Authority Comparison Chart

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Title	1115 1115 Research and Demonstration Project Waiver
Authority Type	Demonstration Waiver Information found at: https://www.medicaid.gov/medicaid/section-1115-demonstrations/index.html
Original Effective Date and Governing Regulations	Enacted into statute: 1990 Final Rule: February 27, 2012 Link to 1115 Regulations
Purpose	Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs. Under this authority, the Secretary may waive certain provisions of the Medicaid law to give states additional flexibility to design and improve their programs.
Requirements That May Be Waived or Disregarded (for state plan options)	Secretary may waive multiple requirements under §1902 of the Social Security Act if waivers promote the objectives of the Medicaid law and intent of the program.
Application Process and Application Templates/Preprints	Standardized application requirements found at: 431.412(a)(1): https://www.medicaid.gov/medicaid/section-1115-demonstrations/1115-application-process/index.html Depending on the nature and scope of the 1115 application, different processes may apply. It is advisable for states to contact CMS to discuss application intentions prior to submission.
Approval Duration and Requirements for Amendments	Initial application: 5 years Renewal: 5 years
Reporting Requirements	Monthly progress calls, quarterly and annual progress reports and other reports as required in the approved STCs.
Administration & Operation	Administered by the Single State Medicaid Agency (SSMA). Certain provisions may be operated by other entities as approved by CMS.
Provider Agreements	Required unless otherwise stipulated in the approved standard terms and conditions and approved waiver authorities.
Medicaid Financial Eligibility	State defines eligibility categories and may expand or propose modified eligibility within the 1115 demonstration.
Target Groups (if applicable) and Other Eligibility Criteria	The approved Special Terms and Conditions as approved by the Secretary set forth the eligibility requirements for benefit packages and/or services.
Public Input	States must provide at least a 30-day public notice and comment period for applications for new demonstrations and extensions of existing demonstrations. This process is followed by a federal public comment period. Information about the process can be found at https://www.medicaid.gov/medicaid/section-1115-demonstrations/1115-transparency-requirements/index.html.
Other Unique Requirements	State must operate in accordance with the approved Special Terms and Conditions. Cannot cover: Room & Board costs.
Limits on Numbers Served	State estimates numbers served. Operates as an entitlement to all who are eligible.
Waiting Lists	May depend on state’s approved STPs.
Caps on Individual Resource Allocations or Budgets	Budget neutrality must be maintained. Caps or benefit limits may apply pursuant to approved STPs.
Allowable Services	State decides what services are covered, subject to CMS approval.
Provider Qualifications	Determined by state, subject to CMS approval.
Participant-directed Services	Allowed subject to approved STCs.
Hiring of Legally Responsible Individuals	Allowed at state election.
Cash Payments to Participants	Direct cash payments not permitted.
Financial Management Services	Subject to specific requirements set forth in the approved STPs.
Employer Status for Participant Direction	Subject to specific requirements set forth in the approved STPs.
Goods and Services	Permitted subject to the approved STCs.
Direct Payment of Providers	Required (state may offer options that can be utilized voluntarily by providers to meet this requirement) unless otherwise stipulated in approved STCs.
Provider Payment Rates	Payment rates and methodologies subject to the provisions approved within the STCs.
Cost Requirements	Budget neutrality. Federal spending under the waiver cannot exceed what it would have been spent in absence of the waiver.
Quality Improvement	Extensive data collection and evaluation plans to assess the effectiveness of the project or demonstration as established within the state’s approved STCs. HCBS requirements apply if the 1115 contains HCBS.
Interaction with State Plan Services, Waivers, & Amendments	State defines relationship to state plan, waivers, and amendments, subject to CMS approval.
Conflict of Interest	If HCBS are included in 1115, COI provisions will apply subject to approved STCs.
Person Centered Planning	If HCBS are included in 1115, provisions will apply subject to approved STCs.