GenIC # 59 (New) - Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations

Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
Medicaid Section 1115 Serious Mental Illness/Serious
Emotional Disturbance (SMI/SED) Demonstration
Monitoring Protocol Template Instructions

PRA Disclosure Statement - This information is being collected to assist the Centers for Medicare & Medicaid Services in
program monitoring of Medicaid Section 1115 Severe Mental Illness and Severe Emotional Disturbance Demonstrations.
This mandatory information collection (42 CFR § 431.428) will be used to support more efficient, timely and accurate review
of states’ monitoring report submissions of Medicaid Section 1115 Severe Mental Illness and Severe Emotional Disturbance
Demonstrations, and also support consistency in monitoring and evaluation, increase in reporting accuracy, and reduction
in timeframes required for monitoring and evaluation. Under the Privacy Act of 1974 any personally identifying information
obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148
(CMS-10398 #59). The time required to complete this information collection is estimated to average 29 hours per response,
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improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop
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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
Instructions for Using the 1115 SMI/SED Monitoring Protocol Template
The state should use the CMS-provided 1115 SMI/SED Monitoring Protocol Template to develop its SMI/SED
monitoring protocol, which should describe the state’s monitoring plans for the SMI/SED demonstration and be
submitted to CMS within 150 days of demonstration approval, as described in the Special Terms and Conditions
(STCs). The structure and format of the templates are intended to ensure that information is provided in a
standardized manner across states. A state that encounters challenges using the templates should contact its
project officer for assistance.
Note: If the state’s SMI/SED demonstration is part of a broader demonstration, CMS will work with the state to
ensure there is no duplication in the reporting requirements for different components of the demonstration. For
example, CMS may work with the state to avoid duplication in selecting metrics within Part A (SMI/SED
Monitoring Workbook) and selecting reporting topics within Part B (for example, SMI/SED Demonstrations
Operations and Policy, Budget Neutrality, SMI/SED Demonstration and Evaluation Update, Other SMI/SED
Demonstration Reporting, and Notable State Achievements and/or Innovations).
The state’s SMI/SED monitoring protocol will consist of a monitoring workbook (Part A) and a monitoring
reporting template (Part B).
Part A (SMI/SED Monitoring Workbook) is an Excel file with a (1) “Protocol – Planned metrics” tab in which
the state will identify the metrics it plans to report and a (2) “Protocol – SMI & SED definitions” tab in which the
state will describe the demonstration population and the SMI and SED definitions it will use to calculate the
monitoring metrics
1. “Protocol – Planned metrics” tab. The template that the state received contains the draft set of CMSprovided SMI/SED metrics. The state should review the CMS-provided metrics listed in the “Protocol –
Planned metrics” tab of the SMI/SED Monitoring Workbook and the accompanying CMS-provided
metrics technical specifications to be shared with states as soon as available. After reviewing these
materials, the state should identify the metrics it plans to report (all required metrics, any recommended
metrics, and any additional state-identified metrics), and complete the “Protocol – Planned metrics” tab as
follows:
•

Health IT metrics. The state is expected to identify metrics to measure progress on its SMI/SED
health IT plan. The state should enter the health IT metrics it identifies in the rows in the “Protocol –
Planned metrics” tab. For each key health IT question listed below, the state is required either to
select at least one metric from the list of sample metrics in Table 1 or to identify its own metrics.

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
Table 1. Key health IT questions and sample metrics
Key Health
Questions
1. How is information
technology being
used to identify
individuals with
SMI/SED?

Sample Metrics
•

•

•
•
•

•

2. How is information
technology being
used to effectively
treat individuals
with SMI/SED?

•

•

•

3. How is information
technology being
used to effectively
monitor recovery
supports and
services for
individuals with
SMI/SED?

