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GAO Recommends CMS Improve Transparency Policy for Section 1115 Waivers

May 21, 2019

McDermott+Consulting

On May 17, the Government Accountability Office (GAO) publicly released its report Medicaid Demonstrations: Approvals of Major Changes Need Increased Transparency. Medicaid demonstrations, established through the Section 1115 waiver, grant states flexibility to test new approaches for providing coverage and delivering Medicaid services. The Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to establish procedures to ensure transparency in approvals of new demonstrations and extensions to existing demonstrations. The report found that while transparency has improved, there are still significant gaps.

An example of a lack of transparency was that the federal government doesn’t always require states to share the projected effects of proposals, even when they could significantly affect beneficiary eligibility.

The GAO recommended that CMS develop policies for ensuring transparency when states (1) submit major changes to pending demonstration applications and (2) propose amendments to existing demonstrations. HHS concurred with these recommendations.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Katie Weider Waldo at 212-547-5433 or kwaldo@mcdermottplus.com.

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