Medicaid Section 1115 SUD Demonstration
Monitoring Report Template Instructions
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.
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Instructions for Using the SUD Monitoring Report Template
Customize the template for use in quarterly and annual monitoring reports
Use the customized template to complete each quarterly and annual monitoring report
Detailed Instructions by Reporting Topic
Assessment of Need and Qualification for SUD Services
Access to Critical Levels of Care for OUD and other SUDs (Milestone 1)
Use of Evidence-based, SUD-specific Patient Placement Criteria (Milestone 2)
Use of Nationally Recognized SUD-specific Program Standards to Set Provider Qualifications for Residential Treatment Facilities (Milestone 3)
Sufficient Provider Capacity at Critical Levels of Care including for Medication Assisted Treatment for OUD (Milestone 4)
Implementation of Comprehensive Treatment and Prevention Strategies to Address Opioid Abuse and OUD (Milestone 5)
Improved Care Coordination and Transitions between Levels of Care (Milestone 6)
SUD Health Information Technology (Health IT)
Other SUD-Related Metrics
Budget Neutrality
SUD-Related Demonstration Operations and Policy
SUD Demonstration Evaluation Update
Other Demonstration Reporting
Notable State Achievements and/or Innovations
Instructions for Using the SUD Monitoring Report Template
Note: If the state’s SUD demonstration is part of a comprehensive demonstration, CMS will work with the state to ensure there is not duplication in the reporting requirements for different components of the demonstration. For example, CMS may work with the state to avoid duplication in the following areas: select metrics within Part A (SUD Metrics Workbook) and select reporting topics within Part B (for example, SUD Demonstrations Operations and Policy, Budget Neutrality, SUD Demonstration and Evaluation Update, Other SUD Demonstration Reporting, and Notable State Achievements and/or Innovations).
Review the detailed instructions in Section B of this document.
Complete Part A: SUD Metrics Workbook. CMS requires the state to provide data on SUD demonstration metrics for most reporting topics (see Table 1, and detailed instructions in Section B of this document). For each quarterly and annual report, the state should create new copies of the Metrics Reporting and Data and Reporting Issues tabs within the Excel file.
Metrics Reporting tab: Report metrics values using metrics technical specifications provided by CMS. [Placeholder to describe where technical specifications are available.].
Presenting data for counts. The denominator and rate/percentage columns are shaded grey for any metrics that are reported as counts. The state should use the numerator outlined in technical specification in the numerator column, leaving the denominator and the rate/percentage columns grey. The state should report separately for the overall demonstration and for any subpopulations reported, using the columns provided.
Presenting data for rates. The state should populate the denominator and numerator columns for metrics that are reported as rates and percentages. After these values are entered, the “rate/percentage” cells will calculate the associated rate or percentage. The state should report separately for the overall demonstration and for any subpopulations reported, using the columns provided.
Quarterly and annual reporting. The state should report data for annual metrics only in the annual (fourth quarterly) report for each demonstration year. These reporting columns should remain empty in other quarterly reports, as noted within the tab.
Alignment with CMS-provided technical specifications. The state should attest that reporting matches the CMS-provided technical specifications for each metric, using the column named “Attest that reporting matches the CMS-provided specification (Y/N).” For metrics where reporting does not match the CMS-provided specifications, the state should describe these deviations in the provided column.
Presence of data and reporting issues. In the column named “Reporting issue (Y/N),” the state should indicate whether any data or reporting issues impacted the state’s ability to report metrics as described in the monitoring protocol (for example, difficulty obtaining necessary data or calculating a required measure). For any identified issues, the state should provide further detail in the Data and Reporting Issues tab described below.
Data and Reporting issues tab:
New issues. For each metric with a reporting issue identified in the Metrics Reporting tab, the state should use the Data and Reporting tab to provide CMS with more information on the challenge and how it affects reporting.
Updates on previous issues. The state should also use this tab to provide CMS with updates on any data or reporting issues described in previous reports. When applicable, the state should note when issues are resolved. If an issue was noted as resolved in the previous report, it should not be reported in the current report.
Confirmation that there are no issues. For each metrics reporting topic where metrics are reported as outlined in the monitoring protocol and there are no data and reporting issues, mark the appropriate checkbox.
