The agency must furnish CMS with sufficient information to support the assurances required by §441.302. Except as CMS may otherwise specify for particular waivers, the information must consist of the following:
D+D' [LESS THAN EQUAL TO] G+G'.
The symbol "[LESS THAN EQUAL TO]" means that the result of the left side of the equation must be less than or equal to the result of the right side of the equation.
D = the estimated annual average per capita Medicaid cost for home and community-based services for individuals in the waiver program.
D' = the estimated annual average per capita Medicaid cost for all other services provided to individuals in the waiver program.
G = the estimated annual average per capita Medicaid cost for hospital, NF, or ICF/IID care that would be incurred for individuals served in the waiver, were the waiver not granted.
G' = the estimated annual average per capita Medicaid costs for all services other than those included in factor G for individuals served in the waiver, were the waiver not granted.
42 C.F.R. §441.303