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CMS Posts Fact Sheet and FAQs on State Innovation Waiver Process

Fact Sheet and FAQs About Section 1332 State Innovation Waivers (July 22, 2015)

Available at Asked Questions about 1332 State Innovation Waivers

Visit the Health Care Reform Community on Checkpoint to join the discussion on this development (for Checkpoint subscribers to EBIA’s Health Care Reform manual).

CMS has posted a fact sheet and FAQs about the state innovation waiver process. As background, health care reform authorizes states seeking to implement innovative ways of providing access to quality health care to apply for waivers from certain of its requirements, including requirements regarding qualified health plans (QHPs), Exchanges, premium tax credits, employer shared responsibility, and the individual mandate. Among other things, a state’s innovation has to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver and must provide coverage to a comparable number of the state’s residents as would be provided coverage absent a waiver. An innovation also cannot increase the federal deficit. State innovation waivers can be implemented on or after January 1, 2017, but states must first obtain approval of their waiver requests using an application process detailed in the regulations (see our article).

The FAQs provide basic information about waivers, including when and how to apply and how long the review and approval process will take. They also explain that a state must comply with public notice and comment requirements before submitting an application. Referring to the regulations, the FAQs list the items that must be included with waiver applications—among them, a description and copy of enacted state legislation giving the state authority to implement the proposed waiver. In addition, the FAQs indicate that HHS and the IRS will issue further guidance in the future, as additional questions and issues arise.

EBIA Comment: In addition to providing a high-level summary of the regulations on state innovation waivers, the fact sheet and FAQs serve as a reminder that states may already be preparing to obtain innovation waivers. It will be interesting to see which states request, and ultimately receive, waivers, and what health care reform requirements will be affected. In particular, we wonder if any waivers will affect the employer shared responsibility provisions, and how those waivers would be implemented and administered. For more information, see EBIA’s Health Care Reform manual at Sections XXI.G (“Innovation Waivers Allow State Health Reform Alternatives”) and XXVIII (“Shared Responsibility for Employers (Play or Pay Penalty Tax)”).

Contributing Editors: EBIA Staff.

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