Today we look at how states can get some of the Patient Protection and Affordable Care Act’s requirements waived and how states can enter interstate compacts.
Waivers
States can apply to the federal Department of Health and Human Services for waivers of certain requirements for plan years beginning in 2017 (NOTE: Earlier this year, President Obama announced that he supports moving this date up to 2014.) HHS can waive any or all of the following requirements:
- Establishment of qualified health plans and essential health benefits requirements
- Health benefit exchanges
- Reduced cost-sharing requirements for individuals enrolled in qualified health plans, and
- Premium tax credits, the employer mandate, and minimum essential coverage
HHS evaluates applications for waiver of the first three requirements; the Treasury Department evaluates applications for waiver of the last one.
In situations where a state waiver makes otherwise eligible individuals ineligible for premium tax credits and cost-sharing reductions, HHS must provide an alternate means by which the state will receive the aggregate dollar amount of the credits and reductions that individuals would have received. The state must use these funds to implement its plan. HHS must calculate this reimbursement annually.
HHS was required to issue regulations by September 2010 with regard to the state waivers. The regulations provided:
- A process for public notice and comment at the state level on the proposed waiver request
- A waiver application process specifying the provisions of the PPACA the state wishes to waive and the state’s specific plans to ensure that the waiver will meet requirements (see below)
- A process for public notice and comment after the state has applied for the waiver
- A process for states to report on the implementation of their programs under the waivers
- A process for HHS to periodically review the program under the waiver.
HHS must annually report to Congress its actions regarding waiver applications.
To ease the paperwork burden on the states, HHS must create a process for coordinating and consolidating state waiver process with the pre-existing waiver process under Medicare, Medicaid, the State Children’s Health Insurance Program, and other federal health programs. The process must allow states to submit a single application for all of its waivers.
Requirements for Granting Waivers
HHS must rule on a waiver application within 180 days of receipt. It can grant a waiver to a state if the state can show that its plan:
- Will provide coverage at least as comprehensive as the essential health benefits and offered through the exchanges
- Will provide coverage and cost-sharing protections against excessive out-of-pocket spending at least as affordable as those provided in the PPACA
- Will cover at least a comparable number of its residents as the PPACA would
- Will not increase the federal budget deficit.
The state must pass a law providing for state actions under the waiver, including implementation of its plan. It can also opt out of the waiver by repealing its law.
HHS must determine the scope of all waivers but cannot exceed its legal authority in doing so. If it approves the waiver, it must notify the state of the waiver’s terms and effectiveness. In the case of a denial, HHS must notify the state and the appropriate congressional committees of the reasons for its decision.
Waivers are for five-year terms. A state can request a continuation of its waiver, and HHS must, within 90 days, either deny the request or ask for additional information. If the department fails to do either, the law deems the request approved after 90 days.
Health Care Choice Compacts
By July 2013, HHS must issue regulations for the creation of “health care choice compacts.” These are agreements between two or more states in which the states will offer one or more health plans for individuals in all participating states, but the plans will be subject to the laws and regulations only of the plan’s home state. However, plans are still subject to market conduct, unfair trade practices, network adequacy and consumer protection laws of the purchaser’s home state. The carriers providing coverage must hold licenses in all of the participating states, and they must clearly notify consumers that not all of their state’s laws and regulations apply to their policies. States must enact laws specifically authorizing them to enter these compacts. The compacts will take effect in 2016.
HHS must approve a proposed compact and may do so if the compact:
- Will provide coverage at least as comprehensive as the essential health benefits and offered through the exchanges
- Will provide coverage and cost-sharing protections against excessive out-of-pocket spending at least as affordable as those provided by the PPACA
- Will cover at least a comparable number of residents as the PPACA would
- Will not increase the federal budget deficit
- Will not weaken enforcement of state market conduct, unfair trade practices, network adequacy and consumer protection laws.
Next time: Multi-state plans.
This is such a great resource that you are providing and you give it away for free. I love seeing websites that understand the value of providing a quality resource for free. It's the old what goes around comes around routine.
Posted by: medical waste disposal company | June 16, 2011 at 12:06 AM