I 
113TH CONGRESS 
1ST SESSION H. R. 1841 
To provide for an earlier start for State health care coverage innovation 
waivers under the Patient Protection and Affordable Care Act, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 6, 2013 
Mr. WELCH introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To provide for an earlier start for State health care coverage 
innovation waivers under the Patient Protection and Af-
fordable Care Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘State Leadership in 
Health Care Act’’. 
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SEC. 2. EARLIER START FOR STATE HEALTH CARE COV-
ERAGE INNOVATION WAIVERS. 
(a) IN GENERAL.—Section 1332 of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18052) is 
amended— 
(1) in subsection (a)(1), by striking ‘‘January 
1, 2017’’ and inserting ‘‘January 1, 2015’’; and 
(2) by amending subsection (e) to read as fol-
lows: 
‘‘(e) TERM OF WAIVER.— 
‘‘(1) IN GENERAL.—No waiver under this sec-
tion may extend over a period of more than 5 years 
unless the State requests continuation of such waiv-
er and such request is granted by the Secretary 
under paragraph (2). 
‘‘(2) APPROVAL OF REQUEST.— 
‘‘(A) IN GENERAL.—A request under para-
graph (1) shall be deemed granted unless the 
Secretary, not later than 90 days after the date 
of submission to the Secretary of such request, 
either denies such request in writing or informs 
the State in writing with respect to any addi-
tional information that is needed in order to 
make a final determination with respect to the 
request. 
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‘‘(B) DENIAL
OF
REQUEST.—The Sec-
retary may deny such a request only if the Sec-
retary— 
‘‘(i) determines that the State plan 
under the waiver to be continued did not 
meet the requirements under subsection 
(b); 
‘‘(ii) notifies the State in writing of 
the requirements under subsection (b) that 
the State plan did not meet and provides 
to the State the information used by the 
Secretary in making that determination; 
and 
‘‘(iii) provides the State with an op-
portunity to appeal such determination and 
provide information as to how such re-
quirements were met. 
‘‘(C) RECONSIDERATION OF REQUEST.—In 
the case of an appeal described in subparagraph 
(B)(iii), the Secretary shall consider any infor-
mation provided under such clause and recon-
sider the determination made under subpara-
graph (B)(i), and shall issue a written decision 
on such appeal not later than 60 days after the 
date on which the Secretary receives notice of 
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such appeal. The Secretary shall grant the re-
quest if the Secretary determines upon recon-
sideration that the State plan meets such re-
quirements.’’. 
Æ 
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