Medicaid Section 1115 Eligibility and Coverage Demonstration
Monitoring Report Template Instructions
Note: If the state’s eligibility and coverage 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.
Customize the template for use in quarterly and annual monitoring reports.
Use the customized template to complete each quarterly and annual monitoring report
Metrics reporting tab: Report metrics values using metrics technical specifications provided by CMS. The CMS-provided metrics technical specifications will be shared with states after states complete the point and click agreement process.
Any demonstration metrics. The state should report any demonstration (AD) metrics for demonstrations with any eligibility and coverage policies. The data should include all beneficiaries in the demonstration, as defined in the metrics technical specifications manual.
Presenting data for counts. The denominator and rate/percentage columns are shaded grey for any metrics that are reported only as counts. The state should use the numerator column, leaving the denominator and the rate/percentage columns grey. The state should report separately counts for the total demonstration and any subpopulations reported, using the columns provided.
Presenting data for rates. The state should use 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 (Q4) report for each demonstration year. These reporting columns should remain empty in other quarterly reports.
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 technical specifications, the state should describe these deviations in the provided column.
Presence of data and reporting issues. In the column “Reporting issue (Y/N),” the state should indicate whether any data or reporting issues impacted the state’s ability to report metrics as specified in the monitoring protocol (for example, difficulty obtaining data or calculating a required measure). For any identified issues, the state should provide further detail in the “Data & Reporting Issues” tab described below.
Data and reporting issues tab: Report issues with specific metrics.
New issues. For each metric with an issue identified in the metrics reporting tab, the state should use the data and reporting issues tab to provide CMS with information on the issue and how it affects reporting.
Updates on previous issues. The state should also use this tab to provide CMS with updates on 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 preceding report, it should not be reported in the current report.
Confirmation that there are no issues. For each metrics reporting topic category where metrics are reported as outlined in the monitoring protocol and there are no data and reporting issues, mark the appropriate checkbox.
Section 1. Transmittal title page. The title page is a brief template that the state completed as part of the monitoring protocol. The state should submit this template as the title page of all monitoring reports. The content of this transmittal table should stay consistent over time.
Section 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 eligibility and coverage demonstration or eligibility and coverage components of a broader demonstration. The executive summary should summarize each eligibility and coverage policy in the state’s demonstration separately. The summary should also identify key changes since the last monitoring report, changes in current operating policies; programmatic improvements (e.g., increased outreach or improved beneficiary notices); 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.
Section 3. Narrative information on implementation, by eligibility and coverage policy. The state should report narrative information in this table following the detailed prompts. This section will contain a module for each eligibility and coverage policy in the state’s demonstration. The template currently only includes the CE demonstration module. The narrative information is organized in two subsections:
Subsection 1. Metrics trends. The state should discuss any relevant trends that the data shows related to each metric trend section. Describe and explain changes (+ or -) greater than two percent. 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. CMS will continuously review the threshold (currently +/- 2%) and ensure that it is a helpful threshold for monitoring purposes.
Subsection 2. Implementation update. The state should provide a detailed narrative that compares the demonstration design and operational details outlined in the implementation plan to any changes the state has made since submitting its original implementation plan. If the state has not made any changes since the last report, and does not plan to make any changes, the state should mark the checkbox in the table indicating that there are no implementation updates to report for that topic.
Gray cells indicate that those cells do not need to be filled out for that row because they are not applicable. The reporting topics in the monitoring report correspond to the reporting topics in the state’s implementation plan.
Section 4. Narrative information on implementation for any E&C demonstration. The state should complete the narrative information on metric trends and implementation updates required for demonstrations with any eligibility and coverage policies. In the implementation update, the state should highlight significant 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 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 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
Systems issues or challenges that might impact the demonstration [i.e. eligibility and enrollment, Medicaid management information systems]
Changes in key state personnel or organizational structure
Significant changes in payment rates to providers which will impact demonstration or significant losses for managed care organizations 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.
Section 5. Narrative information on other reporting topics. The state should report narrative information in the table on four other reporting topics: financial/budget neutrality, demonstration evaluation update, other demonstration reporting, and notable state achievements and/or innovations.
Subsection 1. Financial/budget neutrality. The state should provide a detailed narrative on the current status of financial/budget neutrality and provide an analysis of the budget neutrality to date.
Subsection 2. Demonstration evaluation update. The state should include timely updates on 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, 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 demonstration evaluation updates, the state should mark the checkbox in the table indicating it has no update to report.
Subsection 3. Other demonstration reporting. The state should provide a detailed narrative on general reporting requirement and any post-award public forums.
Subsection 4. Notable state achievements and/or innovations. The state should provide a detailed narrative on notable state achievements and/or innovations.
Table 1. Eligibility and Coverage Monitoring Reporting Overview, by Section
# Reporting
|
Reporting Concept |
Part
A. |
Part
B. |
Part
C. |
0 |
Title Page |
-- |
Section 1 |
-- |
0 |
Executive Summary |
-- |
Section 2 |
-- |
Section 3. Narrative
information on implementation, by eligibility and coverage policy
|
||||
CE.Mod_1 |
Specify Community Engagement Policies |
|
Section 3:
|
-- |
CE.Mod_2 |
Establish Beneficiary Supports and Modifications |
|
Section 3:
|
-- |
CE.Mod_3 |
Establish Procedures for Verification and Reporting |
-- |
Section 3:
|
-- |
CE.Mod_4 |
Operationalize Strategies for Non-Compliance |
|
Section 3:
|
-- |
CE.Mod_5 |
Develop Comprehensive Communications Strategy |
-- |
Section 3:
|
-- |
CE.Mod_6 |
Establish Continuous Monitoring |
-- |
Section 3:
|
-- |
CE.Mod_7 |
Develop, Modify, and Maintain Systems |
-- |
Section 3:
|
-- |
Section 4. Narrative information on implementation for any E&C demonstration |
||||
AD.Mod_1 |
Metrics and operations for demonstrations with any eligibility and coverage policies |
|
Section 4:
|
-- |
Section 5. Other reporting topics |
||||
1 |
Financial/budget neutrality |
-- |
Section 5:
|
Submit completed workbook |
2 |
Demonstration evaluation update |
-- |
Section 5:
|
-- |
3 |
Other demonstration reporting |
-- |
Section 5:
|
-- |
4 |
Notable state achievements and/or innovations |
-- |
Section 5:
|
-- |
PRA Disclosure Statement - This information is being collected to assist the Centers for Medicare & Medicaid Services in program monitoring of Medicaid Section 1115 Eligibility and Coverage Demonstrations. This mandatory information collection (42 CFR § 431.428) will be used to support more efficient, timely and accurate review of states’ eligibility and coverage 1115 demonstrations monitoring reports submissions to support consistency of monitoring and evaluation of Medicaid Section 1115 Eligibility and Coverage 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 # 58). Public burden for all of the collection of information requirements under this control number is estimated to take about 4 hours per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CMS, 7500 Security Boulevard, Attn: Paperwork Reduction Act Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Community Engagement Monitoring Report Instructions |
| Subject | Community Engagement Monitoring |
| Author | Centers for Medicare & Medicaid Services (CMS) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |