The Centers for Medicare & Medicaid Services (CMS) uses several waiver authorities, including section 1115 demonstration authority, to permit and support innovation in Medicaid and the Children's Health Insurance Program that is likely to meet the objectives of the program and be budget neutral to the federal government. These innovations concern:
- Service delivery
- Alternatives to eligibility and coverage, including for expansion populations
- Payment approaches intended to align financial incentives with program improvement goals
CMS conducts federal reviews to monitor implementation progress and conducts evaluations on a selection of these demonstrations to examine their impacts on beneficiaries, providers, health plans, states, including impacts on access, quality of care, and costs.
Section 1115 of the Social Security Act also requires that federal regulations specify requirements for demonstration monitoring and evaluation. Title 42 CFR 431.424 outlines general evaluation requirements and evaluation design components such as hypotheses, data sources, and comparison strategies. It also outlines requirements for including initial evaluation designs and evaluation reports in applications for new demonstrations and extensions of existing demonstrations as well as for monitoring activities. Special terms and conditions for each state further specify CMS’ expectations for the contents and timing of evaluation designs and interim and summative evaluation reports as well as monitoring activities.
CMS has developed a variety of resources to support state monitoring and evaluation, and is conducting federal evaluations and meta-analyses of selected policy areas.
For specific questions, comments, or additional technical assistance, states should contact their CMS Central Office project officer or 1115MonitoringAndEvaluation@cms.hhs.gov.