CMS Issues New Section 1115 Tools, Guidance for States

On March 15, 2019 ,the Centers for Medicare & Medicaid Services (CMS) released new state tools and guidance that provide standard monitoring metrics and recommended research methods for Section 1115 demonstrations. The resources include an implementation plan template, monitoring report template and evaluation design guidance.

Section 1115 demonstrations allow states to test new policy approaches such as work requirements, premium assistance to purchase private coverage, and expansion of coverage to new populations. For each approved 1115 demonstration, states are required to:

  • Report on key monitoring metrics upon implementation
  • Conduct evaluations by partnering with an independent evaluator
  • Submit an evaluation design to CMS for approval following approval of the final demonstration

CMS’ new monitoring and evaluation tools and guidance are designed to support these activities. The CMS resources include:

  • Implementation plan template: This template provides a framework for the state to document its approach to implementing community engagement policies. It also helps to determine the appropriate information for the state to report to CMS in the quarterly and annual monitoring reports.
  • Monitoring report template: The monitoring report template provides the state with a framework for how to report information to CMS on a quarterly and annual basis including quantitative monitoring metrics.
  • Evaluation design guidance: The evaluation design guidance highlights key hypotheses, evaluation questions, measures and evaluation approaches, which states can use to inform the development of a rigorous evaluation of section 1115 demonstrations. This includes guidance specific for states pursuing community engagement demonstrations.

CMS plans to provide support to states to adopt the tools through individual technical assistance and through forums such as the Community Engagement Learning Collaborative. CMS will also provide specific instruction on the tools and guidance through a series of technical assistance sessions for states.

The new 1115 Demonstration State Monitoring & Evaluation Resources are located on the CMS website at this address:

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