DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid, CHIP, and Survey & Certification 
 
CMCS Informational Bulletin 
  
 
DATE:  September 16, 2010 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid, CHIP and Survey & Certification (CMCS) 
 
SUBJECT:  Review and Approval Process for Section 1115 Medicaid Demonstration 
Programs  Notice of Proposed Rulemaking on Display in the Federal Register  
 
 
This informational bulletin is to notify you that today the Centers for Medicare & Medicaid 
Services (CMS) put on display at the Federal Register a notice of proposed rulemaking (with a 
60-day comment period) establishing State and Federal transparency and public notice and 
comment procedures relating to demonstration projects under section 1115 of the Social Security 
Act (the Act) relating to Medicaid and the Childrens Health Insurance Program (CHIP).  This 
regulation implements the provisions of section 10201(i) of the Patient Protection and Affordable 
Care Act of 2010 (Affordable Care Act).  The regulation is available for viewing today at 
http://www.ofr.gov.  After today, it will be posted at http://www.access.gpo.gov listed under the 
publication date of September 17, 2010.  You can submit electronic comments to 
http://www.regulations.gov. We encourage all interested parties to review and comment on the 
proposed rules.  The comment period closes on November 16, 2010.       
 
The Affordable Care Act amended section 1115 of the Act, which allows the Secretary of the 
Department of Health and Human Services (the Secretary) to waive selected provisions of the 
Act for experimental, pilot, or demonstration projects and to use Medicaid or CHIP funds for 
expenditures that otherwise would not be permitted under federal law.  The Act requires that 
CMS issue regulations establishing processes to ensure meaningful public input into the 
development of State demonstration projects, as well as in the Federal review and approval of 
State demonstration applications and renewals.  The Act also requires periodic evaluations and 
implementation reports to ensure that information on the outcomes of demonstration projects is 
available to the public. 
 
The proposed rule provides that information about Medicaid and CHIP demonstration 
applications and approved demonstration projects will be publicly available at the State and 
Federal levels and that there will be an opportunity for the public to comment on the proposals as 
they move through the process. At the same time the proposed rule seeks to assure that the 
development and review of demonstration proposals proceed in a timely and responsive manner.  
Among other procedures, the rule proposes State and Federal public notice processes, identifies  the information that must be provided in such notices, and proposes minimum 30 day public 
comment periods at both the State and Federal levels.  The rule also proposes a good cause 
exception under which CMS and States could bypass transparency requirements in the event of 
an emergency, such as a flood or other natural disaster.   
 
Once the comment period has concluded, CMS will review all comments received and issue final 
regulations.