GenIC #57 (Revision): Medicaid Section 1115 Substance Use Disorder (SUD) Demonstration: Monitoring Reports Documents and Templates

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GenIC #57 (Revision): Medicaid Section 1115 Substance Use Disorder (SUD) Demonstration: Monitoring Reports Documents and Templates

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Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Medicaid Section 1115 Substance Use Disorder Demonstrations
Monitoring Protocol Instructions
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 18.5 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.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Table of Contents
A. Introduction ............................................................................................................... 3
B. Instructions for completing a monitoring protocol ....................................................... 4
1.

Download the Monitoring Protocol Workbook (Part A) and Monitoring Protocol
Template (Part B) from the Performance Metrics Database and Analytics (PMDA)
system................................................................................................................. 4

Complete Parts A and B. ..................................................................................... 5
2a) Complete Part A: Monitoring Protocol Workbook. ....................................... 5
2b) Complete Part B: Monitoring Protocol Template. ....................................... 22

Submit Parts A and B using PMDA. .................................................................. 23
3a) Name the files. ........................................................................................... 23
3b) Upload the files using PMDA. .................................................................... 24

APPENDIX A: Guidelines for including Medicaid section 1115 SUD demonstrations
monitoring metrics and narrative information in monitoring reports ........................... 25
APPENDIX B: Instructions for determining baseline reporting periods for
Medicaid section 1115 SUD demonstrations monitoring metrics................................ 28
APPENDIX C: Selecting annual goals and overall demonstration targets for
Medicaid section 1115 SUD demonstrations monitoring metrics................................ 32
APPENDIX D: Completing the “SUD reporting schedule” tab for a state with SUD
demonstration year 1 shorter than 12 months............................................................. 35
APPENDIX E: Completing the “SUD reporting schedule” tab for a state with
approved SUD demonstration extension.................................................................... 40

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

A. Introduction
The Centers for Medicare & Medicaid Services (CMS) has developed tools and instructional
resources to help each state with a section 1115 substance use disorder (SUD) demonstration
meet the reporting requirements in its special terms and conditions (STC). Specifically, CMS
has developed the instructions and templates for the monitoring protocol and monitoring report,
and the Medicaid Section 1115 Substance Use Disorder Demonstrations: Technical
Specifications for Monitoring Metrics (hereafter referred to as “technical specifications
manual”). The structure and format of these tools are intended to ensure that information is
provided in a standardized manner across states. Table 1 describes these tools and their
components.
Table 1. Monitoring tools and component documents
Tool
Monitoring
protocol

Description
•

•

Monitoring
report

•

•
•

•
Technical
specifications
for monitoring
metrics

•

Component documents

•
Describes what the state agrees to report in its
quarterly and annual monitoring reports, developed •
collaboratively with CMS
In Part A, the state will identify the monitoring
metrics and subpopulations it plans to report and will
confirm its reporting schedule
In Part B, the state will agree to provide narrative
information reporting, budget neutrality reporting,
and retrospective reporting, if applicable

Instructions

Standardized component documents for the state to •
submit quarterly and annual monitoring reports
•
according to the approved monitoring protocol
In Part A, the state will submit monitoring metrics in
alignment with approved monitoring protocol
In Part B, the state will include qualitative
summaries of metrics trends and implementation
updates
In Part C, the state will submit standardized Budget
Neutrality Workbook

Instructions
Monitoring report
o Part A (Monitoring Report
Workbook)
o Part B (Monitoring Report
Template)
o Part C (Budget Neutrality
Workbook)

Technical specifications for CMS-provided
monitoring metrics for SUD demonstrations

Monitoring protocol
o Part A (Monitoring Protocol
Workbook)
o Part B (Monitoring Protocol
Template)

•

Technical specifications manual

•

Supporting value sets

Each state should use the CMS-provided SUD monitoring protocol tools to develop its
monitoring protocol, which should describe the state’s monitoring plans for its section 1115 SUD
demonstration and be submitted to CMS no later than 150 calendar days from the start date of
the approval period of the demonstration, as described in the STCs. 1 For any questions on the
1

This can vary depending on a state’s STCs and other considerations provided by CMS to a state.

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use of these tools, the state should contact the section 1115 demonstration monitoring and
evaluation mailbox ([email protected]), copying the CMS
demonstration team on the message.
Note: Upon initial approval of its SUD demonstration, the state will complete a monitoring
protocol; if the state is later granted an extension to its SUD demonstration, the state is expected
to submit an updated monitoring protocol for CMS approval (more details on demonstration
extensions follow directly below). If the state’s section 1115 SUD 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 reporting metrics in Part A and narrative information
in Part B (e.g., SUD-related demonstration operations and policy, budget neutrality, SUD
demonstration evaluation update, other demonstration reporting, and notable state achievements
and/or innovations).
B. Instructions for completing a monitoring protocol
The state’s monitoring protocol will consist of a completed Monitoring Protocol Workbook (Part
A) and a completed Monitoring Protocol Template (Part B). The steps to access and complete
these documents are described below.
1. Download the Monitoring Protocol Workbook (Part A) and Monitoring Protocol
Template (Part B) from the Performance Metrics Database and Analytics (PMDA)
system.
The state can download Part A and Part B from its state demonstration dashboard on PMDA.
This dashboard will list all section 1115 demonstrations associated with the state. To
download Parts A and B, the state should navigate to the demonstration name (name of the
state’s stand-alone SUD demonstration or broader demonstration with a SUD component).
In the “Actions” column, select “Deliverables” from the drop-down menu and click “Go,”
which takes the state to its “Deliverables” page. From here, the state can click the link in the
top right-hand corner named “Download Templates and Instructions” to navigate to the
“Download Templates and Instructions” page where it can access the reporting tools. Part A
and B of the monitoring protocol will appear on this page (i.e., “Monitoring Protocol
Workbook for Substance Use Disorder (SUD)” and “Monitoring Protocol Template for
Substance Use Disorder (SUD)”). 2

For further technical assistance on downloading the reporting tools, the state should review the PMDA state user
manual. To access this manual, the state should navigate to the “Frequently Asked Questions” page by clicking the
“FAQ” button, which appears at the bottom of every page on PMDA. From here, the state should click on the
“Training and Support Materials” link found on the top right of the page to navigate to the “Training and Support
Materials” page, which contains the user manual and other resources.

