Title: State Flexibility and Patient Choice Act of 2019
Policy area: Health

Summary:
State Flexibility and Patient Choice Act of 2019
This bill revises the procedures for states to waive certain federal health insurance requirements and implement state-administered health insurance programs. Specifically, the bill revises the affordability requirement to allow states to provide coverage of comparable affordability to what is available through the federal health insurance exchange.  Further, the reviewing agencies may consider the budgetary impact of a state waiver program on other federal programs (e.g., Medicaid) when determining whether the waiver application would increase the federal deficit. Additionally, the bill applies the budget-neutrality requirement over the term of the waiver period.  States may certify that a governor has the authority to apply for a waiver under current state law, as an alternative to referencing a specific state statute. The bill also provides expedited review and approval of state applications that are substantially similar to a waiver program that already has been approved.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2183 Introduced in House (IH)]

<DOC>






116th CONGRESS
  1st Session
                                H. R. 2183

 To amend the Patient Protection and Affordable Care Act to streamline 
      the State innovation waiver process, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 9, 2019

 Mr. Marshall 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 jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend the Patient Protection and Affordable Care Act to streamline 
      the State innovation waiver process, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``State Flexibility and Patient Choice 
Act of 2019''.

SEC. 2. STREAMLINING THE STATE INNOVATION WAIVER PROCESS.

