Voglio sapere a riguardo di…

lotter on DSK11XQN23PROD with RULES2

53504

Federal Register / Vol. 86, No. 184 / Monday, September 27, 2021 / Rules and Regulations
if they elect to change their QHP
enrollment. If a qualified individual or a dependent who is not an enrollee qualifies for a special enrollment period in accordance with paragraph d16 of this section and has one or more household members who are enrollees, the Exchange must allow the enrollee to add the newly enrolling household member to his or her current QHP; or, to change to a silver-level QHP and add the newly enrolling household member to this silver-level QHP; or, to change to a silver level QHP and enroll the newly enrolling qualified individual or dependent in a separate QHP;
iii For the other triggering events specified in paragraph d of this section, except for paragraphs d2i, d4, and d6i and ii of this section for becoming newly eligible or ineligible for CSRs and paragraphs d8, 9, 10, 12, 14, and 16 of this section:

b
2
vii If a qualified individual or enrollee, or the dependent of a qualified individual or enrollee, who is eligible for advance payments of the premium tax credit, and whose household income, as defined in 26 CFR 1.36B
1e, is expected to be no greater than 150 percent of the Federal poverty level, enrolls in a QHP or changes from one QHP to another one time per month in accordance with paragraph d16 of this section, the Exchange must ensure that coverage is effective in accordance with paragraph b1 of this section or on the first day of the month following plan selection, at the option of the Exchange.

d
16 At the option of the Exchange, a qualified individual or enrollee, or the dependent of a qualified individual or enrollee, who is eligible for advance payments of the premium tax credit, and whose household income, as defined in 26 CFR 1.36B1e, is expected to be no greater than 150
percent of the Federal poverty level, may enroll in a QHP or change from one QHP to another one time per month during periods of time when the applicable taxpayers applicable percentage for purposes of calculating the premium assistance amount, as defined in section 36Bb3A of the Internal Revenue Code, is set at zero.

f For purposes of this section, references to eligibility for advance payments of the premium tax credit refer to being eligible for such advance
VerDate Sep<11>2014

18:50 Sep 24, 2021

Jkt 253001

payments in an amount greater than zero dollars per month. References to ineligibility for advance payments of the premium tax credit refer to being ineligible for such payments or being eligible for such payments but being eligible for a maximum of zero dollars per month of such payments.
16. Amend 155.1308 by revising paragraphs f3iv introductory text and f3ivA through C to read as follows:
155.1308

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 the Treasury, 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;
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 the Treasury, 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 the Treasury, as applicable, must determine that the coverage under the State plan is forecasted to be at least as affordable overall for State residents as coverage absent the waiver;

PO 00000

Frm 00094

Fmt 4701

Sfmt 4700

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 Treasury, 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

17. Amend 155.1318 by revising the section heading and paragraphs a and b3 and adding paragraphs b5 and g to read as follows:
155.1318 Modification from the normal public notice requirements during an emergent situation.

a The Secretary and the Secretary of the Treasury may modify, in part, the State public notice requirements under 155.1312a1, b, c, and d and the Federal public notice procedures under 155.1316b 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 result from a natural disaster; public health emergency; or other emergent
E:FRFM27SER2.SGM

27SER2