Using Concurrent Authorities
Sections 1115 and 1115A give the Secretary broad authority to approve demonstrations and innovative models of care that could include managed care features, waivers of Section 1902 (e.g., statewideness and comparability), expanded eligibility and new services. But these broad authorities are only appropriate for proposals that are truly innovative and seek to test new ideas. If you want to implement an MLTSS program that is similar to one operating elsewhere, you may be able to achieve all of the program features you want by using a managed care authority concurrently with an LTSS authority.
This section provides two examples already in use in states: concurrent 1915(a) and (c) authorities for a voluntary program; and concurrent 1915(b) and (c) for a mandatory program.
Concurrent authorities are not limited to these examples and are likely to evolve over time as states adopt some of the new and amended LTSS options from the Affordable Care Act. As of December 2011, no state had yet used a managed care authority concurrently with 1915(i) authority, for example, but you may want to consider discussing the approach with CMS if your state is moving toward the use of state plan HCBS under 1915(i). There are no set rules on which authorities may be used concurrently.
