CMS Plans To Streamline Medicaid Demonstration Waiver Renewals
The waivers, known as Section 1115 waivers, request federal grants to test Medicaid initiatives that would not otherwise be permitted under the program. For example, states can use the waivers to change benefits offered under Medicaid or to alter eligibility requirements for the program.
The current waiver process has encountered mounting criticism, after some requests have been active for years, according to Modern Healthcare.
In response, CMS will implement a "fast-track" federal review process for Section 1115 waivers. The process uses a streamlined extension application template.
To support the changes, CMS has created a new unit for reviewing Section 1115 waivers and has increased staffing at the agency.
To qualify for the fast-track process, demonstrations must be established, meaning they have gone through at least one full extension cycle without making any significant changes.
The demonstrations must report deliverables, as well as show positive evaluation and monitoring results that align with the goals of both the demonstration and Medicaid. The state also cannot propose any significant or complicated changes to the demonstration.
Under the new process, CMS will notify the state within 15 days whether its request for an extension has been accepted for expedited review. If CMS grants a renewal, it will be for five years, up from three years, to reduce the frequency a state must apply for renewal.
CMS will aim to notify states about a decision within about 90 days.
However, CMS did not address continuing criticism over the program's budget. According to the Government Accountability Office, five demonstration projects in 2013 and 2014 went $33 billion over budget (Dickson, Modern Healthcare, 7/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.