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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules human life and could not reasonably have been foreseen and how the application of the post-award public notice requirements would be contrary to the interests of consumers.
iii The Secretary and the Secretary of Health and Human Services will consider circumstances to be emergent when they could not have been reasonably foreseen. The Secretary and the Secretary of Health and Human Services 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.

5. Section 33.122 is added to read as follows:

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33.122 Pass-through Funding for Approved Waivers.

a Pass-through Funding. With respect to a States approved section 1332 waiver, under which, due to the structure of the approved State waiver plan, individuals and small employers in the State would not qualify for or would qualify for a reduced amount of premium tax credit under section 36B of the Internal Revenue Code, small business tax credit under section 45R of the Internal Revenue Code, or costsharing reductions under ACA part I of subtitle E for which they would otherwise be eligible, the Secretary and the Secretary of the Health and Human Services shall provide for an alternative means by which the aggregate amount of such credits or reductions that would have been paid on behalf of participants in the Exchanges had the State not received such waiver shall be paid to the State for purposes of implementing the approved State waiver plan. Such amount shall be determined annually by the Secretary and the Secretary of Health and Human Services, taking into consideration the experience of other States with respect to participation in an Exchange and credits and reductions provided under such provisions to residents of the other States. This amount can be updated to reflect applicable changes in Federal or State law.
b Reserved 6. Amend 33.128 by revising paragraph a to read as follows:
33.128

Periodic evaluation requirements.

a The Secretary and the Secretary of Health and Human Services, as applicable, shall periodically evaluate the implementation of a program under a section 1332 waiver consistent with
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33.108f3iv and any terms and conditions governing the section 1332
waiver.

7. Section 33.130 is added to read as follows:
33.130

Waiver Amendment.

a Amendment to an approved section 1332 waiver. A State may request an amendment to an approved section 1332 waiver from the Secretary and the Secretary of Health and Human Services. A section 1332 waiver amendment is considered a change to an approved section 1332 waiver plan that is not otherwise allowable under the terms and conditions of an approved waiver, a change that could impact any of the section 1332 statutory guardrails or a change to the program design for an approved waiver. A state is not authorized to implement any aspect of the proposed amendment without prior approval by the Secretary and the Secretary of Health and Human Services.
b Reserved 8. Section 33.132 is added to read as follows:
33.132

a Extension. A State may request continuation of an approved section 1332 waiver, and such request shall be deemed granted unless the Secretary and the Secretary of Health and Human Services, within 90 days after the date of submission of a complete waiver extension request to the Secretary and the Secretary of Health and Human Services, either denies such request in writing or informs the State in writing with respect to any additional information that is needed in order to make a final determination with respect to the request.
b Reserved For the reasons set forth in the preamble, under the authority at 5
U.S.C. 301, the Department of Health and Human Services proposes to amend 45 CFR subtitle A, subchapter B, as set forth below.
PART 147HEALTH INSURANCE
REFORM REQUIREMENTS FOR THE
GROUP AND INDIVIDUAL INSURANCE
MARKETS
9. The authority citation for part 147
continues to read as follows:

Authority: 42 U.S.C. 300gg through 300gg 63, 300gg91, and 300gg92, as amended, and section 3203, Pub. L. 116136, 134 Stat.
281.

10. Amend 147.104 by a. Revising paragraphs b2iE and F; and
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b. Adding paragraph b2iG.
The revisions and addition read as follows:

147.104 Guaranteed availability of coverage.

b
2
i
E Section 155.420d12 of this subchapter concerning plan and benefit display errors;
F Section 155.420d13 of this subchapter concerning eligibility for insurance affordability programs or enrollment in the Exchange; and G Section 155.420d16 of this subchapter concerning eligibility for advance payments of the premium tax credit and household income, as defined in 26 CFR 1.36B1e, that is expected to be no greater than 150
percent of the federal poverty level.

PART 155EXCHANGE
ESTABLISHMENT STANDARDS AND
OTHER RELATED STANDARDS
UNDER THE AFFORDABLE CARE ACT
11. The authority citation for part 155
continues to read as follows:

Waiver Extension.

35213

Authority: 42 U.S.C. 1802118024, 18031
18033, 1804118042, 18051, 18054, 18071, and 1808118083.

12. Amend 155.210 by revising paragraph e9 to read as follows:

155.210

Navigator program standards.

e
9 The Exchange may require or authorize Navigators to provide information and assistance with any of the following topics. In Federallyfacilitated Exchanges, Navigators are required to provide information and assistance with all of the following topics:
i Understanding the process of filing Exchange eligibility appeals;
ii Understanding and applying for exemptions from the requirement to maintain minimum essential coverage granted through the Exchange;
iii The Exchange-related components of the premium tax credit reconciliation process, and understanding the availability of IRS
resources on this process;
iv Understanding basic concepts and rights related to health coverage and how to use it; and v Referrals to licensed tax advisers, tax preparers, or other resources for assistance with tax preparation and tax advice related to consumer questions about the Exchange application and
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