,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #ahda  ,,in ,,the ,,house ,,of  
,,representatives  ,may #f1 #bjac ,mr4  
,welch introduced the following bill2   
which was referred to the ,committee on 
,energy and ,commerce1 and in addition  
to the ,committee on ,ways and ,means1  
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
provide for an earlier start for ,state 
health care coverage innovation waivers 
under the ,patient ,protection and      
,affordable ,care ,act1 and for other   
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,state ,leadership  
in ,health ,care ,act4  #b4 ,earlier    
start for ,state health care coverage   
innovation waivers  7a7 ,in general     
,section #accb of the ,patient          
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjeb7 is amended--     
7#a7 in subsection 7a77#a71 by striking 

,january #a1 #bjag and inserting        
,january #a1 #bjae2 and  7#b7 by        
amending subsection 7e7 to read as      
follows3  7e7 ,term of waiver  7#a7 ,in 
general ,no waiver under this section   
may extend over a period of more than #e
 years unless the ,state requests       
continuation of such waiver and such    
request is granted by the ,secretary    
under paragraph 7#b74  7#b7 ,approval of
 request  7,a7 ,in general ,a request   
under paragraph 7#a7 shall be deemed    
granted unless the ,secretary1 not later
 than #ij days after the date of        
submission to the ,secretary of such    
request1 either denies such request in  
writing or informs the ,state in writing
 with respect to any additional         
information that is needed in order to  
make a final determination with respect 
to the request4  7,b7 ,denial of request
 ,the ,secretary may deny such a request
 only if the ,secretary--  7i7          
determines that the ,state plan under   
the waiver to be continued did not meet 

the requirements under subsection 7b72  
7ii7 notifies the ,state in writing of  
the requirements under subsection 7b7   
that the ,state plan did not meet and   
provides to the ,state the information  
used by the ,secretary in making that   
determination2 and  7iii7 provides the  
,state with an opportunity to appeal    
such determination and provide          
information as to how such requirements 
were met4  7,c7 ,reconsideration of     
request ,in the case of an appeal       
described in subparagraph 7,b77iii71 the
 ,secretary shall consider any          
information provided under such clause  
and reconsider the determination made   
under subparagraph 7,b77i71 and shall   
issue a written decision on such appeal 
not later than #fj days after the date  
on which the ,secretary receives notice 
of such appeal4 ,the ,secretary shall   
grant the request if the ,secretary     
determines upon reconsideration that the
 ,state plan meets such requirements4  4