The administration cannot submit certain new section 1115 Medicaid waiver changes unless the legislature authorizes them by statute, and it must review, monitor, and notify legislative bodies in specified cases.
36-3302 - Waiver proposal; legislative approval required; notification 36-3302. Waiver proposal; legislative approval required; notification A. The administration may not submit to the centers for medicare and medicaid services, or the successor agency, a new amendment proposal for a demonstration waiver under section 1115 of the social security act, or include any new proposed provision in a section 1115 waiver extension, unless the proposed amendment or provision has been authorized by the legislature in the form of a statute, if the waiver does any of the following: 1. Expands eligibility for title XIX or title XXI coverage to populations not authorized by chapter 29 of this title as of January 1, 2025. 2. Adds new categories of covered services or benefits not authorized by chapter 29 of this title as of January 1, 2025. 3. Will, as a result of the changes being proposed, lead to an annual increase in utilization greater than ten percent for specific services affected by the proposed amendment or provision above what the utilization would have been without the proposed amendment or provision. B. Before submitting a new amendment proposal for a demonstration waiver under section 1115 of the social security act or including a new proposed provision in a waiver extension, the administration shall determine whether the proposed changes are subject to subsection A of this section. Any proposed changes that are subject to subsection A of this section shall be reviewed by the health and human services committees of reference, or their successor committees of reference, and the committees of reference shall forward their recommendation to the senate and house of representatives on whether to approve the proposed changes. C. If the administration determines the proposed changes are not subject to subsection A of this section, the administration shall monitor changes in annual utilization specific to the services impacted by the new waiver changes for three years after the implementation of the changes to determine whether the changes led to an annual increase in utilization greater than ten percent for the specific services affected by the waiver change above what the utilization would have been without the waiver change. D. If the monitoring required by subsection C of this section demonstrates that the changes led to an annual increase in utilization greater than ten percent for the specific services affected by the waiver change above what the utilization would have been without the waiver change, the administration shall notify the president of the senate, the speaker of the house of representatives and the chairperson of the joint legislative budget committee and, if the legislature has not enacted a statute authorizing the specific waiver change that led to the increased utilization within one year after the administration's notification pursuant to this subsection, the administration shall submit a request to the centers for medicare and medicaid services, or the successor agency, to terminate the new waiver changes that were not authorized by the legislature. E. The administration shall notify the joint legislative budget committee in writing of any section 1115 waiver application or amendment submitted, regardless of whether legislative approval is required pursuant to subsection A of this section, at the time the application or amendment is posted for public comment.