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1332 State Innovation Waivers
To receive approval, the state must demonstrate that a proposed waiver will provide access to quality health
Before submitting its Section 1332 waiver application the state must also provide a public notice and comment period, including public hearings, sufficient to ensure a meaningful level of public input, and enact a law providing for implementation of the waiver.
Under a Section 1332 waiver, a state may receive pass-through funding associated with the resulting reductions in federal spending on Marketplace financial assistance consistent with the statute.
Fiscal Year 2016: N/A.
Fiscal Year 2017: Alaska 1332 Waiver Program request to establish a state-re-insurance program
Hawaii 1332 Waiver Program request to waive key SHOP requirements to implement the Hawaii Prepaid Healthcare Act.
Fiscal Year 2018: N/A.
The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.
Selected Recipients for this Program
| Recipient | Amount | Start Date | End Date | |
| New Hampshire Individual Health Plan Benefit Association | $ 22,723,855 | 2021-01-01 | 2025-12-31 | |
| Insurance, Pennsylvania Department Of | $ 91,671,799 | 2021-01-01 | 2025-12-31 | |
| State Auditor, Montana | $ 46,179,502 | 2020-01-01 | 2024-12-31 | |
| Insurance, North Dakota Dept Of | $ 36,172,111 | 2020-01-01 | 2024-12-31 | |
| Executive Office Of State Of Rhode Island | $ 15,041,624 | 2020-01-01 | 2024-12-31 | |
| Health And Social Services, Delaware Department Of | $ 49,737,988 | 2020-01-01 | 2024-12-31 | |
| Banking And Insurance, New Jersey Department Of | $ 593,394,539 | 2019-01-01 | 2023-12-31 | |
| Maryland Health Benefit Exchange | $1,156,056,201 | 2019-01-31 | 2023-12-31 | |
| Executive Office Of The State Of Wisconsin | $ 435,448,327 | 2019-01-01 | 2023-12-31 | |
| Maine Guaranteed Access Reinsurance Association | $ 119,343,902 | 2019-01-01 | 2023-12-31 |
Program Accomplishments
Fiscal Year 2016: N/A. Fiscal Year 2017: It is expected that 4 requests and 2 awards will be made in FY17. Fiscal Year 2018: It is expected that 8 requests and 8 awards will be made in FY18.
Uses and Use Restrictions
Federal passthrough funding made available through Section 1332 must be used only to implement the waiver program.
Passthrough funding is equivalent to the amount of premium tax credits (PTC) that would have been provided to individuals in a state under Section 36B of the Internal Revenue Code but will not be provided under the waiver program, while considering all federal revenue.
Federal passthrough funding made available through Section 1332 must be used only to implement the waiver program.
The passthrough funds cannot be obligated by the state prior to the waiver effective date.
The state agrees to use the full amount of passthrough funding for purposes of implementing the state?s plan as approved by the Departments.
To the extent any passthrough funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implement the state?s plan under the waiver.
If the waiver is not extended or is suspended/terminated, unused passthrough funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so.
Eligibility Requirements
Applicant Eligibility
This funding opportunity is only open to US States, Terrortories and Possessions.
Beneficiary Eligibility
N/A.
Credentials/Documentation
Written notification from HHS/CMS that a complete 1332 Waiver Application package has been submitted for review. 2 CFR 200, Subpart E - Cost Principles applies to this program.
Aplication and Award Process
Preapplication Coordination
N/A.
Environmental impact information is not required for this program.
This program is excluded from coverage under E.O.
12372.
Application Procedures
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. N/A
Award Procedures
OMB Circular N. A-102 applies. Applicants must complete a 1332 Waiver Program application package available at http://XXXXXXXXXXXX. This package must be submitted via Grants.gov. HHS/CMS will review the request and coordinate accordingly with the applicant. A review team will review the package and make recommendaitons. The final approval authority rest with the Secretary of Health and Human Services.
Deadlines
Not Applicable.
Authorization
The Affordable Care Act, Section 1332.
Range of Approval/Disapproval Time
No more than 180 days from the determination of application completeness of a 1332 Waiver Program application.
Appeals
Not Applicable.
