,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #bahc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #i1 #bjai ,mr4 
,m>%all introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d ! ,pati5t  
,protection & ,af=dable ,c>e ,act to    
/reaml9e ! ,/ate innovation waiv]       
process1 & = o!r purposes4  #a4 ,%ort   
title ,?is ,act may be cit$ z ! ,/ate   
,flexibility & ,pati5t ,*oice ,act (    
#bjai4  #b4 ,/reaml9+ ! ,/ate innovation
 waiv] process ,section #accb ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjeb7 is am5d$--  
7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 
7#a7--  7i7 9 subp>agraph 7,b77ii71 by  
ins]t+ ov] bo? ! t]m ( ! propos$ waiv] &
 ! #aj-ye> budget plan aft] ,gov]nm5t2 &
  7ii7 9 subp>agraph 7,c71 by /rik+ !   

law describ$ 9 subsection 7b77#b7 &     
ins]t+ a law or has 9 effect a          
c]tification describ$ 9 subsection      
7b77#c72 &  7,b7 9 p>agraph 7#c7-- 7i7 9
 ! fir/ s5t5ce--  7,i7 by ins]t+ or w\ld
 qualify = a less] am\nt ( aft] w\ld n  
qualify =2  7,,ii7 by ins]t+ 1 or !     
,/ate w\ld n qualify = or w\ld qualify =
 a less] paym5t "u section #acca1 aft]  
subtitle ,e2  7,,iii7 by ins]t+ 1 or on 
behalf ( p>ticipants 9 a basic heal?    
program e/abli%$ "u section #acca _h su*
 p>ticipants be5 enroll$ 9 an ,ex*ange1 
aft] ?is title2 &  7,,iv7 by ins]t+ or =
 implem5t+ a basic heal? program        
e/abli%$ "u section #acca be=e ! p]iod2 
&  7ii7 9 ! second s5t5ce1 by ins]t+    
be=e ! p]iod ! foll[+3 1 & ) respect to 
p>ticipation 9 ! basic heal? program &  
funds provid$ to su* o!r ,/ates "u      
section #acca2  7#b7 9 subsection 7b7-- 
7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph
 7,b71 by /rik+ at lea/ z af=dable &    
ins]t+ ( comp>able af=dability2 &  7ii7 
9 subp>agraph 7,d71 by ins]t+ ov] ! t]m 

( ! waiv] & ov] ! #aj-ye> budget plan ) 
respect to su* waiv] be=e ! p]iod at !  
end2  7,b7 by r$esignat+ p>agraph 7#b7 z
 p>agraph 7#c72  7,c7 by ins]t+ aft]    
p>agraph 7#a7 ! foll[+ new p>agraph3    
7#b7 ,budget>y effect  7,a7 ,9 g5]al ,9 
det]m9+ :e!r a ,/ate plan submitt$ "u   
subsection 7a7 meets ! deficit          
neutrality requirem5ts ( p>agraph       
7#a77;,d71 ! ,secret>y %all take into   
consid]ation ! direct budget>y effect ( 
! provisions ( su* plan on s\rces (     
,f$]al fund+ o!r ?an ! fund+ describ$ 9 
subsection 7a77#c74  2 &  7,d7 9        
p>agraph 7#c7 7z s r$esignat$7-- 7i7 9 !
 p>agraph head+1 by ins]t+ ,,or ,,h ,,9 
,,effect ,a ,,c]tification aft] ,,law2  
7ii7 9 subp>agraph 7,a7-- 7,i7 by /rik+ 
,a law & ins]t+ ! foll[+3  7i7 ,laws ,a 
law  2 &  7,,ii7 by add+ at ! end !     
foll[+3  7ii7 ,c]tifications ,a         
c]tification describ$ 9 ?is p>agraph is 
a docum5t1 sign$ by ! ,gov]nor ( !      
,/ate1 t c]tifies t su* ,gov]nor has !  
au?ority "u exi/+ ,/ate law to take     

action "u ?is section1 includ+          
implem5tation ( ! ,/ate plan "u         
subsection 7a77#a77;,b74  2 &  7iii7 9  
subp>agraph 7,b7--  7,i7 9 ! subp>agraph
 head+1 by /rik+ ,,( ,,opt ,,out2 &     
7,,ii7 by /rik+ may repeal a law & all t
 foll[s ?r\gh ! p]iod at ! end & ins]t+ 
! foll[+3 may t]m9ate ! au?ority provid$
 "u ! waiv] ) respect to ! ,/ate by--   
7i7 repeal+ ! law describ$ 9 subp>agraph
 7,a77i72 or  7ii7 t]m9at+ !            
c]tification describ$ 9 subp>agraph     
7,a77ii71 ?r\gh a c]tification = su*    
t]m9ation sign$ by ! ,gov]nor ( ! ,/ate4
  2  7#c7 9 subsection 7d7-- 7,a7 9     
p>agraph 7#a71 by /rik+ #ahj & ins]t+   
#ij2 &  7,b7 by add+ at ! end ! foll[+  
new p>agraph3  7#c7 ,exp$it$ det]m9ation
  7,a7 ,9 g5]al ,) respect to any       
application "u subsection 7a77#a7       
submitt$ on or aft] ! date ( ! enactm5t 
( ?is p>agraph1 ! ,secret>y %all make a 
det]m9ation on su* application1 us+ !   
crit]ia = approval o!rwise applicable "u
 ?is section1 n lat] ?an #fj days aft] !