•

•
•

Connecting Behavioral and Mental Health Providers to Health Information
Exchange (HIE)
o Sample Process Measure: Number of Behavioral Health Providers
Connected to HIE
o Sample Process Measure: Number of Inpatient Psychiatric Facilities
Connected to HIE
Connecting Community-Based Organizations to HIE
o Sample Process Measure: Number of Community Based Organizations
Connected to HIE (i.e. Residential Treatment Facilities, Housing
programs)
Connecting Primary Care Providers (PCPs) to HIE
o Sample Process Measure: Number of PCPs connected to HIE
Connecting EMS providers to HIE
o Sample Process Measure: Number of EMS providers connected to HIE
Use of technology in screening/assessment
o Sample Process Measure: Number of providers using structured data
capture for screening, intake and/or assessment
o Sample Process Measure: Number of providers using speech-analysis
technology to detect schizophrenia
Connecting jails/criminal justice to HIE
o Sample Process Measure: Number of jails/criminal justice systems
connected to HIE
eReferral/eConsult – closed-loop referral services for consultation and/or
follow up services
o Sample Process Measure: Number of referrals and/or consultations and
completed services
Access to additional services using Provider/Resource directory - connecting
primary care to mental health service offerings
o Sample Process Measure: Number of providers and resources managed
in provider/resource directory; accuracy of information; frequency of
information update
Consent Management / Inter-Intra State e-Consent capture and use
o Number of individuals for whom consent to disclose or access information
per state policy (both covered and non-covered 42CFR Part 2 and
HIPPA) has been obtained and captured.
Care management/recovery– shared care plan accessibility across care team
o Sample Process Measure: Creation of statewide functionalities for
possible use by care team members (e.g., direct secure messaging for
sharing behavioral health treatment data with proper consent).
Connecting corrections systems to care delivery systems for incarcerated
individual release to community
o Sample Process Measure: Number of connections live.
Individuals connected to community-based resources
o Sample Process Measure: Number of clinicians with list of community
resources that individuals can be referred to in an e-directory.
o Sample Process Measure: Number of providers and resources on a
community list that can be provided to clinicians to SMI treating providers
for the purpose of individual referrals in an e-directory.

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
•

Additional state-identified metrics. A state that chooses to report on additional metrics beyond
those provided by CMS (or those required for health IT reporting) should add rows for each
additional state-identified metric to the bottom of the “Protocol—Planned metrics” tab.

•

Standard information on CMS-provided metrics. The following columns of the “Protocol –
Planned metrics” tab contain standard information on CMS-provided metrics:
o
o
o
o
o
o
o
o
o
o

Number (#)
Metric name
Metric description
Milestone or reporting topic (milestone number, “Health IT”, “other SMI/SED-related
metric”)
Metric type (CMS-constructed, established quality measure, or state-identified)
Reporting category (grievances and appeals, other monthly and quarterly metric, annual
metric that is an established quality measure, and other annual metric)
Data source
Measurement period (year, quarter, or month)
Reporting frequency (annually or quarterly)
Reporting priority (required or recommended)

Metric type describes whether the metric is CMS-constructed or an established quality measure. This
should be used to inform the baseline reporting period for each metric. Reporting category describes
the category associated with reporting guidelines for including metrics in monitoring reports. See
Appendix A of this document and the 1115 SMI/SED metrics technical specifications for additional
guidance.
Standard information on CMS-provided metrics cannot be altered by the state. However, the state can
propose modifications in the column entitled “Explanation of any deviations from the technical
specifications.”
•

Standard information on state-identified metrics. For state-identified reporting metrics, including
health IT-related metrics, the state should populate the following columns according to this guidance:
o
o

Reporting priority: The state should populate this column as “state-identified” for all stateidentified metrics except health IT, which are listed as “required.”
Number (#): The state should number any additional state-identified metric according to the
following numbering convention: S1, S2, S3, etc. Please note that the health IT metrics are
already numbered Q1, Q2, and Q3 to align with the three key health IT questions.

The state should populate the remaining columns to provide a level of detail similar to that of the
CMS-provided metrics:
o
o
o
o

Metric description
Milestone or reporting topic: The state should populate this column with the milestone or
reporting topic associated with the metric (for example, the milestone number, “Health IT”,
“other SMI/SED-related metric”).
Metric type: The state should populate this column with “state-identified.”
Reporting category: The state should populate this column with the metric’s reporting
category (for example, grievances and appeals, other monthly and quarterly metric, annual

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions

•

•

metric that is an established quality measure, and other annual metric). States should use this
classification to inform the reporting schedule for the metric.
o Data source
o Measurement period (year, quarter, or month)
o Reporting frequency (annually or quarterly)
Plans to report metrics. The column “State will report” identifies whether the state plans to report
each metric. The state should mark Y or N to indicate whether it will include each metric in its
reporting.
Baseline, demonstration target, and annual goals. As described in the STCs, for each metric, the
state must provide a baseline, a target to be achieved by the end of the demonstration, and an annual
goal for closing the gap between baseline and the demonstration target. States should consult the 1115
SMI/SED metrics technical specifications for detailed guidance regarding baseline periods for each
metric type. The state should provide this information in columns:
o Baseline reporting period (MM/DD/YY–MM/DD/YY)
o Annual goal (increase, consistent, or decrease)
o Overall demonstration target (increase, consistent, or decrease)
For metric #19, the state’s annual goal should be to decrease the average length of stay in
participating psychiatric hospitals and residential settings to achieve an overall demonstration target
of no more than 30 days. If a state’s average length of stay in IMDs is already less than 30 days, the
state should indicate that its goal is to stay consistent with its current average length of stay. For all
other metrics, demonstration targets and annual goals can be directional (increase, consistent, or
decrease), rather than values, and be benchmarked against performance in best practice settings.

