Case Studies

From multi-year task orders with a team of subcontractors to smaller-scale individual research efforts, L&M has led dozens of research projects from government agencies, as well as private clients.


Centers for Medicare & Medicaid Services (CMS), August 2018 through August 2020 (with 3 additional option years)

Objective

Assist the State Demonstrations Group (SDG) in the Center for Medicaid and CHIP Services (CMCS) by providing technical and analytical support for evaluation and monitoring of Medicaid Section 1115 demonstrations. Section 1115 of the Social Security Act authorizes the Secretary of the Department of Health and Human Services (HHS) to approve experimental, pilot, or demonstration projects to allow states flexibility to test unique approaches to program design and administration that are aimed at enhancing beneficiary access to quality services. L&M provides assistance with monitoring and evaluation activities by review and assessment of state demonstration program monitoring reports, evaluation designs, evaluation reports, implementation, monitoring, and payment protocols, and other deliverables to assess and provide recommendations concerning comprehensiveness, scientific and technical merits, and adherence to CMS requirements.

Challenges

There are currently over 50 active Section 1115 demonstrations, with others approved on an ongoing basis. Each demonstration has deliverables outlined in CMS’s Special Terms & Conditions that require review, assessment, and rapid cycle feedback to the state. CMS relies on the project team to conduct reviews and ad hoc requests quickly (usually within two weeks); the team works on multiple assignments simultaneously. L&M provides the CMCS team with technical expertise in research methods and program evaluation, knowledge of process and outcome measures and data sources, as well as deep subject matter expertise in a range of topics (e.g., family planning, substance use disorders, and behavioral health) and populations (such as aged and disabled, pediatric, homeless) relevant to current and future Section 1115 Medicaid demonstrations.

Approach

The team routinely provides rapid turnaround guidance to support CMS oversight of state’s Section 1115 Medicaid demonstrations. Among other activities completed in the base year of our project, L&M and our partner organization have reviewed states’ proposed evaluation designs, providing thorough assessments of the designs’ technical merits to CMS with unique demonstration goals and concerns, histories and available data sources in mind. To support CMS’ ongoing monitoring of Section 1115 demonstrations, L&M reviews states’ semi-annual and annual progress reports, including those related to Delivery System Reform Incentive Payment (DSRIP) and Medicaid managed care programs. We have analyzed stakeholder responses to public comment periods for new demonstrations and have compiled metrics that would allow CMS to better monitor these demonstrations.


Results

Our Team:

  • Provided actionable recommendations to assist states’ in developing more rigorous evaluation designs and reports to understand demonstration impacts on program goals.
  • Recommended new metrics for specialized demonstrations.
  • Reviewed states’ compliance with program monitoring and reporting through adherence to STCs.