1 1115 SUD Monitoring Report Template

Medicaid Section 1115 SUD Demonstration Monitoring Report – Part B

[State] [Demonstration Name]

[Demonstration Year] – [Calendar Dates for Demonstration Year]

[Reporting Period] – [Calendar Dates for Reporting Period]

Submitted on [Insert Date]

Medicaid and CHIP State Plan, Waiver, and Program Submissions

PRA Disclosure Statement - This information is being collected to assist the Centers for Medicare & Medicaid Services in program monitoring of Medicaid Section 1115 Substance Use Disorder Demonstrations. This mandatory information collection (42 CFR 431.428) will be used to support more efficient, timely and accurate review of states’ SUD 1115 demonstrations monitoring reports submissions to support consistency of monitoring and evaluation of SUD 1115 Demonstrations, increase in reporting accuracy, and reduce 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number. The OMB control number for this project is 0938-1148 (CMS-10398 #57). Public reporting burden for this collection of information is estimated to average 20 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

1. Title Page for the State’s SUD Demonstration or SUD Components of Broader Demonstration

The state should complete this Transmittal Title Page at the beginning of a demonstration and submit as the title page of all SUD Monitoring Reports. The content of this transmittal table should stay consistent over time.

State		Enter state name
Demonstration Name		Enter full demonstration name as listed in the demonstration approval.
Approval Date		Enter approval date of the demonstration as listed in the demonstration approval letter.
Approval Period		Enter the entire approval period for the demonstration. This should include a start date and an end date
SUD (or if broader demonstration, then SUD Related) Demonstration Goals and Objectives		Enter summary of the SUD (or if broader demonstration, then SUD related) demonstration goals and objectives as summarized in the STCs and/or demonstration fact sheet.

2. Executive Summary

The executive summary should be reported in the fillable box below. This executive summary is intended for summary level information only. The recommended word count is 500 words or less.

Enter the executive summary text here .

