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2601 - 5-Year Period for Demonstration Projects

 
Implementation Status 
Statutory Text 

Summary

Effective March 23, 2010, authorizes section 1115 Medicaid waivers (as well as waivers under sections 1915(b) and 1915(c)) through which a state serves individuals who are dually eligible for Medicaid and Medicare to be carried out over a 5-year initial period.  Upon Secretarial approval, waivers may be extended for additional 5-year periods.  (Note that under pre-ACA law, section 1915(c) waivers were initially approved for a 3-year period with the ability to be renewed for up to 5 year periods.  Section 1915(b) waivers were initially approved for 2 years and renewed for up to 2-year periods.  Section 1115 demonstrations were initially approved for a period of 5 years and extended for a period of up to 3 years).

#Demonstration Programs, #Dual Eligibles, #Waivers

Implementation Status

 
Summary 
Statutory Text 

In the fall 2010, CMS issued guidance in the form of a SMD letter.  CMS published a proposed rule in May 2012 in which this provision is addressed.  The rule has yet to be finalized, but per the OMB, is “targeted” for final action in May of 2013.

On January 10, 2014, CMS issued a final rule detailing states’ option to cover HCBS under Medicaid and use Federal matching funds, including expanded flexibilities and a transition period for states to align with specified requirements, among other provisions. A fact sheet is available here and a press release here. A CMS-prepared document providing an overview of the rule, along with other related resources, is available here. Webinars on the content of the rule were held on January 23 and 30; see here for details.

2015

On Mar. 10, CMS issued updates to its current Medicaid HCBS toolkit guidance available to states pursuant to the HCBS requirements outlined in CMS’ Jan. 2014 rulemaking. Specifically, as part of this updated guidance installment, CMS announced additional changes to the HCBS Basic Element Review Tool for Statewide Transition Plans (i.e., “Version 1.0”) and the HCBS Content Review Tool for Statewide Transition Plans (the latter of which is embedded, beginning on p. 7, of the former document here). More information is available here. Also, in late Mar., CMS updated its website here to provide a compilation of approved Statewide Transition Plans pursuant to the above-referenced Jan. 2014 HCBS final regulation and supplemental guidance issued by the agency toward that end in the fall of 2014.

On July 24, CMS issued an informational bulletin delineating a new fast-track federal review process for Medicaid and CHIP waiver extensions. The new fast-track application process will be available to extend all types of 1115 ((a), (e) & (f)) waivers, and will allow for a 5-year extension period for states with 1115(a) demonstrations.

Statutory Text

 
Implementation Status 
Summary 

SEC. 2601. 5-YEAR PERIOD FOR DEMONSTRATION PROJECTS. (a) IN GENERAL.—Section 1915(h) of the Social Security Act (42 U.S.C. 1396n(h)) is amended— (1) by inserting ‘‘(1)’’ after ‘‘(h)’’; (2) by inserting ‘‘, or a waiver described in paragraph (2)’’ after ‘‘(e)’’; and (3) by adding at the end the following new paragraph: ‘‘(2)(A) Notwithstanding subsections (c)(3) and (d) (3), any waiver under subsection (b), (c), or (d), or a waiver under section 1115, that provides medical assistance for dual eligible individuals (including any such waivers under which non dual eligible individuals may be enrolled in addition to dual eligible individuals) may be conducted for a period of 5 years and, upon the request of the State, may be extended for additional 5-year periods unless the Secretary determines that for the previous waiver period the conditions for the waiver have not been met or it would no longer be cost-effective and efficient, or consistent with the purposes of this title, to extend the waiver. ‘‘(B) In this paragraph, the term ‘dual eligible individual’ means an individual who is entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and is eligible for medical assistance under the State plan under this title or under a waiver of such plan.’’. (b) CONFORMING AMENDMENTS.— (1) Section 1915 of such Act (42 U.S.C. 1396n) is amended— (A) in subsection (b), by adding at the end the following new sentence: ‘‘Subsection (h)(2) shall apply to a waiver under this subsection.’’; (B) in subsection (c)(3), in the second sentence, by inserting ‘‘(other than a waiver described in subsection (h)(2))’’ after ‘‘A waiver under this subsection’’; (C) in subsection (d)(3), in the second sentence, by inserting ‘‘(other than a waiver described in subsection (h)(2))’’ after ‘‘A waiver under this subsection’’. (2) Section 1115 of such Act (42 U.S.C. 1315) is amended— (A) in subsection (e)(2), by inserting ‘‘(5 years, in the case of a waiver described in section 1915(h)(2))’’ after ‘‘3 years’’; and (B) in subsection (f)(6), by inserting ‘‘(5 years, in the case of a waiver described in section 1915(h)(2))’’ after ‘‘3 years’’.

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