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October 24, 2007 Kerry N. Weems Dear Mr. Weems: We are writing to you to follow up on the report issued by the Government Accountability Office (GAO) on July 24, 2007, which addressed the process for approving Medicaid waivers under Section 1115 of the Social Security Act. In looking at the approval process for waivers submitted by Florida and Vermont, the GAO found that both states took steps to obtain input at the state level, but that the Department of Health and Human Services (HHS) did not provide an opportunity for public input at the federal level. The undersigned groups representing health care providers, children and parents, seniors, and people with disabilities include many national organizations with members from around the country. Given our direct stake in the Medicaid program, we were pleased to see press accounts of your comments in which you recognized the importance of operating your agency in a transparent manner. The GAO report presents an opportunity for us to work together to enhance public involvement and increase the transparency of the work of CMS. As noted in the GAO report, HHS issued policy in 1994 stating that it would notify interested organizations when it received a waiver proposal and allow a 30-day public comment period. Although that policy has never been rescinded, the agency now contends that public input is not necessary. The GAO disagreed, pointing out a number of reasons why input is necessary at the federal level, including potential implications of waivers for other states and the fact that the proposals are not final until they reach HHS. The GAO recommended that an opportunity for public comment be made available at the federal level, and stated that in the absence of action by HHS, Congress should require such a process through legislation. Given your recognition of the importance of transparency and your pledge to conduct the agency’s business in the open, we would like to request an opportunity to meet with you to discuss improvements in the waiver process that could respond to the concerns outlined in the GAO report. Please let us know when we may be able to meet with you by contacting Judith Solomon at 202-408-1080 or solomon@cbpp.org. Thank you. AARP |
