DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland21244-1850 
 
 
CMCS Informational Bulletin
 
DATE:   November 23, 2021 
 
FROM:   Daniel Tsai, Deputy Administrator and Director 
Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Updates to Intake Process for State Submissions to CMS 
 
 
This CMCS Informational Bulletin provides direction to state Medicaid and Childrens Health 
Insurance Program (CHIP) agencies on a new process for certain key state submissions to the Centers 
for Medicare & Medicaid Services (CMS).  These actions include certain Medicaid state plan 
amendments (SPAs), CHIP SPAs, 1915(b) waiver actions, and Appendix K 1915(c) waiver 
amendments that are not already submitted through an electronic platform.  Effective February 1, 
2022, state officials are asked to adjust their processes for submitting these actions in accordance with 
this Bulletin to ensure that they are received and processed timely by CMCS. 
 
Background 
             
Over the last several years, CMS undertook several steps to review and improve the SPA and 
1915 waiver review process, including decreasing processing times.  To inform the process 
improvement efforts, CMS analyzed various SPA and waiver processing metrics, conducted an 
intensive review of the current SPA standard operating procedures, and consulted with key 
stakeholders including the National Association of Medicaid Directors (NAMD), state Medicaid 
agency staff, and several National Associations involved in the administration of 1915 waivers.  
Based on these steps, CMCS implemented a series of operational improvements that have led to 
increased efficiency and a significant reduction in processing times.  The changes included: 
 
  Early SPA and waiver review, including a call with the state within 15 days of each 
submission to review the intent of the submission and any critical timelines; 
  SPA and 1915 waiver toolkits posted on Medicaid.gov that include a package of tools 
available to states to help develop complete SPA and section 1915 waiver submissions, 
including preprints, templates, checklists and other guidance; 
  A strategy to partner with states to reduce the backlog of SPAs pending a response to a 
Request for Additional Information (RAI); 
  Updates to the CMS SPA and 1915 waiver processing Standard Operating Procedures 
(SOPs) to create three potential paths that a SPA or waiver can follow (expedited, 
escalation, and standard review) to ensure that each action is processed as efficiently as 
possible; and 
  Three specific updates to the 1915(c) waiver processing SOPs to increase efficiency of 
their review. 
 
The collective changes are described in two CMCS Informational Bulletins released in 
November of 2017 and August of 2018. 
The contents of this document do not have the force and effect of law and are not meant to bind the public in any way, unless 
specifically incorporated into a contract. This document is intended only to provide clarity to the public regarding existing 
requirements under the law.  Page 2  CMCS Informational Bulletin 
 
 
Since CMS began this initiative, the processing times for Medicaid SPAs and 1915 waiver 
actions have steadily improved each calendar year, reflecting a continuing decline in median 
total processing times, and a corresponding increase in the percentage of actions approved on the 
first 90-day clock (review period) for both SPA and waiver business lines.  For example: 
 
  As compared to 2016, median total processing times in 2019 for Medicaid SPAs 
decreased by 18% from 82 days to 67 days. 
  During the same timeframe, median total processing times for 1915(c) waiver 
amendments decreased by 18% from 78 to 49 days. 1915(c) waiver renewal times 
decreased by 41% and 1915(b) waiver action times decreased by 14%. 
 
However, CMCS continues to explore additional improvements to our business processes to 
increase the efficiency, effectiveness, and quality of SPA and 1915 waiver reviews.   
 
To that end, CMS is announcing an update in the submission process for certain Medicaid SPAs, 
1915(b) and 1915(c) waiver actions, certain CHIP SPAs, and all managed care-related actions.  With 
this letter, CMS is announcing that, effective February 1, 2022, we will be ending the use of regionally 
based mailboxes for submission of these actions, and instead, states will be required to submit all 
Medicaid and CHIP SPA and 1915(b) and 1915(c) waiver actions that are not submitted through one 
of CMS electronic systems, to a single web-based portal.  In addition, states will submit Medicaid 
and CHIP managed care contract actions to a dedicated mailbox, and follow separate mailbox 
instructions for rate certifications and state directed payment preprints.  These changes will enable 
CMS to more quickly process these state submissions, and is part of CMS continuing commitment to 
streamline the SPA, 1915(b) and 1915(c) waiver, and managed care contract and preprint submission 
and adjudication processes.  
 
