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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 (CY) 2016, 2017, 2018, 2019 and 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 CY 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 CY 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 CY 2020. During CY 2020, CMS also approved COVID-19 related SPAs on expedited timeframes, which skewed the processing time data. 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 CY 2020.

Source: CMCS Informational Bulletin and analysis of administrative data.

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** 81 792

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** 73 792

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** 73 792

**State Plan Amendment Processing in 2020


DOMAIN: State Plan Amendment and 1915 Waiver Processing (State)
The SPA graphs show processing times for non-COVID-19 related SPAs in CY 2020 only. The table below shows processing times for non-COVID-19 related and COVID-19 related SPAs in CY 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 792 81% 73 116.5 73
COVID-19 SPAs 151 99% 22 21 22