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PPACA revamp provision: Feds emphasize limits

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Obama administration officials are telling states not to get too excited about a section of the Patient Protection and Affordable Care Act (PPACA) that could let a state revamp its version of PPACA rules and programs.

The U.S. Department of Health and Human Services (HHS) and the U.S. Treasury Department are about to give states advice about how to interpret PPACA Section 1332, which created the Waivers for State Innovation program, in a batch of PPACA Section 1332 guidance.

Some consultants have suggested that a state could use PPACA Section 1332 waivers to, in effect, “reboot PPACA,” or create a “PPACA 2.0″ program.

See also: Medicaid alternative architect drafting PPACA 2.0 proposal

In the new guidance, which is set to appear in the Federal Register Wednesday, HHS and Treasury officials say Section 1332 puts strict limits on the secretaries’ discretion to waive PPACA rules.

The secretaries can approve a waiver only if a state’s program would “provide coverage to a comparable number of residents of the state as would be provided coverage absent the waiver,” officials say in a preliminary version of the guidance.

The revamped coverage must also be at least as comprehensive and affordable as ordinary PPACA coverage, officials say.

“Increasing the number of state residents with large health care spending burdens would cause a waiver to fail the affordability requirement, even if the waiver would increase affordability for many other state residents,” officials say.

An affordability assessment will take into account “the effects across different groups of state residents, and, in particular, vulnerable residents, including low-income individuals, elderly individuals, and those with serious health issues or who have a greater risk of developing serious health issues,” officials add.

A state that submits a waiver proposal is supposed to show how the proposal would affect low-income people, elderly people and people with serious health problems.

A state can start applying for waivers after Jan. 1, 2017. The waivers that are approved can last for periods of up to five years.

The Center for Consumer Information & Insurance Oversight (CCIIO), an arm of HHS, set up a public Section 1332 document library in July.

See also: Feds create PPACA Web revamp page


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