Renewals
Not Applicable.
Assistance Considerations
Formula and Matching Requirements
This program has no statutory formula. This program has no matching requirements. This program has MOE requirements, see funding agency for further details. Maintenance of Effort requirements, as applicable, will be detailed in a grantee?s Special Terms and Conditions document. States will only receive federal passthrough funding assistance to which it has been calculated they are entitled in accordance with statutory and regulatory requirements, and are expected to supplement any remaining costs of the waiver program with state and/or other funding sources.
Length and Time Phasing of Assistance
The passthrough funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of passthrough funding for purposes of implementing the state?s plan as approved by the Departments. To the extent any passthrough funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implement the state?s plan under the waiver. The default waiver period is five years, but waivers can be extended beyond that timeframe. If the waiver is not extended or if it is suspended/terminated, unused passthrough funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so. Assistance is in the form of a grant, and will be released using the Payment Management System on a quarterly basis. Method of awarding/releasing assistance: quarterly.
Post Assistance Requirements
Reports
Progress Reports.
SF 424 and 424A SF425 quarterly and final.
The state must submit annual and periodic reports pursuant to 31 CFR 33.120 and 33.124, as well as 45 CFR 155.1320 and 155.1324.
Annual reports must indicate:
- Progress of the waiver;
- Data sufficient to show compliance with Sections 1332(b)(1)(A)-(D) of the PPACA;
- A summary of the annual post-award public forum; and
- Other information consistent with the state?s approved terms and conditions.
Periodic reports must indicate progress as determined through periodic state-led reviews related to the implementation of the waiver.
Expenditure Reports.
Yes ? states must conduct periodic reviews and report on progress, including relevant data metrics, as laid out in the specific terms and conditions of the state?s waiver.
Additionally, pursuant to 31 CFR 33.120(f) and 45 CFR 155.1320(f), at the request of the Departments of Health and Human Services and Treasury (the Departments), states must fully cooperate with the Departments or an independent evaluator selected by the Departments to undertake an independent evaluation of any component of the waiver.
Finally, the state must participate in all monitoring calls with the Departments that the Departments deem necessary.
Audits
In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503.
Records
The draft and final annual reports are to be published on a State?s public Web site within 30 days of submission to and approval by the Secretary of Health and Human Services, respectively.
Financial Information
Account Identification
20-0949-0-1-551 - 20-0949-0-1-551 ? APTC and CSR payments. 20-0951-0-1-551 ? SBTC payments.
Obigations
(Cooperative Agreements) FY 16 $0; FY 17 Estimate Not Available(Exp: TBD); and FY 18 Estimate Not Available(Exp: TBD)
Range and Average of Financial Assistance
TBD.
Regulations, Guidelines, and Literature
Regulations governing the application process for State Innovation Waivers can be found at the Federal Register at 77 Fed. Reg. 11700 (Feb. 27, 2012). Among other things, these regulations provide guidance on how to apply for a waiver and what an application from a state must contain, including actuarial and economic analyses. The regulations detail public notice and comment requirements that a state must comply with before an application is submitted, including holding public hearings, in order to facilitate a meaningful level of public involvement, input, and transparency in the state application process. They also describe the Federal public notice and comment process that will occur after a completed application has been received. The regulations also describe the requirements for post-award reporting and the standards under which post-award monitoring will take place. In December of 2015, the Departments of Health and Human Services and Treasury (Departments) released Federal Register guidance at 80 Fed. Reg. 11700 (December 16, 2015) that provided additional information on PPACA Section 1332?s statutory requirements. On May 11, 2017, Departments posted a 1332 waiver application checklist to help states as they develop and complete the required elements of their applications. This checklist follows a March 2017 letter from U.S. Health and Human Services? Secretary Price to all states encouraging the use of innovative strategies to strengthen their health insurance markets.
Information Contacts
Regional or Local Office
None.
Headquarters Office
Michelle Koltov 7500 Security Blvd., Baltimore, Maryland 21244 Email: Michelle.Koltov@cms.hhs.gov Phone: 301-492-4225
Criteria for Selecting Proposals
Not Applicable.
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