CMS Issues Guidance Implementing Rule To Improve Section 1115 Waiver Process

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By Ralph Lindeman  

The Centers for Medicare & Medicaid Services April 27 issued guidance on the process the agency will use to review and approve state demonstration projects under Medicaid and the Children's Health Insurance Program (CHIP).

The guidance explains how CMS plans to implement a final rule it issued in February that sets out requirements for improving public input and transparency in the process the agency uses to handle requests by states to conduct demonstration projects (35 HCDR, 2/23/12).

The demonstration projects, authorized under Section 1115 of the Social Security Act, allow states to test new coverage and delivery models after obtaining so-called Section 1115 waivers from CMS.

Medicaid stakeholders have complained for years about a lack of public input into the design of state demonstration projects authorized under Section 1115 waivers. The final rule, which became effective April 27, applies to applications for new demonstration projects and applications for extensions of existing projects.

User Guide Also Available.

The CMS guidance, which was issued along with a letter to state Medicaid directors, explains that CMS is making available a user guide for stakeholder organizations interested in participating in the enhanced public notice and comment process the final rule requires.

The user guide is designed to assist interested parties in navigating a new part of the CMS website, where information about approved and pending Section 1115 waiver applications is available for review.

In addition, the guide provides information about how to access the public comment feature for pending demonstration applications and amendment requests, CMS said.

CMS said it will also post on its website state applications for Section 1115 waivers and will enable the public to submit comments on a specific application.

In the final rule, CMS said it will not make a final decision on a state application until 45 days after it is complete, to allow CMS to consider public comments submitted during a 30-day comment period.

After approval of a demonstration project, CMS said it will maintain and publish on its website an administrative record that will include the demonstration application, public comments sent to CMS and, if the application is approved, final special terms and conditions for the project

By Ralph Lindeman  

The CMS guidance, along with links to the letter to Medicaid directors and the CMS user guide, is at

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