•

Alignment with CMS-provided technical specifications. The state should attest that planned
reporting matches the CMS-provided technical specifications for each CMS-provided metric, using
the column named “Attest that planned reporting matches the CMS-provided specification (Y/N).”
For metrics where reporting does not match the CMS-provided specifications, describe these
deviations in the provided column. For example, deviations may include reporting on fewer
subpopulations than those outlined in the technical specifications.

•

Initial reporting date. The state should indicate when reporting will begin for each metric. States
should consult the detailed guidance on metrics reporting and calculation in Appendix A to complete
the “initial reporting dates” columns in the SMI/SED Monitoring Workbook.
o

In the column “Dates covered by first measurement period for metric (MM/DD/YYYY–
MM/DD/YYYY),” the state should note the first measurement period for each metric.

o

In the column “Name of first report in which the metric will be submitted,” the state should
note the first report in which each metric will appear (for example, DY1 Q3 report).

o

The state should use the “Submission date of first report in which the metric will be reported”
column to provide the calendar year dates associated with the demonstration year and the
quarter in which the metric will first be reported.

o

A state that plans to phase in reporting of any metric should complete the column “State
plans to phase in reporting (Y/N)” and use the “Explanation of any plans to phase in
reporting over time” column to describe and justify plans to phase in the metric reporting.

Table 2 provides an example of how to complete these columns. The example state has a
demonstration that aligns with a calendar year, and its first demonstration year begins January 1,
2019.
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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
Table 2. Example of completed “initial reporting dates” columns in the SMI/SED Monitoring Workbook,
assuming a state with DY1 that aligns with calendar year 2019 (1/1/2019–12/31/2019)

Reporting
category
Grievances and
appeals
Other monthly
and quarterly
metric
Annual metrics
that are
established
quality measurea
Other annual
metrics

Dates covered by first
measurement period
for metric
(MM/DD/YYYY MM/DD/YYYY)

Name of first report in
which the metric will
be submitted (Format:
DY1 Q3 report)

Submission date of
first report in which
the metric will be
reported
(MM/DD/YYYY)

State plans
to phase in
reporting
(Y/N)

1/1/2019 – 3/31/2019

DY1 Q1 report

5/30/2019

N

1/1/2019 – 3/31/2019

DY1 Q2 report

8/29/2019

N

1/1/2019 – 12/31/2019

DY2 Q2 reportb

8/29/2020

N

1/1/2019 – 12/31/2019

DY2 Q1 report

5/30/2020

N

a

Metrics that are established quality measures should be calculated for the calendar year. All other metrics should be
calculated for the SMI/SED demonstration year.
b In this example, the state reports its established quality measures in the second quarterly report following the annual report
because its demonstration year ends on 12/31; this lag allows adequate time for claims runout and other data completeness
issues, as well as time to incorporate annual measure steward updates to specifications. States with demonstration years that
end January 31 or February 28 should instead report established quality measures in the first quarterly report following the
annual report. All other states should report established quality measures in the annual report.

2. State-specific SMI & SED definitions. In the tab named “Protocol – SMI & SED definitions” the state
should describe the populations covered by the demonstration and the definitions for SMI and SED it will
use to calculate monitoring metrics. State definitions should include a list of diagnosis codes and service
requirements. The definitions included in the state’s monitoring protocol should not change over the
course of the demonstration.
Part B (SMI/SED Monitoring Protocol Template) is a Word document containing five narrative reporting
sections:
1. The Title Page is a brief form that the state should complete as part of the SMI/SED Monitoring
Protocol. The state will submit this form as the title page for all Monitoring Reports. The content of this
table should remain consistent over time.
2. The Proposed Modifications to SMI/SED Narrative Information on Implementation table is a
companion to Part B, Section 3 of the SMI/SED Monitoring Report Template (Narrative Information on
Implementation). The state should review the information requested in the SMI/SED Monitoring Report
Template Section 3 and identify any modifications it would like to make in its reporting on each topic,
including any potential challenges to reporting the requested information. In the Proposed Modifications
to SMI/SED Narrative Information on Implementation table in Section 2 of the monitoring protocol
template, the state should describe each proposed modification and summarize the reasoning for this
modification. The state should then mark the appropriate check box confirming that it will report the
narrative information as planned, either with no modifications or with the exception of any modifications
described in the table.