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2. Complete Parts A and B.
The state should provide information as requested in the instructions below for Part A and
Part B. Please note that embedded objects (e.g., any additional document links, shapes,
SmartArt, screenshots, charts, tables) are not permitted in Part A or Part B. If necessary, a
state may upload separate attachments containing additional information. The state should
reference any attachments within Part A or Part B. Instructions for how to upload documents
using PMDA can be found in Section B.3.
Demonstration extensions: If a state receives CMS approval for an extension of its SUD
demonstration, the state is required to submit an updated monitoring protocol for CMS
approval. The state should use the latest available version of the monitoring protocol tools to
complete its updated monitoring protocol. When conducting this update, the state should
make only limited changes to its previously approved monitoring protocol, and as
appropriate, the state may transfer information from its previously approved monitoring
protocol into its updated monitoring protocol. However, the state should update its
monitoring protocol in the following areas:
•

In the “SUD planned metrics” tab of Part A, the state should review and (if needed)
revise (1) its “Annual goal” (column M) and “Overall demonstration target” (column N)
for monitoring metrics and (2) its plans for phased-in metrics reporting – “State plans to
phase in reporting (Y/N)” (column Q), “SUD monitoring report in which metric will be
phased in (Format DY#Q#; e.g., DY1Q3)” (column R), and “Explanation of any plans to
phase in reporting over time” (column S). The instructions (“‘SUD planned metrics’ tab”
section below) outline how to complete this tab. Please note, the state should use the
same metric baseline reporting periods as listed in its previously approved monitoring
protocol.

•

In the “SUD reporting schedule” tab of Part A, the state should update the reporting
schedule based on the new dates for the extension approval period. Appendix E has
instructions on completing this tab for demonstration extensions.

•

For Section 4 (Retrospective reporting) in Part B, the state should mark the second check
box in this section (proposing an alternate approach to retrospective reporting) and enter
“Not applicable; monitoring protocol applies to a demonstration extension period” in the
text box. Please note that during the period in which the state is updating its monitoring
protocol – but prior to CMS approval of its updated monitoring protocol for the
demonstration extension period – the state should report metrics in accordance with its
previously approved monitoring protocol.

2a) Complete Part A: Monitoring Protocol Workbook.
Part A is an Excel file that includes a (1) “SUD planned metrics” tab in which the state will
identify the metrics it plans to report, (2) “SUD planned subpops” tab in which the state will

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identify the subpopulations it plans to report for specified metrics, and (3) “SUD reporting
schedule” tab in which the state will complete a proposed reporting schedule. The
instructions for each tab are presented according to the order of the columns listed in each.

• “SUD planned metrics” tab. The state should review the CMS-provided metrics listed
in the “SUD planned metrics” tab of Part A and the most recent version of the CMSprovided technical specifications manual. The most recent version of the technical
specifications manual will download in a separate zipped file when the state downloads
Part A from the “Download Templates and Instructions” page described in Section B.1.
The technical specifications manual can also be accessed on the “Reference Materials”
page on PMDA.3 The link to the “Reference Materials” page is available on the right
side of the state demonstration dashboard.
PMDA will populate the header rows (State and Demonstration Name) in the “SUD
planned metrics” tab and the state should review these for accuracy. Please note that
these header rows will also be pre-populated in the other tabs of Part A (“SUD planned
subpops” and “SUD reporting schedule”). The state should determine the metrics it plans
to report, including all required CMS-provided metrics and any recommended CMSprovided metrics, as well as state-specific metrics (including required health information
technology [IT] metrics). The state should complete the remainder of the “SUD planned
metrics” tab according to the following instructions:
–

CMS-provided metrics
▪

Standard information on CMS-provided metrics. The following columns of
the “SUD planned metrics” tab (columns A-J) contain standard information on
CMS-provided metrics:
o Number (#)
o Metric name
o Metric description
o Milestone or reporting topic (milestone number, “Health IT,” “Other SUDrelated metrics,” or “Assessment of need and qualification for SUD treatment
services”)4
o Metric type (CMS-constructed or established quality measure)

The technical specifications manual can be accessed on PMDA on the “Reference Materials” page after the state
completes the National Measure Stewards Terms and Conditions ‘Point and Click’ Agreement. The state can access
this agreement by clicking on the technical specifications manual it wishes to download. A pop -up will appear that
allows the state to download and read the ‘Point and Click’ Agreement directly, or to receive it by email.
3

The milestones correspond with those listed in State Medicaid Director Letter #17-003, which announced the SUD
demonstration opportunity. The full letter is available here: https://www.medicaid.gov/sites/default/files/federalpolicy-guidance/downloads/smd17003.pdf

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o Reporting category (grievances and appeals, 5 other monthly and quarterly
metrics, annual metrics that are established quality measures, and other annual
metrics)
o Data source
o Measurement period (year, quarter, or month)
o Reporting frequency (annually or quarterly)
o Reporting priority (required or recommended)
“Metric type” (column E) should be used to inform the baseline reporting period
for each metric. “Reporting category” (column F) is used to determine the
reporting schedule for including metrics in monitoring reports. See Appendix A
of this document for additional instructions on reporting categories and reporting
guidelines.
Standard information on CMS-provided metrics cannot be altered by the state.
However, a state can propose modifications in the column “Explanation of any
deviations from the CMS-provided technical specifications manual” (column P).
–

State-specific metrics
▪

Health IT metrics. The state is expected to identify metrics to measure progress
on its SUD health IT plan. The state should enter its selected health IT metrics in
the rows in the “SUD planned metrics” tab numbered Q1 through Q3. For each
key health IT question listed below, the state is required to either: (1) select a
metric from the list of sample metrics in Table 2 or (2) identify its own metric that
addresses the question. The state may also choose to adapt the sample metrics in
Table 2 (e.g., if a sample metric lists a rate/percentage, the state may propose a
number/count instead, if such a modification seems more appropriate for the
state’s specific health IT context).

While grievances and appeals metrics are designated as recommended for reporting, the state is required, per 42
CFR 431.428(a)5, to provide updates on the results of beneficiary satisfaction surveys, if conducted during the
reporting year, including updates on grievances and appeals from beneficiaries, in its annual monitoring report.

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Table 2. Key health IT questions and sample metrics
Key health IT questions

Sample metrics

1. How is information technology •
being used to slow down the
rate of growth of individuals •
identified with SUD?

•

•
•
•

•
•

•

E-prescribing of controlled substances
o Sample metric: Percent of eRx dispensed out of eRx prescribed
PDMP checking by provider types (prescribers, dispensers)
o Sample metric: Percent of PDMP users with at least one check out of
PDMP users
o Sample metric: Number of checks by PDMP users
Leveraging PDMP-EHR and/or HIE integration, including possible use
of SSO
o Sample metric: Number of live SSO connections
SBIRT/surveys – electronic
o Sample metric: Percent of administered surveys that are completed
Project ECHO – provider training on pain management
o Sample metric: Number of training sessions held
Onboarding EMS to HIE and/or PDMP (dependent upon state’s PDMP
access policies)
o Sample metric: Number of live connections to HIE and/or PDMP
Emergency room health IT/E capabilities to check PDMP/HIE
o Sample metric: Number of live connections to PDMP/HIE
Connecting corrections/criminal justice systems
o Sample metric: Percentage of corrections entities querying patient
health data from an HIE
o Sample metric: Percentage of correctional institutions uploading data
from the correctional institution’s EHR to an HIE
o Sample metric: Percentage of corrections institutions messaging
providers through secure emails
Connecting housing data sources for identification, eligibility for
housing assistance
o Sample metric: Percent of providers that electronically connect to
databases that track housing need out of providers that have access to
the databases (e.g., Homeless Management Information Systems
[HMIS]) to enter, use, and send data