3. Narrative Information on Implementation, by Reporting Topic

Prompts	Demonstration year (DY) and quarter first reported	Related metric (if any)	Summary
1.2 Assessment of Need and Qualification for SUD Services
1.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.	EXAMPLE DY 1, Qtr. 2	EXAMPLE 8: Medicaid beneficiaries with SUD diagnosis treated in an IMD	EXAMPLE The number of beneficiaries with a SUD diagnoses treated in an IMD in the last quarter decreased by 5% due to the closure of one IMD in the state.
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☐ The state has no metrics trends to report for this reporting topic.
1.2.2 Implementation Update
Compared to the demonstration design details outlined in the STCs and implementation plan, have there been any changes or does the state expect to make any changes to: A) the target population(s) of the demonstration? B) the clinical criteria (e.g., SUD diagnoses) that qualify a beneficiary for the demonstration?	EXAMPLE DY 1, Q2	EXAMPLE N/A	EXAMPLE There are no planned changes to the target population or clinical criteria.
Are there any other anticipated program changes that may impact metrics related to assessment of need and qualification for SUD services? If so, please describe these changes.	DY 1, Q2	EXAMPLE 6 and 7: Medicaid beneficiaries with SUD diagnosis (monthly)	EXAMPLE The state projects an x% increase in beneficiaries with an SUD diagnosis due to an increase in the FPL limits which will be effective on X date.
☐ The state has no implementation update to report for this reporting topic.
2.2 Access to Critical Levels of Care for OUD and other SUDs (Milestone 1)
2.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.
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☐ The state has no metrics trends to report for this reporting topic.
2.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to: Planned activities to improve access to SUD treatment services across the continuum of care for Medicaid beneficiaries (e.g. outpatient services, intensive outpatient services, medication assisted treatment, services in intensive residential and inpatient settings, medically supervised withdrawal management)? SUD benefit coverage under the Medicaid state plan or the Expenditure Authority, particularly for residential treatment, medically supervised withdrawal management, and medication assisted treatment services provided to individuals in IMDs?
Are there any other anticipated program changes that may impact metrics related to access to critical levels of care for OUD and other SUDs? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
3.2 Use of Evidence-based, SUD-specific Patient Placement Criteria (Milestone 2)
3.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. Changes (+ or -) greater than two percent should be described.
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☐ The state is reporting metrics related to Milestone 2, but has no metrics trends to report for this reporting topic.
☐ The state is not reporting any metrics related to this reporting topic.
3.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to: Planned activities to improve providers’ use of evidence-based, SUD-specific placement criteria? Implementation of a utilization management approach to ensure: Beneficiaries have access to SUD services at the appropriate level of care? Interventions are appropriate for the diagnosis and level of care? Use of independent process for reviewing placement in residential treatment settings?
Are there any other anticipated program changes that may impact metrics related to the use of evidence-based, SUD-specific patient placement criteria (if the state is reporting such metrics)? If so, please describe these changes.
☐ The state has no implementation updates to report for this reporting topic.
4.2 Use of Nationally Recognized SUD-specific Program Standards to Set Provider Qualifications for Residential Treatment Facilities (Milestone 3)
4.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. Changes (+ or -) greater than two percent should be described.
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☐ The state is reporting metrics related to Milestone 3, but has no metrics trends to report for this reporting topic.
☐ The state is not reporting any metrics related to this reporting topic.
4.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to: Implementation of residential treatment provider qualifications that meet the ASAM Criteria or other nationally recognized, SUD-specific program standards? State review process for residential treatment providers’ compliance with qualifications standards? Availability of medication assisted treatment at residential treatment facilities, either on-site or through facilitated access to services off site?
Are there any other anticipated program changes that may impact metrics related to the use of nationally recognized SUD-specific program standards to set provider qualifications for residential treatment facilities (if the state is reporting such metrics)? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
5.2 Sufficient Provider Capacity at Critical Levels of Care including for Medication Assisted Treatment for OUD (Milestone 4)
5.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.
[Add rows as needed]
☐ The state has no metrics trends to report for this reporting topic.
5.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to planned activities to assess the availability of providers enrolled in Medicaid and accepting new patients in across the continuum of SUD care?
Are there any other anticipated program changes that may impact metrics related to provider capacity at critical levels of care, including for medication assisted treatment (MAT) for OUD? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
6.2 Implementation of Comprehensive Treatment and Prevention Strategies to Address Opioid Abuse and OUD (Milestone 5)
6.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.
[Add rows as needed]
☐ The state has no metrics trends to report for this reporting topic.
6.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to: Implementation of opioid prescribing guidelines and other interventions related to prevention of OUD? Expansion of coverage for and access to naloxone?
Are there any other anticipated program changes that may impact metrics related to the implementation of comprehensive treatment and prevention strategies to address opioid abuse and OUD? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
7.2 Improved Care Coordination and Transitions between Levels of Care (Milestone 6)
7.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.
[Add rows as needed]
☐ The state has no metrics trends to report for this reporting topic.
7.2.2 Implementation Update
Compared to the demonstration design and operational details outlined the implementation plan, have there been any changes or does the state expect to make any changes to implementation of policies supporting beneficiaries’ transition from residential and inpatient facilities to community-based services and supports?
Are there any other anticipated program changes that may impact metrics related to care coordination and transitions between levels of care? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
8.2 SUD Health Information Technology (Health IT)
8.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. Changes (+ or -) greater than two percent should be described.
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☐ The state has no metrics trends to report for this reporting topic.
