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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
iv The analyses, actuarial certifications, data, assumptions, targets, and other information set forth in paragraph f4 of this section sufficient to provide the Secretary and the Secretary of Health and Human Services, as applicable, with the necessary data to determine that the States proposed waiver satisfies the general requirements for approval under section 1332b1 of the Affordable Care Act consistent with the provisions of this paragraph f3iv:
A As required under section 1332b1A of the Affordable Care Act the comprehensive coverage requirement, will provide coverage that is at least as comprehensive as the coverage defined in section 1302b of the Affordable Care Act and offered through Exchanges established under the Affordable Care Act as certified by the Office of the Actuary of the Centers for Medicare & Medicaid Services based on sufficient data from the State and from comparable States about their experience with programs created by the Affordable Care Act and the provisions of the Affordable Care Act that the State seeks to waive. To satisfy the comprehensive coverage requirement, the Secretary and the Secretary of Health and Human Services, as applicable, must determine that the coverage under the State plan is forecasted to be at least as comprehensive overall for residents of the state as coverage absent the waiver;
B As required under section 1332b1B of the Affordable Care Act the affordability requirement, will provide coverage and cost sharing protections against excessive out-ofpocket spending that are at least as affordable as the provisions of Title I of the Affordable Care Act would provide.
To satisfy the affordability requirement, the Secretary and the Secretary of Health and Human Services, as applicable, must determine that the coverage under the State plan is forecasted to be as affordable overall for state residents as coverage absent the waiver;
C As required under section 1332b1C of the Affordable Care Act the scope of coverage requirement, will provide coverage to at least a comparable number of its residents as the provisions of Title I of the Affordable Care Act would provide. To satisfy the scope of coverage requirement, the Secretary and the Secretary of the Health and Human Services, as applicable, must determine that the State plan will provide coverage to a comparable number of state
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residents under the waiver as would have coverage absent the waiver; and

3. Amend 33.118 by a. Revising the section heading;
b. Revising paragraph a;
c. Revising paragraph b3;
d. Adding paragraph b5;
e. Adding paragraph g.
The revisions and additions read as follows:
33.118 Modification from the normal public notice requirements during an emergent situation.

a The Secretary and the Secretary of Health and Human Services may modify, in part, the State public notice requirements under 33.112a1, b, c, and d and the Federal public notice procedures under 33.116b to expedite a decision on a proposed section 1332 waiver request during an emergent situation, when a delay would undermine or compromise the purpose of the proposed waiver request and be contrary to the interests of consumers.
These flexibilities are limited to emergent situations, including natural disasters; public health emergencies; or other emergent situations that threaten consumers access to health insurance coverage, consumers access to health care, or human life.
b
3 The State must, as applicable, detail in its request for a modification from State-level notice procedures under paragraph a of this section the justification for the request as it relates to the emergent situation and the alternative public notice procedures it proposes to implement at the State level, including public hearings, that are designed to provide the greatest opportunity and level of meaningful public input from impacted stakeholders that is practicable given the emergency circumstances underlying the States request for a modification.

5 The State must explain in its request for a modification from Statelevel notice procedures under paragraph a of this section how the emergent circumstances underlying its request results from a natural disaster; public health emergency; or other emergent situations that threaten consumers access to health insurance coverage, consumers access to health care, or human life could not reasonably have been foreseen and how a delay would undermine or compromise the purpose of the waiver and be contrary to the interests of consumers.

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g The Departments will consider circumstances to be emergent when they could not have been reasonably foreseen. The Departments will assess reasonable foreseeability based on the specific issues that a section 1332
waiver proposes to address and other relevant factors, and will not make this assessment based solely on the number of days a State may have been aware of such issues.
4. Amend 33.120 by a. Revising paragraph a;
b. Revising paragraph c2i; and c. Adding paragraphs c2iiF and c2iii.
The revisions and additions read as follows:
33.120

Monitoring and compliance.

a General. 1 Following the issuance of a final decision to approve a section 1332 waiver by the Secretary and the Secretary of Health and Human Services, as applicable, a State must comply with all applicable Federal laws and regulations, unless expressly waived. A State must, within the timeframes specified in law and regulation come into compliance with any changes in Federal law and regulation affecting section 1332
waivers, unless the provision being changed is expressly waived.
2 The Secretary and the Secretary of Health and Human Services will examine compliance with Federal and regulatory requirements consistent with 155.1308f3iv when conducting implementation reviews under paragraph b of this section.

c
2 i The Secretary and the Secretary of Health and Human Services may modify, in part, State post award requirements under this paragraph c2
for an approved section 1332 waiver request during an emergent situation, when the application of the post award public notice requirements would be contrary to the interests of consumers.
These flexibilities are limited to emergent situations, including natural disasters; public health emergencies; or other emergent situations that threaten consumers access to health insurance coverage, consumers access to health care, or human life.
ii
F The State must explain in its request for modification under this paragraph c2 how the emergent circumstances underlying its request results from a natural disaster; public health emergency; or other emergent situations that threaten consumers access to health insurance coverage, consumers access to health care, or
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