Complete Part B: SUD Monitoring Report Template. The SUD Monitoring Report Template contains three sections:
1. Transmittal Title Page. The title page is a brief form that the state completed as part of the SUD Monitoring Protocol. The state should submit this form as the title page of all Monitoring Reports. The content of this transmittal table should stay consistent over time.
2. Executive Summary. The state should provide a brief, targeted executive summary to communicate key achievements, highlights, issues, and/or risks identified during the current reporting period for the SUD Demonstration or SUD components of a broader demonstration. This should also identify key changes since the last monitoring report, including the implementation of new program components; programmatic improvements (e.g., increased outreach or any beneficiary or provider education efforts); and highlight unexpected changes (e.g., unexpected increases or decreases in enrollment or complaints, etc.). Historical background or general descriptions of the waiver components should not be included. The recommended word count is 500 words or less.
3. Narrative Information on Implementation. The state should report narrative information in this table following the prompts contained in the detailed instructions (for example, on metrics trends and implementation). These detailed instructions vary for each reporting topic; the state should consult the detailed instructions in Section B of this document for more information. The state should add rows as needed to report all relevant information. For any given reporting topic, if no information is available or relevant at this time, leave the row blank and instead mark the appropriate checkbox in the table.
Complete Part C: Budget Neutrality Workbook. The Budget Neutrality reporting topic incorporates a budget neutrality workbook for the demonstration. This budget neutrality workbook should be submitted as part of each report.
Note: Any narrative/summary text provided in the report should be brief. With the exception of the executive summary, the recommended word count for any response should not exceed 250 words (2-3 paragraphs).
Table 1. SUD Monitoring Reporting Overview, by Reporting Topic
# |
Reporting Topic |
Part A. SUD Metrics Workbook |
Part B. SUD Monitoring Report TemplateA |
Part C. Budget Neutrality Workbook |
0 |
Transmittal Title Page |
-- |
Section 1 |
-- |
0 |
Executive Summary |
-- |
Section 2 |
-- |
1 |
Assessment of Need and Qualification for SUD Services |
|
Section 3:
|
-- |
2 |
Access to Critical Levels of Care for OUD and other SUDs (Milestone 1) |
|
Section 3:
|
-- |
3 |
Use of Evidence-based, SUD-specific Patient Placement Criteria (Milestone 2) |
|
Section 3:
|
-- |
4 |
Use of Nationally Recognized SUD-specific Program Standards to Set Provider Qualifications for Residential Treatment Facilities (Milestone 3) |
|
Section 3:
|
-- |
5 |
Sufficient Provider Capacity at Critical Levels of Care including for Medication Assisted Treatment for OUD (Milestone 4) |
|
Section 3:
|
-- |
6 |
Implementation of Comprehensive Treatment and Prevention Strategies to Address Opioid Abuse and OUD (Milestone 5) |
|
Section 3:
|
-- |
7 |
Improved Care Coordination and Transitions between Levels of Care (Milestone 6) |
|
Section 3:
|
-- |
8 |
SUD Health Information Technology (Health IT) |
|
Section 3:
|
-- |
9 |
Other SUD-Related Metrics |
|
Section 3:
|
-- |
10 |
Budget Neutrality |
|
Section 3:
|
Submit completed workbook |
11 |
SUD-Related Demonstration Operations and Policy |
|
Section 3:
|
-- |
12 |
SUD Demonstration Evaluation Update |
-- |
Section 3:
|
-- |
13 |
Other Demonstration Reporting |
-- |
Section 3:
|
-- |
14 |
Notable State Achievements and/or Innovations |
-- |
Section 3:
|
-- |
A See detailed instructions for guidance on narrative reporting, which varies by reporting topic.
B There are no CMS-provided metrics for these reporting topics. However, if the state identifies metrics for reporting on these topics, they should be reported as shown.
C There are no CMS-provided metrics for the health IT topic; the state must identify relevant health IT metrics according to the guidance provided in the SUD Monitoring Protocol Template instructions.
This reporting topic focuses on the state’s assessment of beneficiary need and qualification for SUD services. The state should report the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to assessment of need and qualification for SUD services:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
NOTE: Any metric additions to the Monitoring Protocol tab should also be reflected within the Metrics report tab of the SUD Metrics Workbook. These changes should only be made once the Protocol has been approved and the state is ready for their submission. Additional metrics should be added after row 58 on the Protocol tab and insert rows after row 95 on the Metrics report tab.
