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Special Terms and Conditions

Overview

The Special Terms and Conditions (with waivers and expenditure authorities) document linked below (often referred to as “The Waiver”) contains:

  • A listing of the Waivers of federal law or regulation that are necessary to establish and maintain Oregon’s transformed health care system under the approved section 1115 Medicaid Demonstration;
  • A listing of the specific Expenditures CMS will allow the state to make, with federal matching funds included, on items, programs or services that were not previously allowed, but are permitted under the Demonstration; and
  • The numerous Special Terms and Conditions that CMS requires that Oregon meet to fulfill the State’s obligations under the Demonstration, including a wide range of topics, from rate-setting, to complaints and grievances, to training activities under the Transformation Center, and much more.

CMS Amended Waiver List, Expenditure Authorities and Special Terms and Conditions, 5-19-2016

Agreement

The state and CMS reached agreement on the Special Terms and Conditions of the July 1115 Medicaid Demonstration, including an unprecedented Accountability Plan and Expenditure Trend Review (beginning on page 161). Here is a summary of the main points of the Accountability Plan. You can also watch a recording of an introductory presentation or download a PDF of the presentation.

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