Updated Submission Process for Certain Medicaid SPAs, 1915 (b) and (c) Waiver Actions, and 
certain CHIP SPAs 
 
State Medicaid agencies are currently required to submit certain paper-based Medicaid SPAs, 1915(b) 
waiver actions, Appendix K 1915(c) waiver amendments, state responses to request for additional 
information (RAIs) for these corresponding actions, and state requests for temporary extensions to 
their 1915(b) and (c) waivers, to one of ten regional office SPA mailboxes.  Starting on February 1, 
2022, CMS is modifying the state transmittal process for these submissions.  In order to be processed, 
States will need to submit these state actions (described in more detail below and in Appendix A) to 
the new centralized portal at http://onemac.cms.gov/.  The ten regional office SPA mailboxes will no 
longer accept state action items.  
 
States are currently required to submit paper-based CHIP SPAs to a CHIP SPA mailbox.  Starting on 
February 1, 2022, CMS is modifying the state transmittal process for these submissions.  States will be 
required to submit these state actions (described in more detail below and in Appendix A) to the new 
centralized portal at http://onemac.cms.gov/.  The CHIP SPA mailbox will no longer accept state 
action items. 
 
  Page 3  CMCS Informational Bulletin 
 
The OneMAC Portal  was developed by CMS in close consultation with a team of states who 
provided integral feedback during the design and testing process.  It is available at 
http://onemac.cms.gov/is a web-based platform that allows states to submit certain official SPA and 
Waiver actions to CMS.  The actions will not be created in the OneMAC portal; rather, the submission 
documents will be created in advance (as states do today) and states will upload those documents into 
the portal and input basic information about the submission.  The new portal will replace the current 
10 submission email boxes: 
 
  Creating one submission process for all states to use for the designated submission types 
described below, eliminating state confusions about the submission procedures;  
  Allowing all related attachments to be submitted in one submission through the portal, 
eliminating multiple emails, and 
  Eliminating failed submissions based on e-mail attachment sizes. 
 
CMS anticipates that this will reduce burden on states and CMS, thereby leading to more efficient and 
timely processing of all submissions.  Appendix B provides additional information on the fields states 
will need to complete for each submission, as well as, instructions on how to enter and upload 
information to the portal. 
 
This change does not apply to electronic Medicaid SPAs, CHIP SPAs and waiver submissions 
processed in the following systems: Medicaid and CHIP Program Portal (MACPro), Medicaid Model 
Data Lab (MMDL), and the Waiver Management System (WMS).  States will continue to submit 
these actions electronically through the appropriate system.  
  
Effective February 1, 2022, states should submit the following paper-based actions to the new 
centralized OneMAC portal at http://onemac.cms.gov/: 
 
  Amendments to your Medicaid state plans (not submitted through MACPro or MMDL);  
  Official state responses to formal RAIs for Medicaid SPAs submitted through the new portal 
(not submitted through MACPro),  
  Section 1915(b) waiver submissions and all associated attachments (not submitted through 
WMS),  
  Section 1915(c) Appendix K amendments (which cannot be submitted through WMS);  
  Official state responses to formal RAIs for Section 1915(b) waiver actions (in addition to 
submitting waiver changes in WMS, if applicable);  
  State requests for temporary extensions for section 1915(b) and 1915(c) waivers; 
  Amendments to your CHIP state plans (not submitted through MMDL); and 
  Official state responses to formal RAIs for CHIP SPAs submitted through the new portal. 
 
