Voglio sapere a riguardo di…

khammond on DSKJM1Z7X2PROD with PROPOSALS2

35192

Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules federal comment period should also generally not be less than 30 days.130
The Departments seek comment on these proposals.

national standards issued by the Architectural and Transportation Barriers Compliance Board often referred to as section 508
standards,125 or alternatively, the World Wide Web Consortiums Web Content Accessibility Guidelines WCAG 126 2.0 Level AA standards.
Through this preamble, the Departments are proposing policies and interpretations for the state public notice requirements. More specifically, the Departments propose to maintain the current standard that the state comment period for a section 1332
waiver application should generally be no less than 30 days.127 The Departments are of the view that a general standard requiring a minimum 30 day comment period will be sufficient to allow for meaningful and robust public engagement on a states waiver application and reiterate that a longer period may be appropriate for complex proposed waiver plans.
Section 1332a4Biii of the ACA
and its implementing regulations 128
also require the federal government to provide a public notice and comment period, once the Secretaries receive an application. The period must be sufficient to ensure a meaningful level of public input and must not impose requirements that are in addition to, or duplicative of, requirements imposed under the Administrative Procedure Act, or requirements that are unreasonable or unnecessarily burdensome with respect to state compliance.129 Under existing regulations, 31 CFR 33.108f and 45
CFR 155.1308f, a submitted section 1332 waiver application will not be deemed received until the Secretaries have made the preliminary determination that the application is complete. As with the comment period described in this preamble, the length of the federal comment period should reflect the complexity of the section 1332 waiver proposal and the Departments similarly propose that the
6. Modification From the Normal Public Notice Requirements 31 CFR 33.118, 31
CFR 33.120, 45 CFR 155.1318, and 45
CFR 155.1320
In the November 2020 IFC,131 the Departments revised regulations to set forth flexibilities in the public notice requirements and post award public participation requirements for waivers under section 1332 during the COVID
19 PHE. In this proposed rule, the Departments are proposing to extend these changes beyond the COVID19
PHE to allow similar flexibilities in the event of future natural disasters; PHEs;
or other emergent situations that threaten consumers access to health insurance coverage, consumers access to health care, or human life. The Departments propose to consider a situation to be emergent if it is both unforeseen and urgent. The Departments are not proposing any changes or soliciting further comments at this time with respect to the flexibility made available in the November 2020 IFC during the COVID
19 PHE. The Departments further clarify that states with approved section 1332
waivers and states seeking approval for proposed waivers will continue to have flexibility to submit requests to the Departments to modify certain public participation requirements during the COVID19 PHE.132
In the 2022 Payment Notice proposed rule,133 CMS similarly proposed an extension of COVID19 policy flexibilities, specifically the calculation of plan average premium and state average premium requirements for extending future premium credits temporary premium credits, which was originally published in the November 2020 IFC.134 In part 2 of the 2022 Payment Notice final rule, HHS
finalized these policies to extend
125 For more information on 508 standards see here: https section508.gov/manage/programroadmap.
126 For more information, see the WCAG website at http www.w3.org/TR/WCAG20/.
127 Notwithstanding this proposal, we clarify that states with approved waivers and states seeking approval for proposed waivers would continue to have flexibility to submit requests to the Departments to modify certain public participation requirements during the COVID19 PHE. See 31
CFR 33.118 and 45 CFR 155.1318. Also see the November 2020 IFC, 85 FR 71142. As detailed below, in this rulemaking, the Departments propose to extend similar flexibilities during future emergent situations.
128 See 31 CFR 33.116 and 45 CFR 155.1316.
129 See section 1332a4Biii of the ACA, 31
CFR 33.116b and 45 CFR 155.1316b.

130 Notwithstanding this proposal, the Departments clarify that states with approved waivers and states seeking approval for proposed waivers would continue to have flexibility to submit requests to the Departments to modify certain public participation requirements during the COVID19 PHE. See 31 CFR 33.118 and 45 CFR
155.1318. Also see the November 2020 IFC, 85 FR
71142. As detailed below, in this rulemaking, the Departments propose to extend similar flexibilities during future emergent situations.
131 85 FR 71142 See https
www.federalregister.gov/documents/2020/11/06/
2020-24332/additional-policy-and-regulatoryrevisions-in-response-to-the-covid-19-public-healthemergency.
132 See 85 FR 71142.
133 See 85 FR at 7859778598 and 7860878609.
134 85 FR 54820.

VerDate Sep<11>2014

19:24 Jun 30, 2021

Jkt 253001

PO 00000

Frm 00038

Fmt 4701

Sfmt 4702

beyond the COVID19 PHE, to be available, if permitted by HHS, during a future declared PHE.135 In developing the policies in this rulemaking, the Departments considered extending the section 1332 flexibilities adopted in the November 2020 IFC only to future declared PHEs, but are of the view that these flexibilities, as proposed in this proposed rule to be available on a broader basis in different times of emergent situations, will allow states to use or modify their waivers to respond to state or local emergent situations that may not rise to the level of a national declared PHE. The Departments are of the view that this best aligns with the overall statutory purpose and goals for section 1332 waivers, which are meant to allow states to craft their own unique solutions to respond to the specific health care needs in their respective markets. If the Departments were to limit these flexibilities only to future declared national PHEs, states may not be able to utilize or modify their section 1332 waivers as a tool to address state or local emergent situations or state designated emergencies which may similarly threaten consumers access to health insurance coverage, consumers access to health care, or human life.
In addition, the flexibilities outlined in this proposed rule are similar to those available under section 1115
demonstrations. Existing regulations at 42 CFR 431.416g, relating to demonstration programs under section 1115 of the Act, provide that CMS may waive, in whole or in part, the state and federal public notice requirements to expedite a decision on a proposed 1115
demonstration or 1115 demonstration extension request that addresses a natural disaster, PHE, or other sudden emergency threat to human life. The Departments are of the view that using a similar standard for section 1332
waivers will provide states the necessary flexibility to enable them to quickly respond to various emergent situations. For example, some states have used flexibilities for section 1115
demonstrations in emergent situations to address threats to human life such as mudslides and wildfires which were state designated emergencies.
The Secretaries value the importance of the public input process, but also intend to propose to provide reprieve from certain requirements, where appropriate, in emergent situations.
Allowing the Secretaries to modify the public notice and post award requirements, as proposed in this rule, would allow states to seek emergency relief in support of the development of 135 86

E:FRFM01JYP2.SGM

FR at 2418224183 and 2420224203.

01JYP2