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Key health IT questions

Sample metrics

2. How is information technology •
being used to effectively treat
individuals identified with
SUD?
•

•

eReferral/eConsult – closed loop referral services for consultation and/or
follow up services
o Sample metric: Percent of referrals and/or consultations that resulted
in completed services
Tracking MAT
o Sample metric: Number of patients who received both medication
and counseling/behavioral therapy for SUD through telehealth
appointments and other virtual or electronic services
Access to additional services using electronic provider/resource
directory – connecting primary care to SUD service offerings a
o Sample metric: Percent of providers who accessed the electronic
provider/resource directory managed by the state Medicaid agency
out of providers who have access
o Sample metric: Number of resources in an electronic
provider/resource directory managed by the state Medicaid agency
Consent Management/Inter-Intra State e-Consent capture and use
o Sample metric: Number of individuals for whom consent to disclose
or access information per state policy (both covered and non-covered
42 CFR Part 2 and HIPAA) has been obtained and captured

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Key health IT questions

Sample metrics

3. How is information technology •
being used to effectively
monitor “recovery” supports
and services for individuals
identified with SUD?

•

Care management/recovery – shared care plan accessibility across care
team
o Sample metric: Number of patients who have electronic access (or
established an account) to their own care plan through a patient
portal or another type of health IT system
o Sample metric: Percent of hospitals that sent electronic alerts of
beneficiary inpatient or emergency department visits to care
providers out of hospitals that have electronic alert capability in their
health IT products
Connecting corrections systems to care delivery systems for incarcerated
individuals released to community
o Sample metric: Number of treatment plans shared with community
providers through data use agreements and HIEs
Connecting housing system databases to care delivery systems for
individuals affected by housing instability
o Sample metric: Number of housing-related resources made available
to providers in an electronic database managed by the state Medicaid
agency
Individuals connected to alternative therapies from other communitybased resources for pain management or general therapy/treatment
o Sample metric: Percent of clinicians who queried an e-directory for
community resources for individual referrals out of clinicians who
have access to the e-directory
o Sample metric: Percent of SUD providers who queried an e-directory
for providers for individual referrals out of SUD providers who have
access to the e-directory
o Sample metric: Percent of SUD providers who queried an e-directory
for community resources for individual referrals out of SUD
providers who have access to the e-directory

If a state plans to report these sample metrics, it should provide narrative updates in the Monitoring Report
Template provided by CMS to explain how it maintains accuracy of information and the frequency of updates.
CFR = Code of Federal Regulations, EHR = electronic health record, EMS = emergency medical services,
eRx = e-Prescribing, Health IT = health information technology, HIE = health information exchange,
HIPAA = Health Insurance Portability and Accountability Act, MAT = medication-assisted treatment,
PDMP = prescription drug monitoring program, SSO = single sign on

▪

Additional state-specific metrics. The state can choose to report on additional
monitoring metrics beyond those provided by CMS and the required state-specific
health IT metrics. The “SUD planned metrics” tab contains a row for one
additional state-specific metric (row 50). If the state wishes to add more than one
state-specific metric, it should add rows for each additional metric to the bottom
of the “SUD planned metrics” tab by right-clicking on row 51 and selecting
“Insert.” The state should populate the remaining columns to provide a level of
detail similar to that of the CMS-provided metrics.

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▪

Reporting the same state-specific metric with multiple rates or counts. The
state should only plan to report one rate or count per state-specific metric,
including health IT metrics. If the state wishes to report multiple rates or counts
for the same state-specific metric, it should treat each additional rate or count as a
separate state-specific metric by adding additional rows to Part A and giving each
of these metrics a unique number (see numbering convention below), name, and
description.

▪

Standard information on state-specific metrics. The state should populate the
standard information columns for state-specific metrics, including health IT
metrics, according to the following instructions (columns A-J):
o Number (#): The state should number any additional state-specific metrics
according to the following numbering convention: S1, S2, S3, etc. Please note
that the three required health IT metrics are already numbered Q1, Q2, and Q3
to align with the three key health IT questions.
o Metric name
o Metric description
o Milestone or reporting topic: This column is pre-populated for health IT
metrics with “Health IT.” For additional state-specific metrics, the state
should use the drop-down options (Assessment of need and qualification for
SUD treatment services, the milestone number, Health IT, or Other SUDrelated metrics) to select the milestone or reporting topic associated with the
metric.
o Metric type: This column is pre-populated for health IT metrics with “Statespecific.” For additional state-specific metrics, the state should use the dropdown option to select State-specific.
o Reporting category: The state should use the drop-down options (Grievances
and appeals, Other monthly and quarterly metrics, Annual metrics that are
established quality measure, or Other annual metrics) to select the reporting
category. The state should use this classification to determine the reporting
schedule for the metric.
o Data source
o Measurement period: The state should use the drop-down options (Year,
Quarter, or Month) to select the measurement period.
o Reporting frequency: The state should use the drop-down options (Annually
or Quarterly) to select the reporting frequency.

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o Reporting priority: This column is pre-populated for health IT metrics with
“Required.” For additional state-specific metrics, the state should use the
drop-down option to select State-specific.
If the state would like to propose non-standard inputs for columns “Measurement
period” and “Reporting frequency” (columns H and I), the state should contact the
section 1115 demonstration monitoring and evaluation mailbox
([email protected]), copying the state’s CMS
demonstration team on the message.
–

Plans to report metrics. The column “State will report (Y/N)” (column K) identifies
whether the state plans to report each metric. The state should use the drop-down
option in this column. The state should select Y for all state-specific metrics. If the
state does not plan to report one or more of the metrics categorized as required (in
column J), it should review the instructions in the “Alignment with CMS-provided
technical specifications manual” section below.

–

Baseline reporting period. For each metric, the state should provide a baseline
reporting period. The state should provide this information in the column “Baseline
reporting period (MM/DD/YYYY—MM/DD/YYYY)” (column L). For additional
instructions regarding the determination of baseline periods for each metric type, the
state should review Appendix B. If a state has received a SUD demonstration
extension, the state should use the same baseline reporting period used in the previous
demonstration approval period. If a state is planning to phase in reporting of certain
metrics, it should review the “Phased-in metrics reporting” section below for more
information on selecting baseline reporting periods for these metrics.

