A section of the waiver reads: "The Commission, by resolution dated February 18, 1999, established a threshold to replace rather than repair or reconstruct CFAP Projects. There are currently a few Washington, D.C. 20201 However, in addition to state plan and managed care options, states can request Section 1115 waiver authority to add certain non-clinical services to the Medicaid benefit package. This includes a financial analysis of changes to the demonstration requested by the state, An evaluation report of the demonstration,including evaluation activities and findings to date, plans for evaluation activities during the extension period, and if changes are requested, identification of research hypotheses related to the changes and an evaluation design for addressing the proposed revisions, Documentation of the states compliance with the public notice process, with report of the issues raised by the public during the comment period and how the state considered the comments when developing the demonstration application. DSRIP programs provide states with funding to incentivize hospitals and other provider types to provide better and more cost-effective care to Medicaid beneficiaries. Azerbaijan military assistance waiver delayed as review drags on ) or https:// means youve safely connected to the .gov website. Section 1115 of the Social Security Act provides broad authority for Secretary of HHS to waive federal Medicaid requirements for demonstration projects likely to assist in promoting Medicaid objectives - Generally intended to test new approaches - Research oriented - Requires evaluation NC Section 1115 Demonstration Waiver | NC Medicaid Uncompensated Care Pool Waivers Undermine Health Coverage for the KFF estimates that this provision has contributed to a 33% increase in Medicaid enrollment. A .gov website belongs to an official government organization in the United States. Share on Facebook. . You may request a copy of the proposed renewal request, notices and/or a copy of submitted public . Proposed Program Design | NC Medicaid The U.S. Department of Health and Human Services (HHS) has discretion to approve these demonstration, and, as seen from the history of work-requirement waivers, each administration develops its own waiver policies and . The Families First Coronavirus Response Act (FFCRA) enacted at the start of the COVID-19 pandemic included a requirement that state Medicaid programs keep people continuously enrolled in exchange for enhanced federal matching funds. Lock Starting April 1, 2023, states can resume Medicaid disenrollments for the first time in three years. But the new investments are significant Arkansas, Arizona, Massachusetts, and Oregon are authorized to spend up to $84.8 million, $481.8 million, $687.9 million, and $904 million, respectively. By continuing on our website, you agree to our use of the cookie for statistical and personalization purpose. 1115 Application Process | Medicaid Section 1115 Waivers - ASAM This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital's disproportionate patient percentage. Section 1115 waivers are required to be budget-neutral, meaning that federal spending under the waiver cannot exceed what it would have been in absence of the waiver. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 The waiver will allow DOT and its assistance recipients to focus their domestic sourcing efforts on products that provide the greatest manufacturing opportunities for American workers and firms and reduce delays in the delivery of important transportation infrastructure projects that provide jobs and promote economic growth. Medicare Program; Medicare Disproportionate Share Hospital (DSH The guidance includes a monitoring report template outlining the specific quantitative and coverage monitoring metrics states are expected to report, as well as evaluation design guidance that includes the key hypotheses, evaluation questions, measures, and methodologies that states are expected to include in their evaluation (CMS 2019). The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. Prior to the ARP, states had to use waivers to extend postpartum coverage beyond 60 days, and several states included postpartum provisions as part of Section 1115 demonstration waiver requests. About Section 1115 Demonstrations | Medicaid Budget neutrality calculations are complicated and reflect a combination of per-capita and aggregate expenditures. Legislative actions and the status of Section 1115 waivers are Notes: Some states use Section 1115 research and demonstration waivers to test policies not allowed under traditional Medicaid, such as imposing higher cost sharing for some expansion enrollees or placing limitations on certain mandatory benefits. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Individuals, Home & Community Based Services Authorities, April 2023 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, COVID-19 1115 Waiver Demonstration Template, Healthy Adult Opportunity Section 1115 Demonstration Application Template, State Medicaid Director Letter Healthy Adult Opportunity, States That Provide Medicaid Coverage for New Adult Group, States That Do Not Provide Medicaid Coverage for New Adult Group, A comprehensive program description of the demonstration, including the goals and objectives to be implemented under the demonstration project, A description of the proposed health care delivery system, eligibility requirements, benefit coverage and cost sharing (premiums, copayments, and deductibles) required of individuals who will be impacted by the demonstration to the extent such provisions would vary from the states current program features and the requirements of the Social Security Act, An estimate of the expected increase or decrease in annual enrollment, and in annual aggregate expenditures, including historic enrollment or budgetary data, if applicable, Current enrollment data, if applicable, and enrollment projections expected over the term of the demonstration for each category of beneficiary whose health care coverage is impacted by the demonstration, Other program features that the demonstration would modify in the states Medicaid program and/or CHIP, The specific waiver and expenditure authorities that the state believes to be necessary to authorize the demonstration, The research hypotheses that are related to the demonstrations proposed changes, goals, and objectives; a plan for testing the hypotheses in the context of an evaluation; and, if a quantitative evaluation design is feasible, the identification of appropriate evaluation indicators, Written documentation of the states compliance with the public notice requirements, with a report of the issues raised by the public during the comment period, which shall be no less than 30 days, and how the state considered those comments when developing the demonstration application, A historical narrative summary of the demonstration project, which includes the objectives set forth at the time the demonstration was approved, evidence of how these objectives have or have not been met, and the future goals of the program, If changes are requested, a narrative of the changes being requested along with the objective of the change and the desired outcomes, A list and programmatic description of the waivers and expenditure authorities that are being requested for the extension period, or a statement that the state is requesting the same waiver and expenditure authorities as those approved in the current demonstration, Summaries of External Quality Review Organization reports, managed care organization and state quality assurance monitoring, and any other documentation of the quality of and access to care provided under the demonstration, Financial data demonstrating the states historical and projected expenditures for the requested period of the extension, as well as cumulatively over the lifetime of the demonstration. TANF funding. The COVID-19 section 1115 demonstration opportunity makes available a number of authorities to assist states in enrolling and covering beneficiaries in Medicaid and to focus agency operations on addressing the COVID-19 pandemic. Benchmark Standards in Effect on December 1, 2009. CMS notes that research shows that increasing Medicaid payments to providers improves beneficiaries access to health care services and the quality of care received., In addition to HRSN services, CMS approved continuous eligibility provisions for MA and OR and is continuing to work with these and other states on pre-release requests. As the COVID-19 continuous enrollment provision unwinds, new continuous eligibility policies that some states are pursuing through 1115 waivers can provide stable coverage beyond the limits allowed or required under current rules. A subset of states that have submitted 1115 waivers have a component to address this issue, generally coined the Delivery System Reform Incentive Payment (DSRIP) program. Share sensitive information only on official, secure websites. Section 1115 waivers are initially approved for five years. The Medicaid Reentry Section 1115 Demonstration Opportunity focuses on covering high-quality services for individuals who are incarcerated, eligible for Medicaid, and returning home to their communities a group of individuals who have been historically underserved and adversely affected by persistent poverty and inequality. The COVID-19 section 1115 demonstration opportunity makes available a number of authorities to assist states in enrolling and covering beneficiaries in Medicaid and to focus agency operations on addressing the COVID-19 pandemic. These caps indicate that HRSN expenditures are a small fraction of overall waiver expenditures and of total Medicaid spending: in year five of each demonstration, the HRSN services expenditure cap is less than 1% of total Medicaid spending (for FY 2021) in AR, AZ, and MA, and about 2% of total spending in OR.
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