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Research and Demonstration Project Waiver

HCBS Authority: 
1115
Applicable CFR Sections: 
42 CFR §431.412
Purpose: 

Authorizes the DHHS Secretary to consider and approve experimental, pilot or demonstration projects likely to assist in promoting the objectives of the Medicaid statute.

Medicaid Requirements That May Be Waived: 

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.

Application Process: 

Standardized Application (PDF) (must be approved by CMS and an External Federal Review Team; CMS readiness review site visit required)

Required Public Input Process (PDF)

Approval Duration: 

Initial application: 5 years

Renewal: 5 years

Reporting: 

Monthly progress calls, quarterly and annual progress reports.

Administration & Operation: 

Administered by the Single State Medicaid Agency (SSMA).

May be operated by other entities as approved by CMS.

Provider Agreements: 

Not required.

Medicaid Eligibility: 

State defines eligible categories and may expand eligibility. Not intended to add new Medicaid eligibility group(s).

Other Eligibility Criteria: 

State determines requirements for services.

Public Input: 

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

Target Groups: 

State determines target groups and defines eligibility criteria.

Other Unique Requirements: 

State must operate under an approved Operations Protocol.

Requires public input.

Case Management: 

Conflict of interest requirements may apply in terms and conditions.

Limits on Numbers Served: 

State estimates numbers served.

Operates as an entitlement to all who are eligible.

Waiting Lists: 
Not applicable.
Combining Service Populations: 
States may combine service populations.
Caps on Individual Resource Allocations or Budgets: 
Budget neutrality must be maintained. Caps or benefit limits may apply.
Allowable Services: 

State decides what services are covered, subject to CMS approval.

Allowable Participant Settings: 

HCB settings rules apply as part of terms and conditions

Regulations and CMS Guidance

Provider Qualifications: 

Determined by state, subject to CMS approval.

Participant-directed Services: 
Allowed.
Hiring of Legally Responsible Individuals: 
Allowed at the State’s discretion.
Cash Payments to Participants: 
Direct cash payments are permitted.
Financial Management Services: 

Required if participant direction is offered. May be a demonstration service or an administrative function.

Goods and Services: 
Permitted as a service.
Direct Payment of Providers: 

Not required.

Provider Payments: 

Payments for allowable services may be paid prospectively (before the service is provided).

Cost Requirements: 

Budget-neutrality.

Services cannot in aggregate cost more than without the §1115 waiver.

Quality Management: 

Extensive data collection and evaluation plans to assess the effectiveness of the project or demonstration.

Interaction with State Plan Services, Waivers & Amendments: 

State defines relationship to state plan, waivers, and amendments, subject to CMS approval.