–

Demonstration target and annual goals. According to the state’s STCs, the state
must provide (1) a target to be achieved by the end of the demonstration and (2) an
annual goal for closing the gap between baseline and the demonstration target for
each metric. The state should provide the annual goal and demonstration target in
columns M and N:
▪

Annual goal (increase, consistent, decrease)

▪

Overall demonstration target (increase, consistent, decrease)

For all metrics, demonstration targets and annual goals can be directional (increase,
consistent, or decrease), rather than values. For additional instructions selecting
annual goals and demonstration targets, the state should review Appendix C.
CMS developed specific instructions for selecting an annual goal and overall
demonstration target for Metric #36 (Average Length of Stay in Institutions for
Mental Diseases [IMDs]). Please review the instructions for each scenario below:

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–

▪

If the average length of stay (ALOS) in IMDs is known to be greater than 30 days
prior to the demonstration, the state’s annual goal should be to “decrease” the
ALOS in IMDs to achieve an overall demonstration target of “no more than 30
days.”

▪

If the state’s ALOS in IMDs is known to be less than 30 days prior to the
demonstration—or if the state’s ALOS is unknown—CMS understands that the
state may initially observe and report an increase in the ALOS as the state
expands coverage for care in IMDs during the demonstration. In this case, the
state should indicate that its goal is to “stabilize” its current ALOS to achieve an
overall demonstration target of “no more than 30 days.”

Alignment with CMS-provided technical specifications manual. The column
“Attest that planned reporting matches the CMS-provided technical specifications
manual (Y/N)” (column O) identifies whether a state plans to report each metric
according to the CMS-provided technical specifications manual. The state should use
the drop-down option in this column, selecting Y or N to indicate whether planned
reporting matches the CMS-provided technical specifications manual for each CMSprovided metric. If a state’s planned reporting does not match the CMS-provided
specifications, the state should describe these deviations in the provided column
“Explanation of any deviations from the CMS-provided technical specifications
manual” (column P). For example, deviations may include using state-specific codes
in metric calculations. The state should also use this column to provide an
explanation for an inability to report any required metrics or justification of why a
required metric does not apply for the state’s demonstration. The state should select
N for all state-specific metrics, but does not need to provide an explanation in column
P.
Metric calculation methods: The technical specifications manual provides the state
flexibility in choosing how to calculate certain metrics. For these metrics, the state
should provide information on the planned methodology to calculate the metrics in
column P. If the state would instead prefer to upload information on its planned
metric calculation methods as an attachment, the state should enter “See attachment
for metric calculation methods” in column P. Please note that the state may need to
provide multiple pieces of information for specific metrics. If the state plans to report
these metrics according to the CMS-provided technical specification manual, the state
should select Y in column O and include a description of its metric calculation
methods in column P. If the state would like to propose a deviation for any of these
metrics, the state should select N in column O and include a description of the
deviation(s) in column P in addition to its metric calculation methods.
▪

Metrics related to SUD spending: The state should provide the methodology, data
source(s), and/or data elements the state plans to use to estimate the amount paid
13

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by Medicaid on encounter claims for these metrics. Specifically, CMS would like
to understand whether the state is planning to use MCO payment rates, FFSequivalent estimates, a Medicaid-to-Medicare Fee Index, the T-MSIS variable
MEDICAID-FFS-EQUIVALENT-AMT, or other methodologies to estimate
Medicaid spending for the following metrics:
o Metric #28: SUD Spending
o Metric #29: SUD Spending Within IMDs
o Metric #30: Per Capita SUD Spending
o Metric #31: Per Capita SUD Spending Within IMDs
The state should also identify whether any SUD treatment services are excluded
from the metrics.
▪

Metrics related to provider availability: The state should provide the
methodology, data source(s), and/or data element(s) the state plans to use to
identify SUD providers for SUD provider availability (Metric #13) and MAT
providers for SUD provider availability—MAT (Metric #14). The state should
identify the types of providers (e.g., clinical psychologists, opioid treatment
programs) included in each metric, the approach to identifying each type
including any provider enrollment databases used (e.g., a state may use claims
data to identify all providers who prescribed buprenorphine during the
measurement period), and whether providers are identified at the individual or
facility level. CMS would also like to understand how the methods for
identifying SUD providers for Metric #13 and MAT providers for Metric #14
overlap and differ, and whether any SUD provider types are excluded for either of
the metrics. Finally, the state should provide the time period reflected in the
provider counts.

▪

Metrics related to IMDs: The state should provide data source(s) (such as a
published list of IMDs in the state) and any state-specific codes or criteria the
state plans to use to identify IMDs for the following metrics:
o Metric #5: Medicaid Beneficiaries Treated in an IMD for SUD
o Metric #29: SUD Spending Within IMDs
o Metric #31: Per Capita SUD Spending Within IMDs
o Metric #36: Average Length of Stay in IMDs

Further information on metric calculation methods for these metrics can be found in
Chapter II of the technical specifications manual.

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–

Phased-in metrics reporting. The state should review the detailed instructions on
metrics reporting and calculation in Appendix A to assist in determining whether it
will need to begin reporting a metric later than expected according to the current
instructions. These expectations also apply should the state need to complete any
retrospective reports (see section “Section 4. Retrospective reporting” below). If a
state is unable to begin reporting a metric according to these expectations, then the
state should indicate when it will be able to phase-in reporting on the metric
according to the following guidance:
▪

The state should select Y or N, using the options in the column “State plans to
phase in reporting (Y/N)” (column Q), to indicate whether it plans to begin
reporting a metric later than expected (according to the instructions in
Appendix A). If the state does not plan to phase in a metric, it should select N in
this column.

▪

The state should list the demonstration year (DY) and quarter (Q) during which it
will begin reporting on this metric in the column “Monitoring report in which
metric will be phased in (Format DY#Q#; e.g., DY1Q3)” (column R).

▪

In the column “Explanation of any plans to phase in reporting over time” (column
S), the state should describe and justify plans to phase in the metric reporting. For
example, a state may note that it plans to delay reporting because it will not have
data available to support reporting until the second year of the demonstration.

Baseline reporting period for phased-in metrics: If possible, the state should align
the baseline reporting period for phased-in metrics with the instructions in
Appendix C. CMS understands that in certain situations, this may not be possible
(e.g., if a new data field is being built in order to report on the metric). If the state is
unable to retrospectively report on any phased-in CMS-constructed metrics, the
baseline reporting period for the metric(s) should be the first 12-months these data
will be available. For phased-in established quality measures (EQMs) that cannot be
reported retrospectively, the baseline reporting period for the metric(s) should be the
first calendar year these data will be available.

