42 USC 18052 - Waiver for State innovation

U.S Code last checked for updates: Nov 23, 2024

§ 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 A of this subchapter.

(B)

Part B of this subchapter.

(C)

Section 18071 of this title.

(D)

Sections 36B, 4980H, and 5000A of title 26.

(3)

Pass through of funding

(4)

Waiver consideration and transparency

(A)

In general

(B)

Regulations

Not later than 180 days after March 23, 2010, 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,² 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

(5)

Coordinated waiver process

(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 18022(b) of this title and offered through Exchanges established under this title ² as certified by Office 3

 So in original. Probably should be preceded by “the”.

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 ² would provide;

(C)

will provide coverage to at least a comparable number of its residents as the provisions of this title ² would provide; and

(D)

will not increase the Federal deficit.

(2)

Requirement to enact a law

(A)

In general

(B)

Termination of opt out

(c)

Scope of waiver

(1)

In general

(2)

Limitation

(d)

Determinations by Secretary

(1)

Time for determination

(2)

Effect of determination

(A)

Granting of waivers

(B)

Denial of waiver

(e)

Term of waiver

(Pub. L. 111–148, title I, § 1332, Mar. 23, 2010, 124 Stat. 203.)

cite as: 42 USC 18052