CMS reminds states that the regulations at 42 C.F.R.  430.12 describe the requirements for 
submitting Medicaid SPAs.  As part of the submission through the portal, states need to include a 
completed Transmittal and Notice of Approval of State Plan Material (CMS 179) form and a cover 
letter to the CMCS.  The regulations at 42 C.F.R.  430.25, 431.55 and 441.301 describe the 
requirements for submitting section 1915(b) and 1915(c) waivers.  The regulations at 42 C.F.R.  
457.60 and 457.65 describe the requirements for submitting CHIP SPAs.  As part of the CHIP 
submission through the portal, states should include a copy of the current state plan, a redline version 
  Page 4  CMCS Informational Bulletin 
 
and a clean version of the proposed changes to the existing state plan pages being amended, and a 
cover letter to CMCS.  The state can include budget documents, public notice or tribal consultation, if 
applicable, and any other documents that will assist in the review of the CHIP SPA. 
 
When submitting a SPA or section 1915 waiver action to http://onemac.cms.gov/, a states submittal 
will be considered an official state submission.  As a result, the state will receive an electronic 
confirmation that the formal action was received along with information about the 90th day.  As of 
February 1, 2022, the formal actions listed above will only be considered received by CMS if they 
have been submitted via http://onemac.cms.gov/ and the state has received an electronic 
receipt.  If a state has not received such a notification for a SPA or waiver submissions, the state 
should contact its state lead or project officer or the CMS lead for home and community-based 
services or managed care.  
 
Please see Appendix B, with additional information regarding the new CMS portal for state 
submissions including access, instructions and Help Desk support.  
 
Updated Submission Process for Managed Care Actions: 
 
Similar to the SPA and waiver submission process, states currently submit all actions related to 
Medicaid and CHIP managed care as well as PACE programs to their respective regional office 
managed care resource mailbox.  To enhance our ability to more quickly process these actions CMCS 
is also updating the submission process for these actions.  These changes are described below.  
 
Managed Care Contracts & Rates and PACE Rates 
 
Starting February 1, 2022, states are expected to submit the following types of managed care and 
PACE submissions to one centralized mailbox at MCOGDMCOActions@cms.hhs.gov:  
 
  All state contract actions with external quality review organizations; 
  All state contract actions with enrollment brokers; 
  All submissions for proposed Medicaid capitation rates for PACE organizations;  
  All state contract actions with Medicaid managed care plans, including contract actions 
incorporating Medicaid risk-based capitation rates (and associated rate certifications); and 
  All state contract actions with CHIP managed care entities. 
 
Additionally, states should continue to submit all state contract actions with Medicaid managed care 
plans, including associated rate certifications, to the MMCratesetting@cms.hhs.gov mailbox to ensure 
timely review of Medicaid managed care rate development.  
 
Preprints for State Directed Payments 
 
The managed care regulations at 42 C.F.R.  438.6(c) provide states the ability, under certain 
conditions, to implement payment arrangements that direct the plans expenditures under Medicaid 
managed care contracts.  These state directed payment initiatives require CMS approval of an 
associated preprint. Similar to the above processes, under our previous organizational structure, there 
were ten regional office mailboxes for state submission of these state directed payment preprints.  
  Page 5  CMCS Informational Bulletin 
 
 
Starting February 1, 2022, states should submit the following materials associated with state direct 
payments to one centralized mailbox at statedirectedpayment@cms.hhs.gov.  
 
  All preprints for Medicaid state directed payment arrangements;  
  All state responses to CMS questions associated with state directed payment preprints; and 
  All state requests for technical assistance on state directed payments. 
 
For your reference, we have included a chart in the attachment to this letter that will help your staff 
clearly identify the correct method or mailbox to use for state submissions, effective February 1, 2022.  
  
These updated transmittal procedures are intended to increase the effectiveness and efficiency of the 
Medicaid and CHIP programs, and to simplify and centralize the submission process.  If you have any 
questions about these changes, please contact the appropriate CMCS MCOG state lead.   
           
Closing 
 
CMS is committed to continuing to improve the efficiency and timeliness of Medicaid SPAs, 1915 
Waivers, CHIP SPAs, managed care contracts and rates, and state directed payment submission and 
review processes.  To do so, the agency is updating the submission process for certain Medicaid 
SPAs, 1915(b) and 1915(c) waivers, CHIP SPAs, and all managed care-related actions.  CMS looks 
forward to working with States to implement the new procedures. 
 