If reporting on additional populations, starting at column AS, add the three columns required for each additional population on the Metrics report tab.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to assessment of need and qualification for SUD services:
Metrics trends. The state should 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 here. For example, the state notes that 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.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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:
The target population(s) of the demonstration?
The clinical criteria (e.g., SUD diagnoses) that qualify a beneficiary for the demonstration?
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. For 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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on access to critical levels of care for OUD and other SUDs to assess the state’s progress towards meeting Milestone 1. The state should report the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 1:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to Milestone 1:
Metrics trends. The state should discuss any relevant trends that the data shows related to access to critical levels of care for OUD and other SUDs, such as those stemming from benefit access, utilization, and delivery network. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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. For example, new legislation was recently signed by the Governor which will allow Medicaid billing for a new form of early intervention services effective X date.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on use of evidence-based, SUD-specific patient placement criteria to assess the state’s progress towards meeting Milestone 2. The state should report the following:
There are no CMS-provided metrics related to Milestone 2. If the state identified any metrics for reporting on this milestone, these metrics should be reported as described below. If the state did not identify any metrics for reporting this milestone, the state should proceed to the next topic.
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 2:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to Milestone 2:
Metrics trends. If the state has proposed metrics related to Milestone 2, the state should discuss any relevant trends that the data shows related to the use of evidence-based, SUD-specific patient placement criteria. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state reported metrics related to Milestone 2 but has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
If the state did not report any metrics related to Milestone 2, the state should mark the checkbox in the table indicating that the state is not reporting any metrics on this milestone.
Implementation update. The state should provide answers to the following questions:
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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on the use of nationally recognized SUD-specific program standards to set provider qualifications for residential treatment facilities to assess the state’s progress towards meeting Milestone 3. The state should report the following:
There are no CMS-provided metrics related to Milestone 3. If the state identified any metrics for reporting on this milestone, these metrics should be reported as described below. If the state did not identify any metrics for reporting this milestone, the state should proceed to the next topic.
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 3:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to Milestone 3:
Metrics trends. If the state has proposed metrics related to Milestone 3, the state should discuss any relevant trends that the data shows related to the use of nationally recognized SUD-specific program standards to set provider qualifications for residential treatment facilities. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state reported metrics related to Milestone 3 but has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
If the state did not report any metrics related to Milestone 3, the state should mark the checkbox in the table indicating that the state is not reporting any metrics on this milestone.
Implementation update. The state should provide answers to the following questions:
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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on provider capacity at critical levels of care including for medication assisted treatment (MAT) for OUD to assess the state’s progress towards meeting Milestone 4. The state should report on the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 4:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to Milestone 4:
Metrics trends. The state should discuss any relevant trends that the data shows related to provider capacity at critical levels of care, including for medication assisted treatment (MAT) for OUD. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on the implementation of comprehensive treatment and prevention strategies to address opioid abuse and OUD to assess the state’s progress towards meeting Milestone 5. The state should report the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 5:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table (Section 3) to report on trends and implementation updates related to Milestone 5:
Metrics trends. The state should discuss any relevant trends that the data shows related to the implementation of comprehensive treatment and prevention strategies to address opioid abuse and OUD. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on care coordination and transitions between levels of care to assess the state’s progress towards meeting Milestone 6. The state should report on the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to Milestone 6:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on trends and implementation updates related to Milestone 6:
Metrics trends. The state should discuss any relevant trends that the data shows related to care coordination and transitions between levels of care. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on SUD health IT to assess the state’s progress on the health IT portion of the implementation plan. The state should report on the following:
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues related to SUD Health IT:
Metrics data tab. The state should report SUD health IT metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on trends and implementation updates related to SUD health IT:
Metrics trends. The state should discuss any relevant trends that the data shows related to SUD Health IT in this table. Changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following questions:
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 information technology is being used to slow down the rate of growth of individuals identified with SUD?
How information technology is being used to treat effectively individuals identified with SUD?
How information technology 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.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
In Part A: SUD Metrics Workbook, report metrics data and any data or reporting issues on other SUD-related metrics:
Metrics data tab. The state should report metrics data in the state-customized Metrics Reporting tab, following the instructions in Section A of this document.
