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 and CHIP Services 
 
CMCS Informational Bulletin 
 
  
DATE:  April 27, 2012 
 
FROM:  Cindy Mann, Director 
  Center for Medicaid and CHIP Services (CMCS) 
 
SUBJECT:  Affordable Care Act Section 1115 Demonstration Transparency Rules 
 
We are pleased to announce the official launch today of the Center for Medicaid and CHIP 
Services approach to ensuring transparency in all aspects of the review and approval process for 
Medicaid/CHIP section 1115 demonstrations.  As you know, section 10201(i) of the Affordable 
Care Act included new requirements related to providing opportunities for feedback into the 
review and approval process for States section 1115 demonstration application.  CMS issued a 
final rule implementing these provisions on February 27, 2012, which becomes effective today.   
 
In order to provide operational guidance to assist States in implementing these rules, we released 
a letter to State Health Officials today to provide further guidance about the revised review and 
approval process for section 1115 demonstrations. The letter reviews the key provisions of the 
regulation and provides additional guidance with respect to amendments to ongoing 
demonstration projects.  The letter is available on the Medicaid.gov website at 
http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SHO-12-001.pdf.  
 
In addition to the letter, we are making available a user guide for stakeholder organizations 
interested in participating in the enhanced public notice and comment process required under the 
final rules.  The user guide is designed to assist interested parties in navigating the new section of 
the Medicaid.gov website where information about approved as well as pending section 1115 
demonstrations is available for review.  In addition, the user guide provides information about 
how to access the public comment feature for pending demonstration applications and 
amendment requests.  Interested stakeholders can get connected to the Idea Factory, CMS tool 
for providing feedback on demonstration requests.  The user guide is available at  
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-
Topics/Waivers/1115/downloads/section-1115-user-guide.pdf.    
 
CMS will post State applications and requests on the website, and the site will enable the public 
to submit comments on a specific application or request.  Medicaid.gov will also enable the 
public to sign up for CMSs electronic mailing list serve which will notify interested parties 
when a new public comment period has begun.  
  CMCS Informational Bulletin, Page 2 
 
  
We encourage interested parties to visit the new section on the Medicaid.gov website at 
http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/public-
comments.html, which will be used to implement the Federal requirements included in the final 
transparency rule.  We will post all demonstration applications, extension requests, and 
amendment requests for the public to review and provide feedback through the tool described 
above.   
 
We hope this information will be helpful and we look forward to your feedback. Questions and 
comments regarding this new approach may be directed to Jessica Schubel, Division of State 
Demonstrations and Waivers, Children and Adults Health Programs Group, CMCS, at 
jessica.schubel@cms.hhs.gov.