On November 7th, CMS Administrator Seema Verma addressed the National Association of Medicaid Directors (NAMD) at the organization’s annual conference in Arlington, Virginia. Verma’s remarks were broad, and they addressed existing Section 1115 and Section 1915 waiver and State Plan Amendment (SPA) approval processes. Specifically, Administrator Verma outlined a plan for shorter approval timelines and allowances for increased state program flexibility.

We are pleased to offer these summary notes and comments about what we heard from Administrator Verma.

Section 1115 and 1915 Waiver Process Changes

States May Now Request a 10-Year Approval For Certain 1115 Waivers

Currently, federal law allows an initial 5 year approval for 1115 waivers with a 3 year extension. Although a 10-year approval request is a new development in the waiver process, we have previously seen some states operate programs under Section 1115 waivers through multiple extensions. For example, TennCare in Tennessee was first approved in 1994.

CMS pledges “fast track” federal review to renew successful 1115 programs

In our experience, states submit 1115 program renewals about a year before they expire. Sometimes, there may be a period of extended conversations between a state and CMS before a program is renewed. A “fast track” process to renew programs that have demonstrated successful outcomes is intended to reduce administrative work at both the state and federal levels.

CMS will reduce 1115 reporting requirements for programs that have a successful track record

Several of our consultants are former state Medicaid officials that were required to do quarterly, bi-annual, and annual reports for 1115 demonstrations. Although these reports may vary from program to program and state to state, when a program has been deemed successful over time, the reporting requirements may be perceived as an inessential investment of effort. Administrator Verma did not pinpoint specific reporting changes in her remarks.

CMS will implement a “within 15-day”initial review call with CMS officials to expedite State Plan Amendment (SPA) and 1915 waiver federal approval processes

Currently, there is a 90-day turnaround deadline for federal review of newly submitted SPAs. If CMS issues a formal Request for Additional Information (RAI), a second 90-day review period begins when CMS receives the state’s response to the RAI. In our experience, CMS often uses the full 90 days they are granted for review. However, we have witnessed some examples of faster SPA response times during Administrator Verma’s tenure.

Medicaid and Children’s Health Insurance Program (CHIP) Scorecards

CMS is working on formal scorecards for Medicaid and CHIP

This concept is intended to provide transparency to tax payers and validation to Medicaid beneficiaries about the effectiveness and fiscal soundness of the programs in which they are enrolled. As of yet, CMS has not revealed any details about scoring criteria or how the scorecards will be used.

While further details are forthcoming, helping our clients understand how federal changes affect their existing programs will be critical. As we observe new processes operate in real time, we look forward to assisting states, providers, and other industries that are vital to the Medicaid program in distilling new opportunities and defining paths to success in program initiatives.