 receipt ( su* application & %all all[ !
 public notice & comm5t at ! ,/ate &    
,f$]al levels describ$ "u subsection    
7a77#d7 to occur concurr5tly if su*     
,/ate application--  7i7 is submitt$ 9  
response to an urg5t situation1 )       
respect to areas 9 ! ,/ate t ! ,secret>y
 det]m9es are at risk = sub/antial      
increases 9 premium rates or hav+ no    
heal? plans (f]$ 9 ! applicable heal?   
insurance m>ket = ! curr5t or foll[+    
plan ye>2 or  7ii7 is = a waiv] t is !  
same or sub/antially simil> to a waiv] t
 ! ,secret>y already has approv$ = ano!r
 ,/ate4  7,b7 ,approval limitations =   
urg5t situations  7i7 ,provisional      
approval ,a waiv] approv$ "u ! exp$it$  
det]m9ation process "u subp>agraph      
7,a77i7 may ext5d ov] a p]iod ( n long] 
?an #c ye>s4  7ii7 ,full approval       
,subject to ! requirem5ts = approval    
o!rwise applicable "u ?is section1 n    
lat] ?an #a ye> be=e ! expiration ( a   
provisional waiv] p]iod describ$ 9      
clause 7i7 ) respect to an application  

describ$ 9 subp>agraph 7,a77i71 !       
,secret>y %all make a det]m9ation on    
:e!r to ext5d ! t]m ( su* waiv] = long] 
?an ! p]iod describ$ 9 clause 7i71 = a  
total waiv] t]m n to exce$ #f ye>s4 ,!  
,secret>y may reque/ additional         
in=mation z ! ,secret>y det]m9es        
appropriate to make su* det]m9ation4    
7,c7 ,,gao /udy ,n lat] ?an #e ye>s aft]
 ! date ( enactm5t ( ! ,/ate            
,flexibility & ,pati5t ,*oice ,act (    
#bjai1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all conduct a review ( all      
waiv]s approv$ pursuant to an           
application "u subp>agraph 7,a77ii7 to  
evaluate :e!r su* waiv]s met !          
requirem5ts ( subsection 7b77#a7 & :e!r 
! applications %\ld h qualifi$ = su* an 
exp$it$ det]m9ation4  2  7#d7 9         
subsection 7e71 by ins]t+ 7or1 9 ! case 
( an application "u subsection 7a77#a7  
submitt$ on or aft] ! date ( ! enactm5t 
( ! ,/ate ,flexibility & ,pati5t ,*oice 
,act ( #bjai1 #f ye>s7 aft] #e ye>s2 &  
7#e7 by add+ at ! end ! foll[+ new      

subsection3  7f7 ,additional provisions 
,9 c>ry+ out ?is section1 ! ,secret>y   
%all--  7#a7 issue guidance1 n lat] ?an 
#cj days aft] ! date ( ! enactm5t ( ?is 
subsection1 t includes initial examples 
( model ,/ate plans t may meet !        
requirem5ts = approval "u ?is section2 &
  7#b7 p]iodically review ! guidance    
issu$ "u p>agraph 7#a7 &1 :5            
appropriate1 issue additional examples (
 model ,/ate plans t may meet !         
requirem5ts = approval "u ?is section1  
:i* may include--  7,a7 model plans     
e/abli%+ re9surance or invisible        
high-risk pool arrangem5ts = purposes ( 
cov]+ ! co/ ( high-risk individuals2    
7,b7 model plans exp&+ insur]           
p>ticipation1 access to af=dable heal?  
plans1 network adequacy1 & heal? plan   
options ov] ! entire applicable heal?   
insurance m>ket 9 ! ,/ate2  7,c7 model  
plans t enc\rage or require heal? plans 
9 a ,/ate to deploy value-bas$ insurance
 designs :i* /ructure enrollee co/-%>+ &
 o!r heal? plan design elem5ts to       

enc\rage enrollees to consume high-value
 cl9ical s]vices2  7,d7 model plans     
all[+ = significant v>iation 9 heal?    
plan b5efit design2 or  7,e7 any o!r    
model plan det]m9$ appropriate by !     
,secret>y4  4