sectionf-connecticut.docVIP

SECTION D. 1915(B) COST-EFFECTIVENESS PREPRINT AND INSTRUCTIONS Cost-effectiveness is one of the three elements required of a 1915(b) waiver. The Cost Effectiveness test for 1915(b) waivers will no longer rely on a comparison of “with waiver” and “without waiver” costs. Instead, States must demonstrate that their waiver cost projections are reasonable and consistent with statute, regulation and guidance. The State must project waiver expenditures for the upcoming two-year waiver period, called Prospective Year 1 (P1) and Prospective Year 2 (P2). The State must then spend under that projection for the duration of the waiver. In order for CMS to renew a 1915(b) waiver, a State must demonstrate that the waiver was less than the projection during the retrospective two-year period. The 1915(b) Cost-Effectiveness Preprint and Instructions are divided into 4 major sections: Section I. Definitions and Terminology Section II. General Principles of the Cost-Effectiveness Test Section III. Instructions for Appendices Section IV. State Completion Section In addition there are seven Appendices: Appendix D1. Member Months Appendix D2.S Services in the Actual Waiver Cost Appendix D2.A Administration in the Actual Waiver Cost Appendix D3. Actual Waiver Cost Appendix D4. Adjustments in Projection Appendix D5. Waiver Cost Projection Appendix D6. RO Targets Appendix D7. Summary Sheet States should complete the Appendices first and then describe the Appendices in the State Completion Section of the Preprint. The Appendices included with the Preprint have been filled in with a completed actual example from the State of Nebraska. Each State should modify the spreadsheet to reflect their own program structure and replace the Nebraska information with its own data. Note: the example is for illustrative purposes only. It does not reflect Nebraska’s actual experience or program structure. In addition, technical assistance is available through each State’s CMS Regional Off