    Section 1332 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18052) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (B)(ii), by inserting 
                        ``over both the term of the proposed waiver and 
                        the 10-year budget plan'' after ``Government''; 
                        and
                            (ii) in subparagraph (C), by striking ``the 
                        law described in subsection (b)(2)'' and 
                        inserting ``a law or has in effect a 
                        certification described in subsection (b)(3)''; 
                        and
                    (B) in paragraph (3)--
                            (i) in the first sentence--
                                    (I) by inserting ``or would qualify 
                                for a lesser amount of'' after ``would 
                                not qualify for'';
                                    (II) by inserting ``, or the State 
                                would not qualify for or would qualify 
                                for a lesser payment under section 
                                1331,'' after ``subtitle E'';
                                    (III) by inserting ``, or on behalf 
                                of participants in a basic health 
                                program established under section 1331 
                                had such participants been enrolled in 
                                an Exchange,'' after ``this title''; 
                                and
                                    (IV) by inserting ``or for 
                                implementing a basic health program 
                                established under section 1331'' before 
                                the period; and
                            (ii) in the second sentence, by inserting 
                        before the period the following: ``, and with 
                        respect to participation in the basic health 
                        program and funds provided to such other States 
                        under section 1331'';
            (2) in subsection (b)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (B), by striking ``at 
                        least as affordable'' and inserting ``of 
                        comparable affordability''; and
                            (ii) in subparagraph (D), by inserting 
                        ``over the term of the waiver and over the 10-
                        year budget plan with respect to such waiver'' 
                        before the period at the end;
                    (B) by redesignating paragraph (2) as paragraph 
                (3);
                    (C) by inserting after paragraph (1) the following 
                new paragraph:
            ``(2) Budgetary effect.--
                    ``(A) In general.--In determining whether a State 
                plan submitted under subsection (a) meets the deficit 
                neutrality requirements of paragraph (1)(D), the 
                Secretary shall take into consideration the direct 
                budgetary effect of the provisions of such plan on 
                sources of Federal funding other than the funding 
                described in subsection (a)(3).''; and
                    (D) in paragraph (3) (as so redesignated)--
                            (i) in the paragraph heading, by inserting 
                        ``OR HAVE IN EFFECT A CERTIFICATION'' after 
                        ``LAW'';
                            (ii) in subparagraph (A)--
                                    (I) by striking ``A law'' and 
                                inserting the following:
                            ``(i) Laws.--A law''; and
                                    (II) by adding at the end the 
                                following:
                            ``(ii) Certifications.--A certification 
                        described in this paragraph is a document, 
                        signed by the Governor of the State, that 
                        certifies that such Governor has the authority 
                        under existing State law to take action under 
                        this section, including implementation of the 
                        State plan under subsection (a)(1)(B).''; and
                            (iii) in subparagraph (B)--
                                    (I) in the subparagraph heading, by 
                                striking ``OF OPT OUT''; and
                                    (II) by striking ``may repeal a 
                                law'' and all that follows through the 
                                period at the end and inserting the 
                                following: ``may terminate the 
                                authority provided under the waiver 
                                with respect to the State by--''
                            ``(i) repealing the law described in 
                        subparagraph (A)(i); or
                            ``(ii) terminating the certification 
                        described in subparagraph (A)(ii), through a 
                        certification for such termination signed by 
                        the Governor of the State.'';
            (3) in subsection (d)--
                    (A) in paragraph (1), by striking ``180'' and 
                inserting ``90''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Expedited determination.--
                    ``(A) In general.--With respect to any application 
                under subsection (a)(1) submitted on or after the date 
                of the enactment of this paragraph, the Secretary shall 
                make a determination on such application, using the 
                criteria for approval otherwise applicable under this 
                section, not later than 60 days after the receipt of 
                such application and shall allow the public notice and 
                comment at the State and Federal levels described under 
                subsection (a)(4) to occur concurrently if such State 
                application--
                            ``(i) is submitted in response to an urgent 
                        situation, with respect to areas in the State 
                        that the Secretary determines are at risk for 
                        substantial increases in premium rates or 
                        having no health plans offered in the 
                        applicable health insurance market for the 
                        current or following plan year; or
                            ``(ii) is for a waiver that is the same or 
                        substantially similar to a waiver that the 
                        Secretary already has approved for another 
                        State.
                    ``(B) Approval limitations for urgent situations.--
                            ``(i) Provisional approval.--A waiver 
                        approved under the expedited determination 
                        process under subparagraph (A)(i) may extend 
                        over a period of not longer than 3 years.
                            ``(ii) Full approval.--Subject to the 
                        requirements for approval otherwise applicable 
                        under this section, not later than 1 year 
                        before the expiration of a provisional waiver 
                        period described in clause (i) with respect to 
                        an application described in subparagraph 
                        (A)(i), the Secretary shall make a 
                        determination on whether to extend the term of 
                        such waiver for longer than the period 
                        described in clause (i), for a total waiver 
                        term not to exceed 6 years. The Secretary may 
                        request additional information as the Secretary 
                        determines appropriate to make such 
                        determination.
                    ``(C) GAO study.--Not later than 5 years after the 
                date of enactment of the State Flexibility and Patient 
                Choice Act of 2019, the Comptroller General of the 
                United States shall conduct a review of all waivers 
                approved pursuant to an application under subparagraph 
                (A)(ii) to evaluate whether such waivers met the 
                requirements of subsection (b)(1) and whether the 
                applications should have qualified for such an 
                expedited determination.'';
            (4) in subsection (e), by inserting ``(or, in the case of 
        an application under subsection (a)(1) submitted on or after 
        the date of the enactment of the State Flexibility and Patient 
        Choice Act of 2019, 6 years)'' after ``5 years''; and
            (5) by adding at the end the following new subsection:
    ``(f) Additional Provisions.--In carrying out this section, the 
Secretary shall--
            ``(1) issue guidance, not later than 30 days after the date 
        of the enactment of this subsection, that includes initial 
        examples of model State plans that may meet the requirements 
        for approval under this section; and
            ``(2) periodically review the guidance issued under 
        paragraph (1) and, when appropriate, issue additional examples 
        of model State plans that may meet the requirements for 
        approval under this section, which may include--
                    ``(A) model plans establishing reinsurance or 
                invisible high-risk pool arrangements for purposes of 
                covering the cost of high-risk individuals;
                    ``(B) model plans expanding insurer participation, 
                access to affordable health plans, network adequacy, 
                and health plan options over the entire applicable 
                health insurance market in the State;
                    ``(C) model plans that encourage or require health 
                plans in a State to deploy value-based insurance 
                designs which structure enrollee cost-sharing and other 
                health plan design elements to encourage enrollees to 
                consume high-value clinical services;
                    ``(D) model plans allowing for significant 
                variation in health plan benefit design; or
                    ``(E) any other model plan determined appropriate 
                by the Secretary.''.
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