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State and Federal Administrative Accountability

State Plan Amendment and 1915 Waiver Processing (Federal)

The following measures report approval times for Medicaid State Plan Amendments (SPAs) and 1915 waiver actions. CMS is committed to working with states to process SPAs and 1915 waivers as efficiently as possible, in accordance with the statute and regulations. The less time CMS and states spend submitting, reviewing and approving SPAs and 1915 waivers, the sooner states can implement their needed program changes and begin claiming federal funds. The measures reported for each action type (SPAs, 1915(b) waiver actions [new waivers, renewals, and amendments], 1915(c) waiver amendments, and 1915(c) waiver renewals) are shown in the table below.  

Measure Pillar
Percentage Approved Within the First 90 Day Review Period State and Federal Administrative Accountability
Median Number of Days Between Submission and Approval State and Federal Administrative Accountability
Median Number of Days Pending State Response to a Request for Additional Information State Administrative Accountability
Median Number of Days Under CMS Review Federal Administrative Accountability

CMS reviews Medicaid SPAs and 1915 waiver requests to make sure they comply with the Social Security Act and other related regulations. CMS must approve, disapprove, or issue a formal request for additional information (RAI) on SPAs and 1915 waivers within 90 calendar days. Once a state responds to an RAI, CMS must approve or disapprove the action within a second 90 day review period. When CMS issues an RAI, the time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to the formal RAI. The figure below shows the review process.

This figures shows the review process for SPA and 1915 waiver actions. As a state submits a 1915 or SPA waiver action, CMS must approve, disapprove, or issue a formal request for additional information (RAI) on SPAs and 1915 waivers within 90 calendar days. If CMS approves, the total approval includes the time it takes CMS to conduct the review. When CMS issues an RAI, the time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to the formal RAI.

Data include all actions approved in calendar years 2016, 2017, 2018, 2019 and the first two quarters of calendar year 2020. For each time period, the total number of approvals is shown in parentheses. The total number of approvals is the denominator for each measure.

During 2017, CMS started an effort to resolve SPA and waiver actions that had been on RAI awaiting a state response for extended periods of time. As CMS and states worked together to move those actions to approval, the median processing times increased for some time periods.

During the first two quarters of 2020, CMS approved 1915(c) waiver amendments related to the COVID-19 public health emergency. Those amendments, referred to as Appendix Ks, are processed on expedited timeframes and significantly skewed the processing data for the first and second quarters of calendar year 2020. During the second quarter of 2020, CMS also approved COVID-19 related SPAs on expedited timeframes, which skewed the processing time data for that quarter. The graphs below include information on processing only for non-COVID-19 1915(c) waiver amendments and SPAs. Refer to the table for a comparison of processing times for COVID-19 related and non-COVID-19 related 1915(c) waiver amendments and SPAs in the first and second quarters of 2020 and the second quarter of 2020, respectively.

Pillar
Type

Percentage Approved Within the First 90 Day Review Period

Year Percentage Approved Within 90 Days Approvals
2016 64 839
2017 63 950
2018 78 907
2019 79 848
2020 Q1 81 229
2020 Q2** 84 204

Median Number of Days Between Submission and Approval

Year Number of Days Approvals
2016 82 839
2017 83 950
2018 69 907
2019 67 848
2020 Q1 72 229
2020 Q2** 64 204

Median Number of Days Under CMS Review

Year Number of Days Approvals
2016 80 839
2017 81 950
2018 67 907
2019 64.5 848
2020 Q1 72 229
2020 Q2** 64 204

*1915(c) Waiver Amendments Processing in 2020 Q1 and Q2


The 1915(c) waiver amendment graphs show show processing times for non-COVID-19 related 1915(c) waiver amendments in the first and second quarters of 2020 only. The table below shows processing times for COVID-19 related 1915(c) amendments, referred to as Appendix Ks.
Number of Actions Approved Percentage Approved Within the First 90 Day Review Period  Median Number of Days Between Submission and Approval Median Number of Days Pending State Response to a Request for Additional Information  Median Number of Days Under CMS Review
2020 Q1
Non-COVID-19 1915(c) Amendments 38 97% 74 32 74
COVID-19 1915(c) Amendments 67 100% 5 N/A 5
2020 Q2
Non-COVID-19 1915(c) Amendments 18 100% 43 N/A 43
COVID-19 1915(c) Amendments 80 100% 7 N/A 7

**State Plan Amendment Processing in 2020 Q2


The SPA graphs show processing times for non-COVID-19 related SPAs in the second quarter of 2020 only. The table below shows processing times for non-COVID-19 related and COVID-19 related SPAs in the second quarter of 2020.

Number of Actions Approved Percentage Approved Within the First 90 Day Review Period  Median Number of Days Between Submission and Approval Median Number of Days Pending State Response to a Request for Additional Information Median Number of Days Under CMS Review
Non-COVID-19 SPAs 204 84% 64 153 64
COVID-19 SPAs 86 100% 17 N/A 17