• “SUD planned subpops” tab. The state should review the subpopulation categories
defined in columns A and B of the “SUD planned subpops” tab of Part A. The state
should also review the CMS-provided technical specifications manual for instructions on
reporting CMS-provided and state-specific subpopulations. After reviewing these
materials, the state should complete the “SUD planned subpops” tab to identify the
subpopulations on which it plans to report according to the following instructions:
–

Standard information on CMS-provided subpopulations. The following columns
of the “SUD planned subpops” tab contain standard information on the CMSprovided subpopulations (columns A-E):
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▪

Subpopulation category

▪

Subpopulations

▪

Reporting priority (required or recommended)

▪

Relevant metrics (metrics for which the subpopulation category applies as defined
by the technical specifications manual)

▪

Subpopulation type (CMS-provided)

Standard information on CMS-provided subpopulations cannot be altered by the state.
However, a state can propose modifications in the columns “If the planned reporting
of subpopulations does not match (i.e., column G = “N”), list the subpopulations
state plans to report” (column H) and “If the planned reporting of relevant metrics
does not match (i.e., column I = “N”), list the metrics for which state plans to report
for each subpopulation category” (column J). See “Alignment with CMS-provided
technical specifications manual” sections below for further instructions.
–

Standard information on state-specific subpopulations. If a state chooses to report
on additional subpopulations, it should add rows for each state-specific subpopulation
to the bottom of the “SUD planned subpops” tab. See Chapter I of the CMS-provided
technical specifications manual for further instructions on state-specific
subpopulations.
For state-specific subpopulations, the state should populate the following columns
according to the following instructions (columns A-E):

–

▪

Subpopulation category: For each subpopulation category on which the state
plans to report, it should populate this column with the name of the subpopulation
category (e.g., “Geographic area”).

▪

Subpopulations: The state should populate this column with the subpopulations
associated with the subpopulation category (e.g., “County X, County Y, and
County Z”).

▪

Reporting priority: The state should populate this column as “state-specific” for
all state-specific subpopulations.

▪

Relevant metrics: The state should populate this column with the metrics it plans
to report for each state-specific subpopulation (e.g., “Metrics #1-3, 6-12, 23, 24,
26, 27”).

▪

Subpopulation type: The state should populate this column (column E) as “statespecific” for all state-specific subpopulations.

Plans to report the subpopulation category. The column “State will report (Y/N)”
(column F) identifies whether a state plans to report the subpopulation category. The
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state should use the drop-down option in this column, selecting Y or N to indicate
whether it will include each subpopulation category in its reporting. The state should
also mark Y for all state-specific subpopulations. Note that reporting of some
subpopulation categories is required.
–

Alignment with CMS-provided technical specifications manual for
subpopulations within each subpopulation category. The state should attest that it
will report the subpopulations within each category as outlined in the CMS-provided
technical specifications manual using the drop-down options in the column “Attest
that planned subpopulation reporting within each category matches the description in
the CMS-provided technical specifications manual (Y/N)” (column G). For
subpopulation categories where reporting will not match the CMS-provided technical
specifications manual, the state should list the subpopulations it plans to report in the
column “If the planned reporting of subpopulations does not match (i.e., column G =
“N”), list the subpopulations state plans to report” (column H). For example,
subpopulations that deviate from those outlined in the technical specifications manual
may include reporting on two of three age groups specified within the “Age group”
subpopulation category. The state should also use this column to provide an
explanation for an inability to report any required subpopulations or justification of
why a required subpopulation does not apply for the state’s demonstration.
Subpopulation identification approach: To support CMS’s understanding of the
state’s data, the state should use column H to provide information on its plans to
identify qualified beneficiaries within each of the subpopulation categories listed
below. If the state would instead prefer to upload this information as an attachment,
the state should enter “See attachment for subpopulation identification approaches” in
column H. If the state plans to report the subpopulations within each category
according to the CMS-provided technical specifications manual, the state should
select Y in column G and include a description of its subpopulation identification
approach in column H. If the state would like to propose a deviation for the
subpopulation category, the state should select N in column G and include a
description of the deviation(s) in column H in addition to its subpopulation
identification approach.
The state should describe its identification approach for each of the following
subpopulation categories:6
▪

Dual-eligible status

▪

Pregnancy status

Additional information on identifying these subpopulations is provided in Table 3 in Chapter I Section A of the
SUD technical specifications manual.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

▪

Criminal justice status

▪

OUD population

For each population the state should provide:
▪

The methodology, data source(s), and/or data elements the state will use to
identify qualified beneficiaries for the subpopulation categories.

▪

The time period during which a beneficiary must meet the criteria for the
subpopulation in order to be assigned to the subpopulation.

▪

If available, the diagnosis or procedure codes or other specific data elements the
state will use to identify the subpopulation.

Phased-in subpopulation reporting: If a state is planning to phase in a subpopulation
category or any of its associated subpopulations, the state should select N in column
G, and enter an explanation and the DY and Q in which it will begin reporting on this
metric in the column H.
–

Alignment with CMS-provided technical specifications manual for relevant
metrics. The relevant metrics associated with each subpopulation category as
specified by the technical specifications manual are listed in the column “Relevant
metrics” (column D). The state should attest it will report the associated metrics for
the subpopulation categories using the drop-down options in the column “Attest that
metrics reporting for subpopulation category matches CMS-provided technical
specifications manual (Y/N)” (column I).
If a state does not plan to report all of the relevant metrics in column D for a
subpopulation category, it should list the metrics it plans to report at the
subpopulation level in the column “If the planned reporting of relevant metrics does
not match (i.e., column I = “N”), list the metrics for which the state plans to report
for each subpopulation category” (column J). For example, Metrics #1-3, 6-12
should be reported for the “Dual-eligible status” subpopulation category. If only
Metrics #1-3 can be reported for the “Dual-eligible status” subpopulation category,
but not Metrics #6-12, the state would mark N in column I and list “1, 2, 3” in
column J.
If the state plans to report all of the relevant metrics in column D for a subpopulation
category but with deviations from the prescribed subpopulation category in the
technical specifications manual, the state should select N in column I and use column
J to document how the planned subpopulation category reporting does not match the
technical specifications manual. The state should enter this information for both
required and recommended subpopulation categories. The state does not need to
include information in this section for metrics it does not plan to report.

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For any state-specific metrics (including health IT), the state should use column J to
list the state-specific metrics it plans to report for each subpopulation category. The
state should mark N in column I. Please note, reporting on subpopulation categories
for state-specific metrics is not required.
•

“SUD reporting schedule” tab. To complete this tab, the state should review
Appendix A of the instructions document, which describes expectations for reporting
metrics and other monitoring information. The state should then populate Table 1 in the
“SUD reporting schedule” tab as described below. Based on the state’s responses to
Table 1, the workbook will auto-generate a standard reporting schedule for the state in
the SUD demonstration reporting schedule table (Table 2). Table 2 outlines every quarter
in the SUD demonstration approval period, the broader demonstration year (as
applicable) associated with each quarter, the due date of each monitoring report, and the
content of those reports. The state will then have the opportunity to indicate whether it
will follow CMS’s standard reporting schedule on reporting metrics and narrative
information or propose any deviations. Appendix D and Appendix E provide instructions
on completing the “SUD reporting schedule” tab for a state with a DY less than 12
months or a state with a demonstration extension, respectively.
The state should complete the “SUD reporting schedule” tab according to the following
instructions:
–

Reporting periods input table (Table 1). The state should use the prompt in
column A to enter the requested information in the corresponding row of column B,
“Demonstration reporting periods/dates.” The workbook will generate a standard
reporting schedule for the state to review. The standard schedule will be aligned with
the instructions for reporting metrics and narrative information outlined in
Appendix A. The state should complete each section of Table 1 as follows:
▪

Dates of first SUD demonstration year (SUD DY1). The state should populate
these rows with the:
1. Start date of the first SUD demonstration year (row 12). CMS defines the
start date of the demonstration as the effective date listed in the state’s STCs
at the time of SUD demonstration approval. The start date should always
align with the first day of a month. 7 For example, if the state’s STCs at the
time of SUD demonstration approval note that the SUD demonstration is
effective January 1, 2020 – December 31, 2025, the state should enter
01/01/2020 in row 12.

