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Georgia's 1332 Waiver to Be Approved, the State Must Demonstrate That the Waiver Complies with the Four "Guardrails” As Listed Below

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Georgia's 1332 Waiver to Be Approved, the State Must Demonstrate That the Waiver Complies with the Four STATE OF GEORGIA OFFICE OF THE GOVERNOR ATLANTA 30334-0900 Brian P. Kemp GOVERNOR July 31, 2020 The Honorable Alex M. Azar II, Secretary U.S. Department of Health and Human Services The Honorable Steven T. Mnuchin, Secreta1y U.S. Department of the Treasury Ms. Seema Verma, Administrator Centers forMedicare & Medicaid Services Dear Secretary Azar, Secretary Mnuchin, and Administrator Verma: The State of Georgia is pleased to submit to the U.S. Depaitment of Health and Human Services (DHSS) the enclosed modifiedSection 1332 State Relief and Empowerment Waiver. The Georgia General Assembly authorized this waiver application with the passage of the Patients First Act, which I signed into law on March 27, 2019. On July 8, 2020, I requested the Departments pause their review of the State's previously submitted 1332 waiver application. Georgia, like most states across the country, had unanticipated budget constraints that emerged and will continue to develop as a result of the COVID-19 pandemic. The State took the opportunity to modify the original waiver application to begin the Reinsurance Program in Plan Year 2022, a shift fromthe originally proposed Plan Year 2021 start date, and to begin the modified Georgia Access Model in Plan Year 2022. The modified waiver also makes minor modificationsto the program design for the Georgia Access Model. Georgia provided the public an oppmtunity to comment on these minor modifications during an additional 15-day public comment period from July 9, 2020 through July 23, 2020. The comments received online, by mail, and from the two in-person/vhtual hearings and the State's responses are included within this waiver application. In Part I of this application, Georgia is requesting a five-yearwaiver of PPACA Title I, Subtitle D, Part II, Section 1312(c)(1) effectivebeginning PY 2022 to establish a statewide reinsurance program. In Part II of this application, Georgia is requesting to waive PPACA Title I, Subtitle D, Part II Section 1311 in part, which requires states to either operate a state-based exchange or paiticipate in the FFE, in order to implement an innovative, consumer-central model, Georgia Access. As demonstrated in the Georgia Section 1332 State Empowerment and Relief Waiver Application July 31, 2020 The Office of the Governor 1332 WAIVER APPLICATION 07/31/2020 Table of Contents Executive Summary ........................................................................................................................ 1 Current Landscape....................................................................................................................... 1 Innovative Solutions Proposed in this Section 1332 Waiver ...................................................... 3 Part I: Reinsurance Program .................................................................................................... 3 Part II: Georgia Access Model ................................................................................................ 4 Part I: Reinsurance .......................................................................................................................... 5 Section I: Program Overview ...................................................................................................... 5 Section II: Authorizing Legislation ............................................................................................. 6 Senate Bill 106: Patients First Act........................................................................................... 6 House Bill 186: The Health Act .............................................................................................. 7 Section III: Provisions of the Law the State is Seeking to Waive............................................... 7 Section IV: Compliance with Guardrails: Data, Analyses, and Certifications ........................... 8 Section V: Alignment with Principles ......................................................................................... 9 Section VI: Reporting Targets..................................................................................................... 9 Section VII: Implementation Plan and Timeline....................................................................... 10 Section VIII: Public Notice, Comment Process, and Communications Plan ............................ 11 Public Notice ......................................................................................................................... 12 Public Comment Process ....................................................................................................... 13 Reinsurance Program Comments .......................................................................................... 14 Tribal Consultation ................................................................................................................ 14 Section IX: Additional Information .......................................................................................... 14 Administrative Burden for Individuals, Issuers, or Employers ............................................. 14 Impact of PPACA Provisions Not Being Waived ................................................................. 14 Impact on Residents Who Need to Obtain Healthcare Services Out-of-State ...................... 14 Providing the Federal Government Information to Administer the Waiver .......................... 15 Guarding Against Fraud, Waste, and Abuse ......................................................................... 15 Information on Groups Convened to Develop This Waiver ................................................. 15 Section X: Administration ......................................................................................................... 15 Part II: Georgia Access Model ...................................................................................................... 17 Section I: Program Overview .................................................................................................... 17 Program Design – Access ...................................................................................................... 17 Program Design – APTC Eligibility and Issuance ................................................................ 19 1332 WAIVER APPLICATION 07/31/2020 Program Design – State IT Infrastructure ............................................................................. 19 Projected Impact on Consumers ............................................................................................ 21 Section II: Authorizing Legislation ........................................................................................... 21 Senate Bill 106: Patients First Act......................................................................................... 21 House Bill 186: The Health Act ............................................................................................ 22 Section III: Provision of the Law the State is Seeking to Waive .............................................. 22 Section IV: Compliance with Guardrails: Data, Analysis, and Certifications. ......................... 23 Section V: Alignment with Principles ....................................................................................... 24 Section VI: Reporting Targets................................................................................................... 25 Section VII: Implementation Plan and Timeline....................................................................... 25 Section VIII: Public Notice, Comment Process, and Communications Plan ............................ 27 Public Notice ......................................................................................................................... 28 Public Comment Process ....................................................................................................... 29 Georgia Access Model Comments ........................................................................................ 30 Tribal Consultation ................................................................................................................ 33 Section IX: Additional Information .......................................................................................... 33 Administrative Burden for Individuals, Issuers, or Employers ............................................. 33 Impact of PPACA Provisions Not Being Waived ................................................................. 34 Impact on Residents Who Need to Obtain Healthcare Services Out-of-State ...................... 34 Providing the Federal Government Information to Administer the Waiver .......................... 34 Guarding Against Fraud, Waste, and Abuse ......................................................................... 34 Information on Groups Convened to Develop This Waiver ................................................. 35 Section X: Administration ......................................................................................................... 35 Appendix A: Letter of Support ..................................................................................................... 37 Appendix B: Authorizing Legislation ........................................................................................... 38 Appendix C: Actuarial and Economic Analysis ........................................................................... 46 Appendix D: Public Notice ........................................................................................................
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