This week, our In Focus section reviews Virginia’s Section 1115 demonstration waiver, which is currently posted for stakeholder review and a public comment period. The 1115 waiver seeks approval from the Centers for Medicare & Medicaid Services (CMS) to implement two initiatives: (1) a Medicaid managed long-term services and supports (MLTSS) program; and (2) a Delivery System Reform Incentive Payment (DSRIP) program. The MLTSS initiative would mandate enrollment in managed care for around 130,000 individuals receiving LTSS benefits, including enrollees in three of the state’s existing 1915(c) home and community based services (HCBS) waivers. Meanwhile, the DSRIP seeks to establish high-performing provider collaborations to provide patient-centered care and explore alternative payment models. The public comment period on the 1115 waiver runs from December 4, 2015, through January 6, 2015. If approved by CMS, the 1115 demonstration will operate from January 2017 through December 2022.