Proposed Rule Outlines State Innovation Waiver Program Application Process and Review

mapofUS2.JPGOn Thursday, the U.S. Department of Health and Human Services (HHS) issued a proposed rule (pdf) that outlines the process through which states can take advantage of the health care innovation waiver program, and the government’s review of these initial applications. Under the innovation waiver program, states would be permitted to implement policies that differ from those contained in the Affordable Care Act so long as the alternate health care delivery system would provide the same level of quality and affordability demanded by the law and would cover the same number of people without increasing the federal deficit. Earlier this month, President Obama expressed his support for a bill that would move the start date of the health care reform law’s state innovation wavier program from 2017 to 2014.

According to a fact sheet on the new regulations, the proposal would, among other things,

  • Outline how a public notice and comment process should work, including public hearings, to enable the public to weigh in on the state’s intent to participate in the innovation wavier program.
  • Explain that the state innovation waiver application must include the provisions of the Affordable Care Act that the state seeks to waive; an explanation of how the proposed waiver will meet the goals related to coverage expansion, affordability, comprehensiveness of coverage, and costs; a budget plan that does not increase the federal deficit, with supporting information; actuarial certifications and economic analysis to support the state’s estimates that the proposed waiver will comply with the comprehensive coverage requirement, the affordability requirement, and the scope of coverage requirement; and analyses of the waiver’s potential impact on provisions that are not waived, access to health care services when residents leave the state, and deterring waste, fraud, and abuse.
  • Outline the requirements for quarterly and annual reports that states must submit once the waiver is granted. These periodic reports would track information related to affordability, comprehensiveness of coverage, the number of people covered, and impact on the federal deficit.
  • Propose criteria that could be used in the evaluation of the waivers once granted, covering such topics as: choice of health plans for individuals and employers; stability of coverage for individuals and employers; small businesses, individuals with pre-existing conditions, and the low-income population; the overall health care system in the state; and other states and the federal government.

In a press release, HHS Secretary Kathleen Sebelius said: “Innovation Waivers empower states to take the lead on implementing the Affordable Care Act,” adding: “Today’s announcement demonstrates the flexibility available to states as they continue to move forward on fixing our broken health insurance marketplace.”

Comments on these proposed regulations are due within 60 days of their publication in the Federal Register, which is scheduled for March 14, 2011. Comments may be submitted electronically through the federal eRulemaking portal; via overnight or express delivery to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9987-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850; by regular mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9987-P, P.O. Box 8016, Baltimore, MD 21244-8016; or by courier or hand-delivery to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201 or to the aforementioned Baltimore address.

This entry was written by Ilyse Schuman.

Photo credit:  Eclipse Digital

Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.