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
3. Annual Assessment of the Availability of Mental Health Providers reporting. The state should
provide the time period covered by the Annual Assessment of the Availability of Mental Health Providers
in its annual monitoring reports.
4. Acknowledgement of Budget Neutrality reporting. The Budget Neutrality Workbook will be provided
by the state’s project officer. To complete Section 3, the state should review the workbook and select the
appropriate check box to indicate that it will provide budget neutrality reporting as requested.
5. Retrospective reporting. If a state’s protocol is approved after its first quarterly monitoring report
submission date, the state should report retrospectively for any prior quarters of SMI/SED demonstration
implementation. To complete Section 4, the state should review the retrospective reporting instructions in
this section of the 1115 SMI/SED Monitoring Protocol Template and select the appropriate check box to
indicate that it will report retrospectively as requested, or propose an alternate approach to retrospective
reporting.
6. Reporting SMI/SED demonstration metrics and narrative information. The state should attest that it
has reviewed the guidance on metrics reporting in Appendix A and will report metrics and narrative
information in its quarterly and annual reports according to the described schedule. Otherwise, the state
should propose deviations from this guidance in the space provided and provide justification for any
proposed deviation. The state should complete the table provided to reflect its proposed reporting
schedule for the duration of its SMI/SED demonstration approval period.

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions

APPENDIX A:
REPORTING 1115 SMI/SED DEMONSTRATION MONITORING METRICS AND
NARRATIVE INFORMATION

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions

This appendix provides reporting guidance applicable to 1115 SMI/SED demonstration monitoring
metrics and other monitoring information. See Chapter 1 Section B of the technical specifications for
additional guidance.
States should report data to CMS in accordance with the schedule and format agreed upon in the
approved monitoring protocol. Because of the dynamic nature of Medicaid data, metrics should be
produced at the same time in each measurement period throughout the demonstration. This applies even
if data are not shared with CMS until a later date. For example, if a state submits data quarterly, the
submission should contain three monthly values for each monthly metric, each produced at the same
time relative to its measurement periods.
Guidelines for including metrics and narrative information in monitoring reports are as follows:
•

Each quarterly report should contain (1) narrative information on implementation for the most
recent demonstration quarter, (2) grievances and appeals metrics for the most recent demonstration
quarter, and (3) all other monthly and quarterly metrics for the prior quarter (which allows at least
90 days for claims run-out and other considerations for data completeness).

•

To allow for adequate time to implement annual specification updates from measure stewards,
annual metrics that are established quality measures should be reported:
o For states with demonstration years (DYs) that end March 31 through November 30: in the
annual report
o For states with demonstration years that end January 31 or February 28: in the first quarterly
report of the next demonstration year
o For states with demonstration years that end December 31: in the second quarterly report of the
next demonstration year

•

All other annual metrics should be reported in the first quarterly report of the following
demonstration year, rather than in the annual report. This allows at least 90 days for claims run-out
and other considerations for data completeness.

Table A.1 illustrates these guidelines, which apply to both CMS-constructed and state-identified
metrics (including Health IT).

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Medicaid Section 1115 SMI/SED Demonstration
Monitoring Protocol Template Instructions
Table A.1. Example of demonstration year 1 reporting in quarterly and annual monitoring reports

Report name:

Report due date:
Measurement periods,
by reporting category
Narrative information
on implementation
Grievances and
appeals
Other monthly and
quarterly metrics

DY1 Q1
report

DY1 Q2
report

DY1 Q3
report

DY1 Q4
(annual)
report

DY2 Q1
report

DY2 Q2
report

Due 60
days after
quarter
ends

Due 60
days after
quarter
ends

Due 60
days after
quarter
ends

Due 90
days after
quarter
ends

Due 60
days after
quarter
ends

Due 60 days
after quarter
ends

DY1 Q1

DY1 Q2

DY1 Q3

DY1 Q4

DY2 Q1

DY2 Q2

DY1 Q1

DY1 Q2

DY1 Q3

DY1 Q4

DY2 Q1

DY2 Q2

NA

DY1 Q1

DY1 Q2

DY1 Q3

DY1 Q4

DY4 Q1

States with
DYs ending
3/31 –
11/30: DY1
(Q1-Q4)
NA

States with States with
DYs ending DYs ending
on 1/31 or
on 12/31:
2/28: DY1
DY1
(Q1-Q4)
(Q1-Q4)
DY1
NA

Annual metrics that are
established quality
measures*

NA

NA

NA

Other annual metrics

NA

NA

NA

Note:

The state is expected to submit retrospective metrics data in the state’s second monitoring report submission after
monitoring protocol approval.

* Metrics that are established quality measures should be calculated for the calendar year. All other metrics should be
calculated for the SMI/SED demonstration year.
DY = Demonstration year
NA = not applicable (information not expected to be included in report

Technical Assistance. To help states collect, report, and use the 1115 SMI/SED demonstration
monitoring metrics, CMS offers technical assistance. Please submit technical assistance requests to:
[email protected] and copy your CMS project officer on the message.

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