11.2.2 Implementation Update
Compared to the demonstration design and operational details outlined in STCs and implementation plan, have there been any changes or does the state expect to make any changes to: How health IT is being used to slow down the rate of growth of individuals identified with SUD? How health IT is being used to treat effectively individuals identified with SUD? How health IT is being used to effectively monitor “recovery” supports and services for individuals identified with SUD? Other aspects of the state’s plan to develop the health IT infrastructure/capabilities at the state, delivery system, health plan/MCO, and individual provider levels? Other aspects of the state’s health IT implementation milestones? The timeline for achieving health IT implementation milestones? Planned activities to increase use and functionality of the state’s prescription drug monitoring program?
Are there any other anticipated program changes that may impact metrics related to SUD Health IT (if the state is reporting such metrics)? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
9.2 Other SUD-Related Metrics
9.2.1 Metric Trends
Discuss any relevant trends that the data shows related to assessment of need and qualification for SUD services. At a minimum, changes (+ or -) greater than two percent should be described.
[Add rows as needed]
☐ The state has no metrics trends to report for this reporting topic.
9.2.2 Implementation Update
Are there any anticipated program changes that may impact the other SUD-related metrics? If so, please describe these changes.
[Add rows as needed]
☐ The state has no implementation updates to report for this reporting topic.
10.2 Budget Neutrality
10.2.1 Current status and analysis
Discuss the current status of budget neutrality and provide an analysis of the budget neutrality to date. If the SUD component is part of a comprehensive demonstration, the state should provide an analysis of the SUD-related budget neutrality and an analysis of budget neutrality as a whole.
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☐ The state has no metrics trends to report for this reporting topic.
10.2.2 Implementation Update
Are there any anticipated program changes that may impact budget neutrality? If so, please describe these changes.
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☐ The state has no implementation updates to report for this reporting topic.
11.1 SUD-Related Demonstration Operations and Policy
11.1.1 Considerations
Highlight significant SUD (or if broader demonstration, then SUD-related) demonstration operations or policy considerations that could positively or negatively impact beneficiary enrollment, access to services, timely provision of services, budget neutrality, or any other provision that has potential for beneficiary impacts. Also note any activity that may accelerate or create delays or impediments in achieving the SUD demonstration’s approved goals or objectives, if not already reported elsewhere in this document. See report template instructions for more detail.
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☐ The state has no related considerations to report for this reporting topic.
11.1.2 Implementation Update
Compared to the demonstration design and operational details outlined in STCs and the implementation plan, have there been any changes or does the state expect to make any changes to: How the delivery system operates under the demonstration (e.g. through the managed care system or fee for service)? Delivery models affecting demonstration participants (e.g. Accountable Care Organizations, Patient Centered Medical Homes)? Partners involved in service delivery?
Has the state experienced any significant challenges in partnering with entities contracted to help implement the demonstration (e.g., health plans, credentialing vendors, private sector providers)? Has the state noted any performance issues with contracted entities?
What other initiatives is the state working on related to SUD or OUD? How do these initiatives relate to the SUD demonstration? How are they similar to or different from the SUD demonstration?
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☐ The state has no implementation updates to report for this reporting topic.
12.1 SUD Demonstration Evaluation Update
12.1.1 Narrative Information
Provide updates on SUD evaluation work and timeline. The appropriate content will depend on when this report is due to CMS and the timing for the demonstration. See report template instructions for more details.
Provide status updates on deliverables related to the demonstration evaluation and indicate whether the expected timelines are being met and/or if there are any real or anticipated barriers in achieving the goals and timeframes agreed to in the STCs.
List anticipated evaluation-related deliverables related to this demonstration and their due dates.
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☐ The state has no SUD demonstration evaluation update to report for this reporting topic..
13.1 Other Demonstration Reporting
13.1.1 General Reporting Requirements
Have there been any changes in the state’s implementation of the demonstration that might necessitate a change to approved STCs, implementation plan, or monitoring protocol?
Does the state foresee the need to make future changes to the STCs, implementation plan, or monitoring protocol, based on expected or upcoming implementation changes?
Compared to the details outlined in the STCs and the monitoring protocol, has the state formally requested any changes or does the state expect to formally request any changes to: The schedule for completing and submitting monitoring reports? The content or completeness of submitted reports? Future reports?
Has the state identified any real or anticipated issues submitting timely post-approval demonstration deliverables, including a plan for remediation?
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☐ The state has no updates on general reporting requirements to report for this reporting topic.
13.1.2 Post Award Public Forum
If applicable within the timing of the demonstration, provide a summary of the annual post-award public forum held pursuant to 42 CFR § 431.420(c) indicating any resulting action items or issues. A summary of the post-award public forum must be included here for the period during which the forum was held and in the annual report.
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☐ There was not a post-award public forum held during this reporting period and this is not an annual report, so the state has no post award public forum update to report for this reporting topic.
14.1 Notable State Achievements and/or Innovations
14.1 Narrative Information
Provide any relevant summary of achievements and/or innovations in demonstration enrollment, benefits, operations, and policies pursuant to the hypotheses of the SUD (or if broader demonstration, then SUD related) demonstration or that served to provide better care for individuals, better health for populations, and/or reduce per capita cost. Achievements should focus on significant impacts to beneficiary outcomes. Whenever possible, the summary should describe the achievement or innovation in quantifiable terms, e.g., number of impacted beneficiaries.
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☐ The state has no notable achievements or innovations to report for this reporting topic.

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