§ 1315

((a)) ** Waiver of State plan requirements; costs regarded as State plan expenditures; availability of appropriations** In the case of any experimental, pilot, or demonstration project which, in the judgment of the Secretary, is likely to assist in promoting the objectives of subchapter I, X, XIV, XVI, or XIX, or part A or D of subchapter IV, in a State or States— ((1)) the Secretary may waive compliance with any of the requirements of section 302, 602, 654, 1202, 1352, 1382, or 1396a of this title, as the case may be, to the extent and for the period he finds necessary to enable such State or States to carry out such project, and ((2)) ((A)) costs of such project which would not otherwise be included as expenditures under section 303, 655, 1203, 1353, 1383, or 1396b of this title, as the case may be, and which are not included as part of the costs of projects under , shall, to the extent and for the period prescribed by the Secretary, be regarded as expenditures under the State plan or plans approved under such subchapter, or for administration of such State plan or plans, as may be appropriate, and ((B)) costs of such project which would not otherwise be a permissible use of funds under part A of subchapter IV and which are not included as part of the costs of projects under , shall to the extent and for the period prescribed by the Secretary, be regarded as a permissible use of funds under such part. ((b)) ** Child support enforcement programs** ((1)) In the case of any experimental, pilot, or demonstration project undertaken under subsection (a) to assist in promoting the objectives of part D of subchapter IV, the project— ((A)) must be designed to improve the financial well-being of children or otherwise improve the operation of the child support program; ((B)) may not permit modifications in the child support program which would have the effect of disadvantaging children in need of support; and ((C)) must not result in increased cost to the Federal Government under part A of such subchapter. ((2)) An Indian tribe or tribal organization operating a program under shall be considered a State for purposes of authority to conduct an experimental, pilot, or demonstration project under subsection (a) to assist in promoting the objectives of part D of subchapter IV and receiving payments under the second sentence of that subsection. The Secretary may waive compliance with any requirements of or regulations promulgated under that section to the extent and for the period the Secretary finds necessary for an Indian tribe or tribal organization to carry out such project. Costs of the project which would not otherwise be included as expenditures of a program operating under and which are not included as part of the costs of projects under , shall, to the extent and for the period prescribed by the Secretary, be regarded as expenditures under a tribal plan or plans approved under such section, or for the administration of such tribal plan or plans, as may be appropriate. An Indian tribe or tribal organization applying for or receiving start-up program development funding pursuant to section 309.16 of title 45, Code of Federal Regulations, shall not be considered to be an Indian tribe or tribal organization operating a program under for purposes of this paragraph. ((c)) ** Demonstration projects to test alternative definitions of unemployment** ((1)) ((A)) The Secretary shall enter into agreements with up to 8 States submitting applications under this subsection for the purpose of conducting demonstration projects in such States to test and evaluate the use, with respect to individuals who received aid under part A of subchapter IV in the preceding month (on the basis of the unemployment of the parent who is the principal earner), of a number greater than 100 for the number of hours per month that such individuals may work and still be considered to be unemployed for purposes of . If any State submits an application under this subsection for the purpose of conducting a demonstration project to test and evaluate the total elimination of the 100-hour rule, the Secretary shall approve at least one such application. ((B)) If any State with an agreement under this subsection so requests, the demonstration project conducted pursuant to such agreement may test and evaluate the complete elimination of the 100-hour rule and of any other durational standard that might be applied in defining unemployment for purposes of determining eligibility under . ((2)) Notwithstanding , a demonstration project conducted under this subsection may be conducted in one or more political subdivisions of the State. ((3)) An agreement under this subsection shall be entered into between the Secretary and the State agency designated under . Such agreement shall provide for the payment of aid under the applicable State plan under part A of subchapter IV as though had been modified to reflect the definition of unemployment used in the demonstration project but shall also provide that such project shall otherwise be carried out in accordance with all of the requirements and conditions of (and, except as provided in paragraph (2), any related requirements and conditions under part A of subchapter IV). ((4)) A demonstration project under this subsection may be commenced any time after , and shall be conducted for such period of time as the agreement with the Secretary may provide; except that, in no event may a demonstration project under this section be conducted after . ((5)) ((A)) Any State with an agreement under this subsection shall evaluate the comparative cost and employment effects of the use of the definition of unemployment in its demonstration project under this section by use of experimental and control groups comprised of a random sample of individuals receiving aid under and shall furnish the Secretary with such information as the Secretary determines to be necessary to evaluate the results of the project conducted by the State. ((B)) The Secretary shall report the results of the demonstration projects conducted under this subsection to the Congress not later than 6 months after all such projects are completed. ((d)) ** Regulations relating to applications for or renewals of demonstration projects** ((1)) An application or renewal of any experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of subchapter XIX or XXI in a State that would result in an impact on eligibility, enrollment, benefits, cost-sharing, or financing with respect to a State program under subchapter XIX or XXI (in this subsection referred to as a “demonstration project”) shall be considered by the Secretary in accordance with the regulations required to be promulgated under paragraph (2). ((2)) Not later than 180 days after , the Secretary shall promulgate regulations relating to applications for, and renewals of, a demonstration project that provide for— ((A)) a process for public notice and comment at the State level, including public hearings, sufficient to ensure a meaningful level of public input; ((B)) requirements relating to— ((i)) the goals of the program to be implemented or renewed under the demonstration project; ((ii)) the expected State and Federal costs and coverage projections of the demonstration project; and ((iii)) the specific plans of the State to ensure