As regular readers of Say Ahhh! know, CMS has issued final regulations on public input and transparency with respect to Section 1115 Medicaid and CHIP waivers. These rules have been a loooong time coming and much needed since 1115 waivers can be very consequential. And today, April 27th, 2012, the rules become effective.
My last blog on this topic mentioned some of the highlights - a 30-day public comment period at the state level for which states must provide the full application they are planning to submit to the federal government. This may not sound like much, but as many state advocates have experienced, the waiver development process often leaves many frustrated people in its wake. Waiver “concept papers” often use general terms like “promoting personal responsibility” and promote apple pie reforms like “promoting efficiency and higher quality” without any meat on the bones to explain how this will be achieved. The rules also call for a federal comment period once the application is finalized and submitted. For a full description of what the new process will look like, please look at the brief I co-authored for the Kaiser Commission on Medicaid on the new requirements.
Another long time frustration of waiver watchers has been the inability to obtain reliable information from the federal government on what states had actually submitted waivers and what those waivers requested. Here too the situation looks to improve as well - CMS is unveiling a new website today which will include a comprehensive list of all waivers by state and their status (i.e. active, expired or pending). And CMS has created a new “Idea Factory” which allows for the public to comment on pending waivers in exciting new ways - Check it out!
I am writing this on Thursday, April 26th and apparently three states, Kansas and New Mexico and Nevada are rushing to submit their waivers TODAY so that they can avoid the new requirements to seek careful input from their citizens. My daughter says they need to “suck it up” and play by the rules like everyone else. Then she asked, ”What are they afraid of???”