This date should align with the first day of a month. If a state’s SUD demonstration begins on any day other than
the first day of a month, the state should list its start date as the first day of the month in which the effective date
occurs.
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2. End date of the first SUD demonstration year (row 13). In the example
mentioned above, the state would enter 12/31/2020 into row 13.
A state’s SUD DY1 is usually 12 months long. If the state would like to propose
a shorter DY1 in order to align with broader demonstration reporting
requirements, the state should contact the section 1115 demonstration monitoring
and evaluation mailbox ([email protected]), copying
the state’s CMS demonstration team on the message.
▪

Dates of first quarter of the baseline reporting period for CMS-constructed
metrics. The state should populate these rows with the:
1. Name of the SUD DY and quarter associated with the first quarterly
monitoring report (usually SUD DY1Q1) (row 15). Appendix D provides
instructions for completing this row when the state’s SUD DY1 is less than 12
months;
2. Start date of the first quarter of the baseline reporting period for CMSconstructed metrics (usually the SUD demonstration start date for a SUD DY1
that is 12 months long) (row 16);
3. End date of the first Q of the baseline reporting period for CMS-constructed
metrics (row 17).

▪

Broader section 1115 demonstration reporting period corresponding with the first
SUD reporting quarter, if applicable (row 18). If a state’s SUD demonstration is
part of a broader section 1115 demonstration, the state should populate this row
with the DY and Q of the state’s broader section 1115 demonstration that
corresponds with the first SUD demonstration reporting period. If the state’s
SUD demonstration is not part of a broader section 1115 demonstration, the state
should populate this row with the DY and Q that correspond with the state’s first
SUD demonstration reporting period. If the state’s SUD DY1 is less than 12
months long, it should review Appendix D for further instructions.

▪

First SUD monitoring report due date (per STCs) (row 19). The state should
populate this row with the calendar date on which the first SUD monitoring report
is due, according to the requirements listed in the state’s STCs. If the state’s SUD
DY1 is less than 12 months long, it should review Appendix D for further
instructions on completing this row.

▪

First SUD monitoring report in which the state plans to report annual metrics
that are established quality measures (EQMs). The state should populate these
rows with the:

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

1. State’s baseline reporting period for annual metrics that are established quality
measures (e.g., CY2019) (row 21);8
2. SUD DY and Q associated with the monitoring report in which the established
quality measures should first be reported, according to the instructions in
Appendix A (row 22);
3. Start date of the reporting Q associated with this monitoring report (row 23);
4. End date of the reporting Q associated with this monitoring report (row 24).
▪

Dates of last SUD reporting quarter. The state should populate these rows with
the:
1. Start date of the last reporting Q of the state’s SUD demonstration (row 26);
2. End date of the last reporting Q of the state’s SUD demonstration (usually the
end date of the demonstration approval period) (row 27).

–

Deviations from the standard reporting schedule (Table 2). The state should
review its standard reporting schedule generated in Table 2 and determine whether it
plans to report accordingly, or propose deviations.9 If Table 2 has not rendered
correctly (e.g., columns A-E are blank and/or column G is entirely blank), the state
should review Table 1 for completeness, including to ensure that both the dates and
the DY and Q references are accurate and consistent.
▪

Standard information on the state’s reporting schedule (columns A-G) cannot be
altered by the state.

▪

The state should select Y or N from the drop-down options in the column
“Deviation from standard reporting schedule (Y/N)” (column H) to indicate
whether the state plans to report on each of the reporting categories according to
the standard reporting schedule (column G).

▪

If a state's planned reporting does not match the standard reporting schedule, the
state should provide an explanation for each proposed deviation in the column,
“Explanation for deviations (if column H = “Y”)” (column I). If the state
perceives a need for any such deviations, the state should contact its CMS
demonstration team to discuss the feasibility of an alternate approach.

▪

If the state proposes a deviation to the standard reporting schedule, it should
complete the column “Proposed deviation in measurement period from standard

For instructions on defining baseline reporting periods for annual metrics that are established quality measures,
please refer to Appendix B.
9

The auto-generated reporting schedule in Table 2 outlines the data the state is expected to report for each DY and
Q. However, states are not expected to begin reporting any metrics data until after protocol approval. The state
should see Section B of the Monitoring Report Instructions for more information on retrospective reporting of data
following monitoring protocol approval.

Medicaid Section 1115 SUD Demonstrations
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reporting schedule in column G (Format DY#Q#; e.g., DY1Q3)” (column J). The
state should propose—for each reporting category in column F, as applicable—
the revised SUD measurement period that will replace the standard SUD
measurement period identified in column G. If the state is unable to indicate a
revised SUD measurement period (e.g., because it will be unable to report certain
data), the state should write “None” in column J.10
▪

If a state is not planning to report an entire reporting category (e.g., Grievances
and appeals), it should enter n.a. in column H and leave columns I and J blank.

▪

If a state has a SUD DY1 that is less than 12 months long, refer to Appendix D
for additional guidance on completing Table 2.

▪

If a state’s SUD demonstration approval period is longer than the five years that
are included within the generated reporting schedule table, the state should
manually insert rows at the bottom of the SUD demonstration reporting schedule
table, following the same format as the previous rows, to complete its reporting
schedule for the duration of its SUD demonstration approval period.

2b) Complete Part B: Monitoring Protocol Template.
Part B is a PDF containing four narrative reporting sections. These sections include:
•

Section 1. Title page. The title page is a brief form that the state should complete as
part of its monitoring protocol. PMDA will populate some of the rows with the state’s
demonstration information. The state should review the populated information for
accuracy. The state should complete the remaining rows of the title page form:
–

Approval period for section 1115 demonstration

–

SUD demonstration start date

–

Implementation date of SUD demonstration, if different from SUD demonstration
start date

–

SUD (or if broader demonstration, then SUD-related) demonstration goals and
objectives

For example, consider a state that proposes delaying its first submission of established quality measures by one
quarter to a ccount for programming adjustments. In the first row in which the standard schedule indicates the state
will report “annual metrics that are established quality measures,” the state should enter “None” in column J to
indicate that the state will not report this information in this monitoring report. Moving to the next quarter’s
monitoring report, the state should then enter “CYXXXX” in column I in the row associated with the “annual
metrics that are established quality measures” reporting category, where “XXXX” stands for the calendar year
measurement period on which the state will submit these metrics in this monitoring report.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

PMDA will use this information to prepopulate part of the title page of the state’s
monitoring reports.
•

Section 2. Acknowledgement of narrative reporting requirements. This section is a
companion to the narrative information on implementation requested as part of a state’s
monitoring reports. The state should review the information requested in Section 3
(Narrative information on implementation) of the Monitoring Report Template and select
the appropriate check box to indicate that it will provide the requested narrative
information.

