HHS published a rule on February 27, 2012 that implements the procedural framework for submission and review of State Innovation Waiver applications under section 1332 of the ACA, effective April 27, 2012. Under the rule, states will have flexibility to apply for a State Innovation Waiver to pursue their own strategies to provide their residents with access to high quality, affordable health insurance. The program is intended to allow states to implement policies that differ from those in the ACA if: they provide coverage that is at least as comprehensive and affordable as the coverage offered through Health Insurance Exchanges; the state provides coverage to at least as many residents as otherwise would have been covered under the ACA; and the policies do not increase the federal deficit. The final rules reflect limited changes to the March 14, 2011 proposed rules based on public comments, including clarification that a state does not have to enact a new law to support a section 1332 waiver if the state already has a law in place.