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Research and Demonstration Project Waiver
Authorizes the DHHS Secretary to consider and approve experimental, pilot or demonstration projects likely to assist in promoting the objectives of the Medicaid statute.
DHHS Secretary may waive multiple requirements under §1902 of the Social Security Act if waivers promote the objectives of Medicaid law and intent of the program.
Initial application: 5 years
Renewal: 5 years
Monthly progress calls, quarterly and annual progress reports.
Administered by the Single State Medicaid Agency (SSMA).
May be operated by other entities as approved by CMS.
State defines eligible categories and may expand eligibility. Not intended to add new Medicaid eligibility group(s).
State determines requirements for services.
Effective 4/27/12, the ACA requires States to develop a process that ensures transparency and public notice.
Information about the process can be found in the State Medicaid Director Letter 12-001 dated 4/2 7/12 (PDF) and at:
42 CFR §431.408
State determines target groups and defines eligibility criteria.
State must operate under an approved Operations Protocol.
Requires public input.
Conflict of interest requirements may apply in terms and conditions.
State estimates numbers served.
Operates as an entitlement to all who are eligible.
State decides what services are covered, subject to CMS approval.
HCB settings rules apply as part of terms and conditions
Determined by state, subject to CMS approval.
Required if participant direction is offered. May be a demonstration service or an administrative function.
Payments for allowable services may be paid prospectively (before the service is provided).
Services cannot in aggregate cost more than without the §1115 waiver.
Extensive data collection and evaluation plans to assess the effectiveness of the project or demonstration.
State defines relationship to state plan, waivers, and amendments, subject to CMS approval.