•

Section 3. Acknowledgement of budget neutrality reporting requirements. The
Budget Neutrality Workbook will be provided to the state by its CMS demonstration
team. To complete Section 3, the state should review the Budget Neutrality Workbook
and select the appropriate check box to indicate that it will provide budget neutrality
reporting as requested.

•

Section 4. Retrospective reporting. If a state’s monitoring protocol is approved after
one or more of its quarterly monitoring report submission due date(s), the state should
report metrics data to CMS retrospectively for any prior Qs of section 1115 SUD
demonstration implementation that precede the monitoring protocol approval date.11 To
complete Section 4, the state should review the retrospective reporting instructions in this
section of Part B and select the appropriate check box to indicate that it will report
retrospectively as requested, or propose an alternate approach to retrospective reporting.
Retrospective reporting is not considered phasing in reporting. CMS understands that if
the state plans to phase in reporting on any metrics or subpopulations, these may not be
available for retrospective reporting.

3. Submit Parts A and B using PMDA.
3a) Name the files.
After completing Part A and Part B according to the instructions above, name the files
according to the following convention:
StateAbbreviation_SUDProtocol_Part-A_DateofSubmission and
StateAbbreviation_SUDProtocol_Part-B_DateofSubmission, where:
•

State abbreviation is the two-letter abbreviation for the state name

While a state does not need to submit metrics data until after its monitoring protocol is approved by CMS, the
state should submit quarterly and annual monitoring reports according to the requirements in its STCs with narrative
updates on implementation progress, and other information that may be applicable. The state is encouraged to use
the Monitoring Report Template, to fulfill this reporting requirement until its monitoring protocol is approved.
Please note that if a state chooses to submit metrics data before its monitoring protocol is approved, it may need to
resubmit these data after monitoring protocol approval.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

•

Date of submission is the date the monitoring report is submitted using PMDA in
YYYYMMDD format

For example, a monitoring protocol submitted on December 31, 2020 would contain two
files: XX_SUDProtocol_Part-A_20201231 and XX_SUDProtocol_Part-B_20201231, where
XX stands for the state’s 2-letter abbreviation.
3b) Upload the files using PMDA.
The state should upload Part A and Part B using PMDA through its state demonstration
dashboard. This dashboard will list all section 1115 demonstrations associated with the state.
The state can upload Parts A and B by navigating to the appropriate demonstration name
(name of the state’s stand-alone SUD demonstration or broader demonstration with a SUD
component). In the “Actions” column, select “Deliverables” from the drop-down menu and
click “Go,” to navigate to the state’s “Deliverables” page. A list of deliverables including
names, types, due dates, and other information will be displayed on this page. The state
should go to the deliverable type (i.e., Monitoring Protocol), click “Upload/View Docs” in
the drop-down menu under the “Actions” column, and finally click “Go.” This will take the
state to the “Deliverable Details” page. In the “Add a New State File” section, the state can
upload Part A and Part B of its monitoring protocol and provide any additional
documents/comments to CMS. The state should make sure to mark the “Ready for CMS
Review” button in the “Submission Confirmation” section of the “Deliverable Details” page
and click the “Update Status” button to complete its submission. The deliverable status will
be displayed as "Submitted" if the state's submission is successful.
If the state does not see the relevant deliverable on its “Deliverables” page, the state should
contact the PMDA help desk using phone number (443) 775-3226 between 6:00 am -12:00
am Eastern Time (ET), or by email at [email protected].
For further instructions on monitoring protocol submission, the state should review the PMDA
state user manual (see Section B.1 for instructions on how to access the PMDA state user
manual).

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

APPENDIX A
GUIDELINES FOR INCLUDING MEDICAID SECTION 1115 SUD
DEMONSTRATIONS MONITORING METRICS AND NARRATIVE INFORMATION
IN MONITORING REPORTS

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

This appendix provides reporting instructions applicable to the section 1115 SUD demonstration
monitoring metrics and other monitoring information. See Chapter I Section B of the technical
specifications manual for additional instructions.
The state should report data to CMS in accordance with the schedule and format agreed upon in
the approved monitoring protocol. Given the dynamic nature of Medicaid data, metrics should
be produced at the same time in each measurement period throughout the SUD 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 period.
Guidelines for including metrics and narrative information in monitoring reports are as follows:
•

Each quarterly monitoring 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 as follows:
− For a state with SUD demonstration years that end July 31 through November 30: in the
annual monitoring report
− For a state with SUD demonstration years that end May 31 or June 30: in the first
quarterly monitoring report of the next SUD demonstration year
− For a state with SUD demonstration years that end February 28 through April 30: in the
second quarterly monitoring report of the next SUD demonstration year
− For a state with SUD demonstration years that end December 31 or January 31: in the
third quarterly monitoring report of the next SUD demonstration year

•

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

Table A.1 illustrates these guidelines.

Medicaid Section 1115 SUD Demonstrations
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Table A.1. Reporting in quarterly and annual section 1115 SUD monitoring reports

Monitoring report name

Monitoring report due date:

DY1Q1
report

DY1Q2
report

DY1Q3
report

DY1Q4
(annual) DY2Q1
reportb report

DY2Q2
report

DY2Q3
report

Due 60 Due 60 Due 60
Due 90 Due 60 Due 60
Due 60
days after days after days after days after days after days after days after
quarter quarter quarter quarter quarter quarter quarter
ends
ends
ends
ends
ends
ends
ends

Measurement periods, by reporting category
Narrative information on
implementation

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

DY2Q2

DY2Q3

Grievances and appeals

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

DY2Q2

DY2Q3

Other monthly and quarterly metrics

n.a.

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

DY2Q2

Annual metrics that are established
quality measuresa

n.a.

Other annual metrics

n.a.

A state A state A state A state
with a
with a
with a
with a
DY
DY
DY
DY
ending
ending
ending ending on
07/31 – on 05/31 on 2/28 – 12/31 or
11/30: or 06/30: 4/30:
1/31:
CY1
CY1
CY1
CY1
n.a.

DY1

n.a.

