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Federal Register / Vol. 86, No. 184 / Monday, September 27, 2021 / Rules and Regulations defined in 5 U.S.C. 8042, because it is likely to result in an annual effect on the economy of $100 million or more.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services, approved this document on September 13, 2021.

33.108

45 CFR Part 147
Age discrimination, Citizenship and naturalization, Civil rights, Health care, Health insurance, Individuals with disabilities, Intergovernmental relations, Reporting and recordkeeping requirements, Sex discrimination.
45 CFR Part 155
Administrative practice and procedure, Advertising, Age discrimination, Brokers, Civil rights, Citizenship and naturalization, Conflict of interests, Consumer protection, Grant programshealth, Grants administration, Health care, Health insurance, Health maintenance organizations HMO, Health records, Hospitals, Indians, Individuals with disabilities, Intergovernmental relations, Loan programshealth, Medicaid, Organization and functions Government agencies, Public assistance programs, Reporting and recordkeeping requirements, Sex discrimination, State and local governments, Technical assistance, Taxes, Women, Youth.

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Authority: Sec. 1332, Pub. L. 111148, 124
Stat. 119.

2. Amend 33.108 by revising paragraphs f3iv introductory text and f3ivA through C to read as follows:

31 CFR Part 33
Health care, Health insurance, Reporting and recordkeeping requirements.

45 CFR Part 156
Administrative practice and procedure, Advertising, Advisory committees, Age discrimination, Alaska, Brokers, Citizenship and naturalization, Civil rights, Conflict of interests, Consumer protection, Grant programs health, Grants administration, Health care, Health insurance, Health maintenance organization HMO, Health records, Hospitals, Indians, Individuals with disabilities, Intergovernmental relations, Loan programshealth, Medicaid, Organization and functions Government agencies, Prescription drugs, Public assistance programs, Reporting and recordkeeping requirements, Sex discrimination, State and local governments, Sunshine Act, Technical assistance, Women, Youth.
For the reasons set forth in the preamble, the Department of the Treasury amends 31 CFR part 33 as set forth below:

18:50 Sep 24, 2021

1. The authority citation for part 33
continues to read as follows:

List of Subjects
VerDate Sep<11>2014

PART 33WAIVERS FOR STATE
INNOVATION

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Application procedures.

f
3
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
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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 residents under the waiver as would have coverage absent the waiver; and

3. Amend 33.118 by revising the section heading and paragraphs a and b3 and adding paragraphs b5 and g to 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 comprehensive 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
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