proposals.
i. Use of Federal Platform Technology HHS operates the Federal platform utilized by FFEs and by some State Exchanges for eligibility and enrollment functions. For technical, operational, and fiscal efficiency, the Federal platform is generally designed to support uniform administration across
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