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CMS Releases Guidance on Waiver Monitoring, Evaluation

The Centers for Medicare & Medicaid Services (CMS) released tools and guidance for states to monitor and evaluate the effects of Section 1115 waiver demonstrations, including those with work and community engagement requirements and those that combat substance use disorder (SUD).

To date, CMS has approved waivers including work requirements in nine states, with several similar waiver requests pending. The agency also has approved waivers to combat SUD, including by waiving the Institutions for Mental Disease (IMD) exclusion in some states.

CMS’ new resources enable states to evaluate whether they are meeting the requirements in their respective waivers and include:

  • an implementation plan template with a framework for states to document their approaches to their demonstrations and determine appropriate information for the state to report to CMS;
  • a monitoring report template that provides a framework for how to report information to CMS quarterly or annually, as well as a list of quantitative metrics on which states will be expected to report; and
  • evaluation design guidance that highlights key hypotheses, evaluation questions, measures, and approaches to enable a rigorous evaluation of these demonstrations.

CMS Administrator Seema Verma released an accompanying blog post, which stressed the importance of state flexibility, accountability, and outcomes in Medicaid.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.

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