that the demonstration project will be in compliance with subchapter XIX or XXI; ((C)) a process for providing public notice and comment after the application is received by the Secretary, that is sufficient to ensure a meaningful level of public input; ((D)) a process for the submission to the Secretary of periodic reports by the State concerning the implementation of the demonstration project; and ((E)) a process for the periodic evaluation by the Secretary of the demonstration project. ((3)) The Secretary shall annually report to Congress concerning actions taken by the Secretary with respect to applications for demonstration projects under this section. ((e)) ** Extensions of State-wide comprehensive demonstration projects for which waivers granted** ((1)) The provisions of this subsection shall apply to the extension of any State-wide comprehensive demonstration project (in this subsection referred to as “waiver project”) for which a waiver of compliance with requirements of subchapter XIX is granted under subsection (a). ((2)) During the 6-month period ending 1 year before the date the waiver under subsection (a) with respect to a waiver project would otherwise expire, the chief executive officer of the State which is operating the project may submit to the Secretary a written request for an extension, of up to 3 years (5 years, in the case of a waiver described in ), of the project. ((3)) If the Secretary fails to respond to the request within 6 months after the date it is submitted, the request is deemed to have been granted. ((4)) If such a request is granted, the deadline for submittal of a final report under the waiver project is deemed to have been extended until the date that is 1 year after the date the waiver project would otherwise have expired. ((5)) The Secretary shall release an evaluation of each such project not later than 1 year after the date of receipt of the final report. ((6)) Subject to paragraphs (4) and (7), the extension of a waiver project under this subsection shall be on the same terms and conditions (including applicable terms and conditions relating to quality and access of services, budget neutrality, data and reporting requirements, and special population protections) that applied to the project before its extension under this subsection. ((7)) If an original condition of approval of a waiver project was that Federal expenditures under the project not exceed the Federal expenditures that would otherwise have been made, the Secretary shall take such steps as may be necessary to ensure that, in the extension of the project under this subsection, such condition continues to be met. In applying the previous sentence, the Secretary shall take into account the Secretary’s best estimate of rates of change in expenditures at the time of the extension. ((f)) ** Application for extension of waiver project; submission; approval** An application by the chief executive officer of a State for an extension of a waiver project the State is operating under an extension under subsection (e) (in this subsection referred to as the “waiver project”) shall be submitted and approved or disapproved in accordance with the following: ((1)) The application for an extension of the waiver project shall be submitted to the Secretary at least 120 days prior to the expiration of the current period of the waiver project. ((2)) Not later than 45 days after the date such application is received by the Secretary, the Secretary shall notify the State if the Secretary intends to review the terms and conditions of the waiver project. A failure to provide such notification shall be deemed to be an approval of the application. ((3)) Not later than 45 days after the date a notification is made in accordance with paragraph (2), the Secretary shall inform the State of proposed changes in the terms and conditions of the waiver project. A failure to provide such information shall be deemed to be an approval of the application. ((4)) During the 30-day period that begins on the date information described in paragraph (3) is provided to a State, the Secretary shall negotiate revised terms and conditions of the waiver project with the State. ((5)) ((A)) Not later than 120 days after the date an application for an extension of the waiver project is submitted to the Secretary (or such later date agreed to by the chief executive officer of the State), the Secretary shall— ((i)) approve the application subject to such modifications in the terms and conditions— ((I)) as have been agreed to by the Secretary and the State; or ((II)) in the absence of such agreement, as are determined by the Secretary to be reasonable, consistent with the overall objectives of the waiver project, and not in violation of applicable law; or ((ii)) disapprove the application. ((B)) A failure by the Secretary to approve or disapprove an application submitted under this subsection in accordance with the requirements of subparagraph (A) shall be deemed to be an approval of the application subject to such modifications in the terms and conditions as have been agreed to (if any) by the Secretary and the State. ((6)) An approval of an application for an extension of a waiver project under this subsection shall be for a period not to exceed 3 years (5 years, in the case of a waiver described in ). ((7)) An extension of a waiver project under this subsection shall be subject to the final reporting and evaluation requirements of paragraphs (4) and (5) of subsection (e) (taking into account the extension under this subsection with respect to any timing requirements imposed under those paragraphs). ((g)) ** Requirement of budget neutrality for Medicaid demonstration projects** ((1)) ** In general** Beginning January 1 2027, the Secretary may not approve an application for (or renewal or amendment of) an experimental, pilot, or demonstration project undertaken under subsection (a) to promote the objectives of subchapter XIX in a State (in this subsection referred to as a “Medicaid demonstration project”) unless the Chief Actuary for the Centers for Medicare & Medicaid Services certifies that such project, or, in the case of a renewal, the duration of the preceding waiver, is not expected to result in an increase in the amount of Federal expenditures compared to the amount that such expenditures would otherwise be in the absence of such project. For purposes of this subsection, expenditures for the coverage of populations and services that the State could have otherwise provided through its Medicaid State plan or other authority under subchapter XIX, including expenditures that could be made under such authority but for the provision of such services at a different site of service than authorized under such State plan or other authority, shall be considered expenditures in the absence of such a project. ((2)) ** Treatment of savings** In the event that expenditures with respect to a State under a Medicaid demonstration project are, during an approval period for such project, less than the amount of such expenditures that would have otherwise been made in the absence of such project, the Secretary shall specify the methodology to be used with respect to the subsequent approval period for such project for purposes of taking the difference between such expenditures into account.