If you have any questions or need additional information, please contact Adrienne Delozier, Senior 
Technical Advisor, Disabled and Elderly Health Programs Group, Adrienne.Delozier@cms.hhs.gov 
and Kaitlin Devine, Director, Division of Information Systems, Kaitlin.Devine@cms.hhs.gov. 
  Page 6  CMCS Informational Bulletin 
 
Appendix A:  Submission of State SPA, 1915(c) Waiver and Managed Care-related Actions 
 
Please use the procedures described below for the following state submissions: 
Submission Type  System of Entry  Location 
Medicaid SPAs and State Responses to RAIs related to: 
  Eligibility 
  Enrollment  MACPro  https://macpro.cms.gov/ 
  Administration 
  Health Homes 
SPAs related to: 
https://wms-
  Medicaid Alternative Benefits Plans (ABP) 
MMDL  mmdl.cms.gov/MMDL/faces/portal.j
  Medicaid Premiums and Cost Sharing 
sp 
  CHIP Eligibility  
Waiver Actions (new, renew, amend) 
  1915(c) actions (except Appendix K Submissions) 
https://wms-
  State Responses to RAIs for 1915(c) waiver actions (resubmit revised waiver 
WMS  mmdl.cms.gov/WMS/faces/portal.js
application) 
p 
  1915(b) actions and all associated attachments  WMS is optional. Paper based 
1915(b) waiver action should go to the Web Portal. 
All other paper-based Medicaid SPA and 1915 Waiver Related Submissions: 
  All Medicaid SPAs not submitted through MACPro or MMDL 
  State responses to RAIs for:  
  Medicaid SPAs (not submitted through MACPro) 
  1915 (b) waivers actions (in addition to submitting waiver changes  Web Portal (New)  https://onemac.cms.gov/  
in WMS, if applicable) 
  Non-WMS submitted 1915(b) waiver actions and all associated attachments 
  1915(c) Appendix K amendment submissions  
  State requests for temporary extensions of 1915(b) and 1915(c) waivers 
SPAs and State Responses to RAIs related to: 
Web Portal (New)  https://onemac.cms.gov/  
  CHIP State Plan 
  Page 7  CMCS Informational Bulletin 
 
Submission Type  System of Entry  Location 
Managed Care and PACE Contract and Rate actions: 
  Medicaid and CHIP Contracts and Rates  All: 
  PACE Rates  MCOGDMCOActions@cms.hhs.go
  External Quality Review Organization (EQRO) Contracts  Managed Care  v 
  Enrollment Broker Contracts  Mailbox (New)   
Medicaid Contracts/Rates: Also send 
to MMCratesetting@cms.hhs.gov 
Managed Care 438.6(c) State Directed Payment Pre-prints  State Directed 
Payment Mailbox  statedirectedpayment@cms.hhs.gov 
(New) 
 
 
   
  Page 8  CMCS Informational Bulletin 
 
Appendix B 
 
The SPA and Waiver Submission Portal (http://onemac.cms.gov/) replaces email submissions to the regional email mailboxes with a 
single, intuitive web portal. 
 
How to access and submit in the portal: 
(screenshots below) 
1.  Sign in using your OneMAC (IDM) account** 
2.  Select your submission type  
3.  Attach your submission documents  
4.  Click submit 
 
Once you submit, you will receive an email confirming your submission was successful.  
 
**If you do not have a OneMAC (IDM) account, please email OneMAC_HelpDesk@cms.hhs.gov and we will assist you in creating a 
new account to use the portal. 
 
We want to build the best possible product that fosters the most efficient collaboration between your state and CMS.  The MACPro 
Help Desk will be available to support you through this process and can be reached via email: OneMAC_HelpDesk@cms.hhs.gov or 
via telephone: (833) 228-2540. Additionally, we will have informational sessions to provide a demo of a portal submission, and to 
answer any questions you may have. You may also see answers to frequently asked questions on the FAQ page: 
https://onemac.cms.gov/FAQ .  
 
 
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