United States: CMS Issues New Guidelines On 1115 Waivers; Signals New Medicaid Objectives

Last Updated: November 10 2017
Article by Ross Margulies

On November 6, 2017 the Centers for Medicare & Medicaid Services (CMS) issued an information bulletin on changes and improvements to the existing Section 1115 waiver process.1 Under Section 1115(a) of the Social Security Act, the Secretary of Health and Human Services is permitted to waive compliance with any of the requirements of section 1902 of the Act (which generally sets forth the requirements for state Medicaid programs in order to receive Federal financial assistance) in order to pilot or test projects which, in the judgment of the Secretary, are likely to assist in "promoting the objectives" of the Medicaid program. Issued by Brian Neale, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services (CMCS), the bulletin generally describes several new policies designed to streamline the 1115 waiver approval process, as well as sets forth broad new policy objectives for such waivers.

Concurrent with the new waiver bulletin, CMS also revised the language on its website which describes revised "objectives" for the Medicaid program, signaling a major shift in the type of waivers CMS will approve – and a potentially even larger, long-term shift in the Medicaid program overall.

CMCS Informational Bulletin

The November 6th bulletin follows on the heels a letter sent to state governors earlier this year, in which former Secretary Price and CMS Administrator Verma set forth new overall goals for the Medicaid program, and the waiver process. The bulletin focuses on two particular areas of this new overall strategic shift in the Medicaid program – (1) reducing the burden and increasing the efficiency of the 1115 waiver application and approval process; (2) improving the ongoing monitoring and evaluation of waivers. The bulletin notes that the current waiver process is burdensome and time consuming, and proposes a number of new policies designed to speed up the waiver approval process, and reduce overall workflow burden for states.

Policies to Reduce the Burden and Increase the Efficiency of the Waiver Approval Process

In order to reduce the overall burden for states throughout the waiver approval process, as well as to speed up approval times, CMS proposes a number of new policies:

  • CMS will revise the 1115 waiver application to streamline and simplify the actual application;
  • CMS will work with states to commit to a particular review timeframe for an individual waiver application;
  • CMS will relax its policies and procedures regarding the content of Special Terms and Conditions (which generally act as the legally binding contract between a state and CMS during a waiver period). CMS is committing to additional flexibility in program operation, increased use of performance metrics and benchmarks, as well as flexibility in how the Special Terms and Conditions are actually developed (CMS proposed to offer standard language, or permit the state to submit its own draft);
  • CMS will develop parameters for expedited approval of waivers that are "substantially similar" to those approved in other states, permitting quicker approval of demonstrations similar to those already approved in other jurisdictions;
  • CMS may approve the extension of routine, non-complex waivers for a period of up to 10 years (with the flexibility to approve more complex waivers for shorter periods of times);
  • CMS will open up its "fast track" application pathway to more states, removing the requirement that states have had at least one full extension cycle in order to be eligible for this streamlined process;
  • CMS may permit states with pending extension requests to separate out routine, non-complex waiver requests for faster approval under an expedited timeframe;
  • CMS will expand the transparency of the waiver approval process by providing states with a transparency review checklist, sharing lists of open issues with states during the approval process, and working with states on the development of waiver-specific timeframes;
  • CMS will commit to coordinating approval efforts across the agency, such that concurrent actions will be addressed in a coordinated manner, and CMS staff will assist states in reviewing other possible approval pathways or funding mechanisms; and
  • CMS will work with states to bring more clarity to the budget neutrality rules, standardizing budget neutrality Terms and Conditions and offering states assistance on these rules.

Policies to Enhance the Monitoring and Evaluation of Section 1115 Waivers

In addition to waiver approval process improvements, CMS is also committing to new enhancements to the ongoing monitoring and evaluation of waivers in order to target resources more effectively and strengthen state evaluation designs (as part of this effort, CMS has formed a State Technical Advisory Group consisting of state-identified experts). The new enhancements include:

  • Combining the fourth quarterly reports with annual reports to reduce the overall reporting burden;
  • Reducing the frequency of reporting (from quarterly to semi-annual or annual) for certain waivers which are long-standing, non-complex, unchanged, and meet several other requirements; and
  • Providing technical assistance in the development of hypotheses and evaluation designs in the evaluation phase.

Updated Medicaid Objectives on Medicaid.gov

Following release of the new 1115 waiver bulletin, and timed with a speech on the Medicaid program by CMS Administrator Verma on November 7, 2017, CMS also made substantial revisions on its webpage to the description of the Medicaid program, and the "objectives" the agency seeks to promote in approving waivers. The new website text notes that "traditional Medicaid approaches to serving this diverse and medically complex population have not always been effective at eliminating barriers to access and quality services," and states that 1115 waivers may allow states to implement reforms beyond routine medical care.

The previous program objectives, and the new objectives are displayed below:

Notable additions to the "objectives" include an increased focus on individual responsibility and independence, as well as a desire to align Medicaid and commercial insurance products. The new objectives, created in the wake of a number of pending waiver applications which would the first time impose work requirements or institute commercial-like formularies, appear to foreshadow likely approval of this never-before-seen policies in the Medicaid program.

Footnotes

1 Note that CMS also issued a guidance document on the State Plan Amendment and 1915 Waiver Process on November 6th. That bulletin is available here: https://www.medicaid.gov/federal-policy-guidance/downloads/cib110617-2.pdf.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Events from this Firm
12 Oct 2018, Other, Boston, United States

The New England Electricity Restructuring Roundtable has been meeting bimonthly since 1995 to discuss current topics related to important changes in the electric power industry in Massachusetts and throughout New England.

Similar Articles
Relevancy Powered by MondaqAI
 
In association with
Related Topics
 
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions