Despite some progress in transparency related to the process for Section 1115 Medicaid waivers, the Centers for Medicare & Medicaid Services’ “approach to ensuring transparency when states propose major changes to their demonstrations has significant gaps,” the Government Accountability Office said in a report released Friday. “The lack of policies for ensuring transparency when states make major changes to pending applications and limited transparency requirements applied for amendments – which are being used by some states to make major changes to their demonstrations – puts CMS’s goal of transparency at risk,” the report notes. “These gaps may leave the agency and the public without key information to fully understand the potential impact of the changes being proposed, including on beneficiaries and costs.” GAO recommended that CMS develop policies for ensuring transparency when states submit major changes to pending demonstration applications and propose amendments to existing demonstrations. The agency concurred with these recommendations.

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