Draft Chapter: Improving the Quality and Timeliness of Section 1115 Demonstration Evaluations

This presentation reviews Improving the Quality and Timeliness of Section 1115 Demonstration Evaluations, a draft chapter that will be included in MACPAC’s March 2020 Report to Congress on Medicaid and CHIP. The chapter provides background information on Section 1115 demonstration waiver authority in Medicaid and evaluation and monitoring requirements. It discusses the concerns with evaluations raised by the U.S. Government Accountability Office and others. It describes recent efforts by the Centers for Medicare & Medicaid Services (CMS) to improve evaluations, including new subregulatory guidance released in 2019. The chapter also examines issues for states and CMS in conducting and using evaluations, which include evaluation planning and funding, methodological challenges, timing issues, standards for evaluation quality, evidence needed to inform policy, and public comment and transparency. The chapter does not contain recommendations.