CMS Issues New Guidelines On 1115 Waivers; Signals New Medicaid Objectives

Author:Mr Ross Margulies
Profession:Foley Hoag LLP

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...

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