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Health & Medicine's Letter to CMS Re: Public Comment on Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

Health & Medicine Policy Research Group (HMPRG)
November 20, 2010

November 15, 2010
From: Health & Medicine Policy Research Group
Re: Public Comment on Medicaid Program; Review and Approval Process for Section 1115 Demonstrations

To Whom It May Concern:

Health & Medicine Policy Research Group is a 29 year old independent policy center that conducts research, educates and collaborates with other groups to advocate policies and impact health systems to improve the health status of all people.  Our mission is to promote social justice and challenge inequities in health and health care, with a vision of a society free of social inequities, with a healthy population accessing high quality health care, delivered in comprehensive health systems by culturally competent providers.

Health & Medicine has undertaken analysis of the health reform law and its potential impact on the State of Illinois and the Chicago region.  In response to the proposed rules for the review and approval process for Section 1115 Demonstrations, Health & Medicine has the following comments:

  • We applaud CMS’s efforts to increase transparency and public engagement in the Section 1115 review and approval processThe proposed rules are sensitive to the potential challenges resulting from demonstration projects and we agree that public input will help deter these problems
  • The proposed rules indicate that a State must provide public notice of a demonstration in either the State’s Administrative Record or in the newspaper with widest circulation in each city or county.  Health & Medicine would encourage CMS to require that public notice be included in BOTH the State record and widely circulated newspapers as to assure public input from those who do not regularly read the State Administrative Record.
  • The proposed rules require States to host at least two public hearings regarding the demonstration application at least 20 days prior to the application’s submission.  Health & Medicine encourages CMS to consider if 20 days is enough time for states to properly analyze the results of public hearings and incorporate the results into the application. 
  • We applaud the proposed rule that CMS may request application modifications and may, at its discretion, direct an additional 30 day public comment period.  Further clarification on when “discretion” would be used would be helpful for advocates and the public.
  • We encourage the requirement of financial data for both new and extension demonstrations.  Projects should also be required to determine per capita cost per value received by the demonstration project and should estimate how the demonstration changes the total costs and revenues for Medicaid.
  • We applaud the rule’s requirement of publishing the status of demonstrations on the CMS website. 
  • Regarding evaluation of demonstration projects, we are concerned the six months may not be enough time to see the impact and outcomes of a demonstration project.  We encourage CMS to consider changing the requirement for public forums after implementation of a demonstration from 6 months to 12 months, as to allow for intended changes to occur. 
  • Overall, the need for greater transparency is recognized in these rules and is appreciated by health policy and advocacy professionals.  Health & Medicine would encourage CMS to set similar transparency standards for State Medicaid Plans so that the plans are available electronically (via the State website) and made available to the public in a variety of means.

Thank you for your consideration of these comments.


Margie Schaps, MPH, Executive Director               

Janna Stansell, MPH, Policy Analyst