Data and reporting issues tab. For each metric with a data or reporting issue identified in the Metrics Reporting tab, the state should provide further detail on the issue using the Data and Reporting Issues tab, following the instructions in Section A of this document.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on trends and implementation updates on other SUD-related metrics:
Metrics trends. The state should discuss any relevant trends that the data shows related to other SUD-related metrics. At a minimum, changes (+ or -) greater than two percent should be described here.
If the state has not identified any trends in the data, the state should mark the checkbox in the table indicating there are no apparent trends.
Implementation update. The state should provide answers to the following question:
Are there any anticipated program changes that may impact these SUD-related metrics? If so, please describe these changes.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on the budget neutrality demonstration requirement. The state should report on the following:
The state should report its completed SUD Budget Neutrality Workbook as Part C. If the SUD demonstration is a component of a broader demonstration, the budget neutrality workbook for the entire demonstration should be included.
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on the current status/analysis and implementation updates related to budget neutrality:
Current status and analysis. The state should 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.
Implementation update. The state should provide answers to the following questions:
Are there any anticipated program changes that may impact budget neutrality? If so, please describe these changes.
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on operations and policy related to the SUD demonstration. The state should report the following:
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on considerations and implementation updates related to demonstration operations and policy:
Considerations. The state should 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. The state should 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. Such considerations could include the following, either real or anticipated:
Any changes to SUD populations served, benefits, access, delivery systems, or eligibility
Legislative activities and state policy changes
Fiscal changes that would result in changes in access, benefits, populations, enrollment, etc.
Related audit or investigation activity, including findings
Litigation activity
Status and/or timely milestones for health plan contracts
Market changes that may impact Medicaid operations
Any delays or variance with provisions outlined in STCs
Systems issues or challenges that might impact the demonstration [i.e. eligibility and enrollment (E&E), Medicaid management information systems (MMIS)]
Changes in key state personnel or organizational structure
Procurement items that will impact demonstration (i.e. enrollment broker, etc.)
Significant changes in payment rates to providers which will impact demonstration or significant losses for managed care organizations (MCOs) under the demonstration
Emergency Situation/Disaster
Other
If the state has not identified any considerations related to demonstration operations and policy, the state should mark the checkbox in the table indicating there are no related considerations.
Implementation update. The state should provide answers to the following questions:
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?
If the state has not identified any implementation updates, the state should mark the checkbox in the table indicating it has no implementation update to report.
This reporting topic focuses on updates related to the SUD demonstration evaluation. The state should report on the following:
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on relevant updates to the state’s SUD demonstration evaluation pursuant to 42 CFR § 431.424 and/or any federal SUD evaluations in which the state is involved [per 42 CFR § 431.420(f) or 42 CFR § 431.400(a) (1) (ii) (C) (4)].
The state should include timely updates on SUD evaluation work and timeline. Depending on when this report is due to CMS and the timing for the demonstration, this might include updates on progress with:
Evaluation design
Evaluation procurement
Evaluation implementation
Evaluation deliverables (information presented in below table)
Data collection, including any issues collecting, procuring, managing, or using data for the state’s evaluation or federal evaluation
For annual report per 42 CFR 431.428, the results/impact of any demonstration programmatic area defined by CMS that is unique to the demonstration design or evaluation hypothesis
Results of beneficiary satisfaction surveys, if conducted during the reporting year, grievances and appeals
State should also 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. In addition to any status updates on the demonstration evaluation, the state should list anticipated evaluation-related deliverables related to this demonstration and their due dates.
If the state has not identified any SUD demonstration evaluation updates, the state should mark the checkbox in the table indicating it has no update to report.
This reporting topic focuses on pertinent information related to SUD (or if broader demonstration, then SUD-related) demonstration not captured under other reporting topics. In particular, the state should report on the following:
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to report on general SUD reporting requirements and the post award public forum:
General Reporting Requirements. The state should provide responses to the following questions:
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?
Post Award Public Forum. If applicable within the timing of the demonstration, the state should 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 in this table for the period during which the forum was held, and must also be included in the annual report.
If there was not a post-award public forum held during this reporting period and this is not an annual report, the state should mark the appropriate checkbox in the table.
This reporting topic focuses on any notable state achievements and/or innovations that occurred during the reporting period. The state should report on the following:
In Part B: SUD Monitoring Report Template, the state should complete the Narrative Information on Implementation table to summarize any relevant 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.
If the state does not have achievements or innovations to note, the state should mark the checkbox in the table indicating it has no update to report.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |