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Statutory Text

SEC. 1332 [42 U.S.C. 18052]. WAIVER FOR STATE INNOVATION.
(a) APPLICATION.—
(1) IN GENERAL.—A State may apply to the Secretary for
the waiver of all or any requirements described in paragraph
(2) with respect to health insurance coverage within that State
for plan years beginning on or after January 1, 2017. Such application
shall—
(A) be filed at such time and in such manner as the
Secretary may require;
(B) contain such information as the Secretary may require,
including—
(i) a comprehensive description of the State legislation
and program to implement a plan meeting the
requirements for a waiver under this section; and
(ii) a 10-year budget plan for such plan that is
budget neutral for the Federal Government; and
(C) provide an assurance that the State has enacted
the law described in subsection (b)(2).
(2) REQUIREMENTS.—The requirements described in this
paragraph with respect to health insurance coverage within
the State for plan years beginning on or after January 1, 2014,
are as follows:
(A) Part I of subtitle D.
(B) Part II of subtitle D.
(C) Section 1402.
(D) Sections 36B, 4980H, and 5000A of the Internal
Revenue Code of 1986.
(3) PASS THROUGH OF FUNDING.—With respect to a State
waiver under paragraph (1), under which, due to the structure
of the State plan, individuals and small employers in the State
would not qualify for the premium tax credits, cost-sharing reductions,
or small business credits under sections 36B of the
Internal Revenue Code of 1986 or under part I of subtitle E for
which they would otherwise be eligible, the Secretary 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 established under this
title had the State not received such waiver, shall be paid to
the State for purposes of implementing the State plan under
the waiver. Such amount shall be determined annually by the
Secretary, 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.
(4) WAIVER CONSIDERATION AND TRANSPARENCY.—
(A) IN GENERAL.—An application for a waiver under
this section shall be considered by the Secretary in accordance
with the regulations described in subparagraph (B).
(B) REGULATIONS.—Not later than 180 days after the
date of enactment of this Act, the Secretary shall promulgate
regulations relating to waivers under this section that
provide—
(i) a process for public notice and comment at the
State level, including public hearings, sufficient to ensure
a meaningful level of public input;
(ii) a process for the submission of an application
that ensures the disclosure of—
(I) the provisions of law that the State involved
seeks to waive; and
(II) the specific plans of the State to ensure
that the waiver will be in compliance with subsection
(b);
(iii) a process for providing public notice and comment
after the application is received by the Secretary,
that is sufficient to ensure a meaningful level
of public input and that does not impose requirements
that are in addition to, or duplicative of, requirements
imposed under the Administrative Procedures Act, or
requirements that are unreasonable or unnecessarily
burdensome with respect to State compliance;
(iv) a process for the submission to the Secretary
of periodic reports by the State concerning the implementation
of the program under the waiver; and
(v) a process for the periodic evaluation by the
Secretary of the program under the waiver.
(C) REPORT.—The Secretary shall annually report to
Congress concerning actions taken by the Secretary with
respect to applications for waivers under this section.
(5) COORDINATED WAIVER PROCESS.—The Secretary shall
develop a process for coordinating and consolidating the State
waiver processes applicable under the provisions of this section,
and the existing waiver processes applicable under titles
XVIII, XIX, and XXI of the Social Security Act, and any other
Federal law relating to the provision of health care items or
services. Such process shall permit a State to submit a single
application for a waiver under any or all of such provisions.
(6) DEFINITION.—In this section, the term ‘‘Secretary’’
means—
(A) the Secretary of Health and Human Services with
respect to waivers relating to the provisions described in
subparagraph (A) through (C) of paragraph (2); and
(B) the Secretary of the Treasury with respect to waivers
relating to the provisions described in paragraph
(2)(D).
(b) GRANTING OF WAIVERS.—
(1) IN GENERAL.—The Secretary may grant a request for a
waiver under subsection (a)(1) only if the Secretary determines
that the State plan—
(A) will provide coverage that is at least as comprehensive
as the coverage defined in section 1302(b) and
offered through Exchanges established under this title as
certified by 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 this Act and the provisions of
this Act that would be waived;
(B) will provide coverage and cost sharing protections
against excessive out-of-pocket spending that are at least
as affordable as the provisions of this title would provide;
(C) will provide coverage to at least a comparable
number of its residents as the provisions of this title would
provide; and
(D) will not increase the Federal deficit.
(2) REQUIREMENT TO ENACT A LAW.— (A) IN GENERAL.—A law described in this paragraph is
a State law that provides for State actions under a waiver
under this section, including the implementation of the
State plan under subsection (a)(1)(B).
(B) TERMINATION OF OPT OUT.—A State may repeal a
law described in subparagraph (A) and terminate the authority
provided under the waiver with respect to the
State.
(c) SCOPE OF WAIVER.— (1) IN GENERAL.—The Secretary shall determine the scope
of a waiver of a requirement described in subsection (a)(2)
granted to a State under subsection (a)(1).
(2) LIMITATION.—The Secretary may not waive under this
section any Federal law or requirement that is not within the
authority of the Secretary.
(d) DETERMINATIONS BY SECRETARY.— (1) TIME FOR DETERMINATION.—The Secretary shall make
a determination under subsection (a)(1) not later than 180
days after the receipt of an application from a State under
such subsection.
(2) EFFECT OF DETERMINATION.— (A) GRANTING OF WAIVERS.—If the Secretary determines
to grant a waiver under subsection (a)(1), the Secretary
shall notify the State involved of such determination
and the terms and effectiveness of such waiver.
(B) DENIAL OF WAIVER.—If the Secretary determines a
waiver should not be granted under subsection (a)(1), the
Secretary shall notify the State involved, and the appropriate
committees of Congress of such determination and
the reasons therefore.
(e) TERM OF WAIVER.—No waiver under this section may extend
over a period of longer than 5 years unless the State requests
continuation of such waiver, and such request shall be deemed
granted unless the Secretary, within 90 days after the date of its
submission to the Secretary, either denies such request in writing
or informs the State in writing with respect to any additional information
which is needed in order to make a final determination
with respect to the request.