,i #aafth ,,congress #ast ,session ,h4 ,r4 #bahc ,,in ,,the ,,house ,,of ,,representatives ,april #i1 #bjai ,mr4 ,marshall 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 amend the ,patient ,protection and ,affordable ,care ,act to streamline the ,state innovation waiver process1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,state ,flexibility and ,patient ,choice ,act of #bjai4 #b4 ,streamlining the ,state innovation waiver process ,section #accb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjeb7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,b77ii71 by inserting over both the term of the proposed waiver and the #aj-year budget plan after ,government2 and 7ii7 in subparagraph 7,c71 by striking the law described in subsection 7b77#b7 and inserting a law or has in effect a certification described in subsection 7b77#c72 and 7,b7 in paragraph 7#c7-- 7i7 in the first sentence-- 7,i7 by inserting or would qualify for a lesser amount of after would not qualify for2 7,,ii7 by inserting 1 or the ,state would not qualify for or would qualify for a lesser payment under section #acca1 after subtitle ,e2 7,,iii7 by inserting 1 or on behalf of participants in a basic health program established under section #acca had such participants been enrolled in an ,exchange1 after this title2 and 7,,iv7 by inserting or for implementing a basic health program established under section #acca before the period2 and 7ii7 in the second sentence1 by inserting before the period the following3 1 and with respect to participation in the basic health program and funds provided to such other ,states under section #acca2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,b71 by striking at least as affordable and inserting of comparable affordability2 and 7ii7 in subparagraph 7,d71 by inserting over the term of the waiver and over the #aj-year budget plan with respect to such waiver before the period at the end2 7,b7 by redesignating paragraph 7#b7 as paragraph 7#c72 7,c7 by inserting after paragraph 7#a7 the following new paragraph3 7#b7 ,budgetary effect 7,a7 ,in general ,in determining whether a ,state plan submitted under subsection 7a7 meets the deficit neutrality requirements of paragraph 7#a77;,d71 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 7a77#c74 2 and 7,d7 in paragraph 7#c7 7as so redesignated7-- 7i7 in the paragraph heading1 by inserting ,,or ,,have ,,in ,,effect ,a ,,certification after ,,law2 7ii7 in subparagraph 7,a7-- 7,i7 by striking ,a law and inserting the following3 7i7 ,laws ,a law 2 and 7,,ii7 by adding at the end the following3 7ii7 ,certifications ,a certification described in this paragraph is a document1 signed by the ,governor of the ,state1 that certifies that such ,governor has the authority under existing ,state law to take action under this section1 including implementation of the ,state plan under subsection 7a77#a77;,b74 2 and 7iii7 in subparagraph 7,b7-- 7,i7 in the subparagraph heading1 by striking ,,of ,,opt ,,out2 and 7,,ii7 by striking may repeal a law and all that follows through the period at the end and inserting the following3 may terminate the authority provided under the waiver with respect to the ,state by-- 7i7 repealing the law described in subparagraph 7,a77i72 or 7ii7 terminating the certification described in subparagraph 7,a77ii71 through a certification for such termination signed by the ,governor of the ,state4 2 7#c7 in subsection 7d7-- 7,a7 in paragraph 7#a71 by striking #ahj and inserting #ij2 and 7,b7 by adding at the end the following new paragraph3 7#c7 ,expedited determination 7,a7 ,in general ,with respect to any application under subsection 7a77#a7 submitted on or after the date of the enactment of this paragraph1 the ,secretary shall make a determination on such application1 using the criteria for approval otherwise applicable under this section1 not later than #fj days after the receipt of such application and shall allow the public notice and comment at the ,state and ,federal levels described under subsection 7a77#d7 to occur concurrently if such ,state application-- 7i7 is submitted in response to an urgent situation1 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 year2 or 7ii7 is for a waiver that is the same or substantially similar to a waiver that the ,secretary already has approved for another ,state4 7,b7 ,approval limitations for urgent situations 7i7 ,provisional approval ,a waiver approved under the expedited determination process under subparagraph 7,a77i7 may extend over a period of not longer than #c years4 7ii7 ,full approval ,subject to the requirements for approval otherwise applicable under this section1 not later than #a year before the expiration of a provisional waiver period described in clause 7i7 with respect to an application described in subparagraph 7,a77i71 the ,secretary shall make a determination on whether to extend the term of such waiver for longer than the period described in clause 7i71 for a total waiver term not to exceed #f years4 ,the ,secretary may request additional information as the ,secretary determines appropriate to make such determination4 7,c7 ,,gao study ,not later than #e years after the date of enactment of the ,state ,flexibility and ,patient ,choice ,act of #bjai1 the ,comptroller ,general of the ,united ,states shall conduct a review of all waivers approved pursuant to an application under subparagraph 7,a77ii7 to evaluate whether such waivers met the requirements of subsection 7b77#a7 and whether the applications should have qualified for such an expedited determination4 2 7#d7 in subsection 7e71 by inserting 7or1 in the case of an application under subsection 7a77#a7 submitted on or after the date of the enactment of the ,state ,flexibility and ,patient ,choice ,act of #bjai1 #f years7 after #e years2 and 7#e7 by adding at the end the following new subsection3 7f7 ,additional provisions ,in carrying out this section1 the ,secretary shall-- 7#a7 issue guidance1 not later than #cj days after the date of the enactment of this subsection1 that includes initial examples of model ,state plans that may meet the requirements for approval under this section2 and 7#b7 periodically review the guidance issued under paragraph 7#a7 and1 when appropriate1 issue additional examples of model ,state plans that may meet the requirements for approval under this section1 which may include-- 7,a7 model plans establishing reinsurance or invisible high-risk pool arrangements for purposes of covering the cost of high-risk individuals2 7,b7 model plans expanding insurer participation1 access to affordable health plans1 network adequacy1 and health plan options over the entire applicable health insurance market in the ,state2 7,c7 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 services2 7,d7 model plans allowing for significant variation in health plan benefit design2 or 7,e7 any other model plan determined appropriate by the ,secretary4 4