S.Amdt. 2846

SA 2846. Mr. SANDERS (for himself and Mr. Wyden) submitted an
amendment intended to be proposed to amendment SA 2786 proposed by Mr.
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the
first-time homebuyers credit in the case of members of the Armed Forces
and certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

Strike section 1332 and insert the following:

SEC. 1332. WAIVER FOR STATE INNOVATION.

(a) Application.--
(1) In general.--A State may apply to the Secretary for the
waiver of all or any requirements described in paragraph (2)
with respect to health insurance coverage within that State
for plan years beginning on or after January 1, 2014. Such
application shall--
(A) be filed at such time and in such manner as the
Secretary may require;
(B) contain such information as the Secretary may require,
including--
(i) a comprehensive description of the State legislation
and program to implement a plan meeting the requirements for
a waiver under this section; and
(ii) a 10-year budget plan for such plan that is budget
neutral for the Federal Government; and

[[Page S12254]]

(C) provide an assurance that the State has enacted the law
described in subsection (b)(2).
(2) Requirements.--The requirements described in this
paragraph with respect to health insurance coverage within
the State for plan years beginning on or after January 1,
2014, are as follows:
(A) Part I of subtitle D.
(B) Part II of subtitle D.
(C) Section 1402.
(D) Sections 36B, 4980H, and 5000A of the Internal Revenue
Code of 1986.
(3) Pass through of funding.--With respect to a State
waiver under paragraph (1), under which, due to the structure
of the State plan, individuals and small employers in the
State would not qualify for the premium tax credits, cost-
sharing reductions, or small business credits under sections
36B of the Internal Revenue Code of 1986 or under part I of
subtitle E for which they would otherwise be eligible, the
Secretary shall provide for an alternative means by which the
aggregate amount of such credits or reductions that would
have been paid on behalf of participants in the Exchanges
established under this title had the State not received such
waiver, shall be paid to the State for purposes of
implementing the State plan under the waiver. Such amount
shall be determined annually by the Secretary, taking into
consideration the experience of other States with respect to
participation in an Exchange and credits and reductions
provided under such provisions to residents of the other
States, except that the Secretary shall determine such amount
on the basis of reasonable estimates until such time as data
regarding the experiences of other States become available
and if such estimates are determined to be incorrect on the
basis of such data, the Secretary shall adjust subsequent
payments to correct errors in earlier payments that were
based on such estimates.
(4) Waiver consideration and transparency.--
(A) In general.--An application for a waiver under this
section shall be considered by the Secretary in accordance
with the regulations described in subparagraph (B).
(B) Regulations.--Not later than 180 days after the date of
enactment of this Act, the Secretary shall promulgate
regulations relating to waivers under this section that
provide--
(i) a process for public notice and comment at the State
level, including public hearings, sufficient to ensure a
meaningful level of public input;
(ii) a process for the submission of an application that
ensures the disclosure of--

(I) the provisions of law that the State involved seeks to
waive; and
(II) the specific plans of the State to ensure that the
waiver will be in compliance with subsection (b);

(iii) a process for providing public notice and comment
after the application is received by the Secretary, that is
sufficient to ensure a meaningful level of public input and
that does not impose requirements that are in addition to, or
duplicative of, requirements imposed under the Administrative
Procedures Act, or requirements that are unreasonable or
unnecessarily burdensome with respect to State compliance;
(iv) a process for the submission to the Secretary of
periodic reports by the State concerning the implementation
of the program under the waiver; and
(v) a process for the periodic evaluation by the Secretary
of the program under the waiver.
(C) Report.--The Secretary shall annually report to
Congress concerning actions taken by the Secretary with
respect to applications for waivers under this section.
(5) Coordinated waiver process.--The Secretary shall
develop a process for coordinating and consolidating the
State waiver processes applicable under the provisions of
this section, and the existing waiver processes applicable
under titles XVIII, XIX, and XXI of the Social Security Act,
and any other Federal law relating to the provision of health
care items or services. Such process shall permit a State to
submit a single application for a waiver under any or all of
such provisions.
(6) Definition.--In this section, the term ``Secretary''
means--
(A) the Secretary of Health and Human Services with respect
to waivers relating to the provisions described in
subparagraph (A) through (C) of paragraph (2); and
(B) the Secretary of the Treasury with respect to waivers
relating to the provisions described in paragraph (2)(D).
(b) Granting of Waivers.--
(1) In general.--The Secretary may grant a request for a
waiver under subsection (a)(1) only if the Secretary
determines that the State plan--
(A) will provide coverage that is at least as comprehensive
as the coverage defined in section 1302(b) and offered
through Exchanges established under this title as certified
by Office of the Actuary of the Centers for Medicare &
Medicaid Services based on sufficient data from the State and
from comparable States about their experience with programs
created by this Act and the provisions of this Act that would
be waived;
(B) will provide coverage and cost sharing protections
against excessive out-of-pocket spending that are at least as
affordable as the provisions of this title would provide;
(C) will provide coverage to at least a comparable number
of its residents as the provisions of this title would
provide; and
(D) will not increase the Federal deficit.
(2) Requirement to enact a law.--
(A) In general.--A law described in this paragraph is a
State law that provides for State actions under a waiver
under this section, including the implementation of the State
plan under subsection (a)(1)(B).
(B) Termination of opt out.--A State may repeal a law
described in subparagraph (A) and terminate the authority
provided under the waiver with respect to the State.
(c) Scope of Waiver.--
(1) In general.--The Secretary shall determine the scope of
a waiver of a requirement described in subsection (a)(2)
granted to a State under subsection (a)(1).
(2) Limitation.--The Secretary may not waive under this
section any Federal law or requirement that is not within the
authority of the Secretary.
(d) Determinations by Secretary.--
(1) Time for determination.--The Secretary shall make a
determination under subsection (a)(1) not later than 180 days
after the receipt of an application from a State under such
subsection.
(2) Effect of determination.--
(A) Granting of waivers.--If the Secretary determines to
grant a waiver under subsection (a)(1), the Secretary shall
notify the State involved of such determination and the terms
and effectiveness of such waiver.
(B) Denial of waiver.--If the Secretary determines a waiver
should not be granted under subsection (a)(1), the Secretary
shall notify the State involved, and the appropriate
committees of Congress of such determination and the reasons
therefore.
(e) Term of Waiver.--
(1) In general.--No waiver under this section may extend
over a period of longer than 5 years unless the State
requests continuation of such waiver and such request is
granted by the Secretary under paragraph (2).
(2) Approval of request.--A request under paragraph (1)
shall be deemed granted unless the Secretary, within 90 days
after the date of its submission to the Secretary, either
denies such request in writing or informs the State in
writing with respect to any additional information which is
needed in order to make a final determination with respect to
the request. The Secretary may deny such a request only if
the Secretary--
(A) determines that the State plan under the waiver to be
continued did not meet the requirements under subsection (b);
(B) notifies the State in writing of the requirements under
subsection (b) that the State plan did not meet and provides
to the State the information used by the Secretary in making
that determination; and
(C) provides the State with an opportunity to appeal such
determination and provide information as to how such
requirements were met.

The Secretary shall consider any information provided under
subparagraph (C) and reconsider its determination under
subparagraph (A). The Secretary shall grant the request if
the Secretary determines upon reconsideration that the State
plan met such requirements.
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