Note:

The state is expected to submit retrospective metrics data in the second monitoring report submission after
monitoring protocol approval.
a
Metrics that are established quality measures should be calculated for the calendar year. Note that one established
quality measure (Metric #22) should be calculated over a 2-year period (starting with the calendar year in which the
demonstration began and the calendar year prior). All other metrics should be calculated for the SUD demonstration
year.
b
Per the STCs, the state’s Q4 information that would ordinarily be provided in a separate fourth quarterly
monitoring report should be reported as distinct information within the annual monitoring report. If the state’s SUD
demonstration is part of a broader section 1115 demonstration, the state should consider its broader section 1115
demonstration Q4 monitoring report to be the state’s annual monitoring report.
CY = calendar year; CY1 = the calendar year in which the demonstration began; DY = Demonstration year; Q =
quarter; n.a. = not applicable (information not expected to be included in report)

Technical assistance. CMS offers technical assistance to help the state collect, report, and use
these metrics. For technical assistance, contact the section 1115 demonstration monitoring and
evaluation mailbox ([email protected]), copying the state’s CMS
demonstration team on the message.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

APPENDIX B
INSTRUCTIONS FOR DETERMINING BASELINE REPORTING PERIODS FOR
MEDICAID SECTION 1115 SUD DEMONSTRATIONS MONITORING METRICS

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

To determine baseline reporting periods, the state must first identify the start date of its SUD
demonstration. For monitoring purposes, CMS defines the start date of the demonstration as the
effective date in the state’s STCs. For example, if the state’s STCs at the time of SUD
demonstration approval note that the SUD demonstration is effective January 1, 2020 –
December 31, 2025, the state should consider January 1, 2020 to be the start date of the SUD
demonstration for purposes of monitoring.12
When reporting metrics, the state should use the following instructions for determining baseline
reporting periods:
•

CMS-constructed and state-specific metrics: For CMS-constructed and state-specific
metrics where the measurement period is a month, quarter, or year, the baseline reporting
period is the first SUD DY (SUD DY1). For example, if the state’s SUD demonstration
began on March 1, 2020, the baseline reporting period is March 1, 2020 – February 28, 2021.
− If the state’s SUD demonstration began on any other day than the first day of the month,
the state should still start its baseline reporting period on the first day of the month for
monitoring purposes. This applies to all baseline reporting periods (month, quarter, and
year). For example, if a state’s demonstration began on March 15, 2020, the state should
consider March 1 as the beginning of its baseline reporting period.
− For a state where the first SUD DY is less than 12 months, the state should report the 12
months preceding the end of SUD DY1 as its baseline reporting period (including months
before the start of the SUD demonstration). For example, if the state has a 10 -month
SUD DY1 that began March 1, 2020 and ended December 31, 2020, the baseline
reporting period should be January 1, 2020 – December 31, 2020.

•

Established quality measures: For metrics that are established quality measures, the
calendar year in which the demonstration started is the baseline reporting period. For
example, if the state’s SUD demonstration began on March 1, 2020, the baseline reporting
period is January 1, 2020 through December 31, 2020.
− For measures calculated over a 2-year period (Metric #22: Continuity of
Pharmacotherapy for Opioid Use Disorder), the baseline reporting period is the calendar
year in which the SUD demonstration started and the prior year. For each subsequent
reporting period, shift the period for the denominator forward by one year.
− For a state where SUD DY1 is less than 12 months, the state should use the last da y of
SUD DY1 to identify the appropriate calendar year for reporting. If the last day of SUD

The effective date is defined as the first day the state may begin its SUD demonstration, as indicated in the state’s
STCs. Note that in many cases, the effective date is distinct from the approval date of a demonstration; that is, in
certain cases, CMS may approve a section 1115 demonstration with an effective date that is in the future. For
example, CMS may approve an extension request on December 15, 2020, with an effective date of January 1, 2021
for the new demonstration period. In many cases, the effective date also differs from the date a state begins
implementing its demonstration.
12

Medicaid Section 1115 SUD Demonstrations
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DY1 is December 31, the baseline reporting period would be the same calendar year. For
example, if a state has a 10-month SUD DY1 starting March 1, 2020 and ending on
December 31, 2020, the baseline reporting period is January 1, 2020 – December 31,
2020 (calendar year 2020). If the last day of SUD DY1 is any other date, the baseline
reporting period should be the prior calendar year. For example, if a state has a 10-month
SUD DY1 that started on September 1, 2020 and ended June 30, 2021, the baseline
period is January 1, 2020 – December 31, 2020 (calendar year 2020).
For any clarifications on measurement periods and baseline reporting periods, the state may send
questions to the section 1115 demonstration monitoring and evaluation mailbox
([email protected]), copying the state’s CMS demonstration team on
the message.
Table B.1 below illustrates these guidelines, using a SUD demonstration that begins March 1,
2020 as an example.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Table B.1. Example of alignment between section 1115 SUD DYs and measurement periods
Section 1115
SUD
demonstration
approval period
start date:
March 1, 2020

SUD measurement period
Start date

SUD DY1
March 1, 2020 Feb 28, 2021
(baseline
reporting period)b

Mar 1
Apr 1
May 1
June 1
…
Feb 1

Mar 31
Apr 30
May 31
June 30
…
Feb 28

Mar 1
June 1
Sep 1
Dec 1

May 31
Aug 31
Nov 30
Feb 28

Jan 1, 2020

Dec 31,
2020

SUD DY2
March 1, 2021 Feb 28, 2022

Month as
defined in the
baseline period
row

Quarter as
defined in the
baseline period
row

Jan 1, 2021

Dec 31,
2021

SUD DY3
March 1, 2022 Feb 28, 2023

Month as
defined in
the baseline
period row

Month as
defined in the
baseline
period row

Quarter as
defined in
the baseline
period row

Jan 1, 2022

Dec 31,
2022

SUD DY4
March 1, 2023 Feb 29, 2024

Month as
defined in the
baseline period
row

Quarter as
defined in the
baseline period
row

Jan 1, 2023

Dec 31,
2023

SUD DY5
March 1, 2024 Feb 28, 2025

Month as
defined in the
baseline period
row

Quarter as
defined in the
baseline period
row

Jan 1, 2024

Dec 31,
2024

Month
End date

Quarter
Start date

End date

CMS-constructed and state-specific metrics

Yeara
Start date

End date

Established quality
measures

This example does not apply to Metric #22, which is calculated over a two-year time period. For a SUD
demonstration with a March 1, 2020 demonstration start date, the SUD DY1 measurement period for Metric #22
would be January 1, 2019 – December 31, 2020. For SUD DY2, the measurement period for Metric #22 would be
January 1, 2020 – December 31, 2021.
b

Baseline reporting period for CMS-constructed and state-specific metrics is SUD DY1. Baseline reporting period
for established quality measures is calendar year in which the SUD demonstration started.
DY = demonstration year

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

APPENDIX C
SELECTING ANNUAL GOALS AND OVERALL DEMONSTRATION TARGETS FOR
MEDICAID SECTION 1115 SUD DEMONSTRATIONS MONITORING METRICS

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

As indicated in the “Demonstration target and annual goals” section, the state is required to set
annual goals and overall demonstration targets for each monitoring metric. This appendix
provides further information on selecting goals and targets for Medicaid section 1115 SUD
demonstration monitoring metrics. CMS appreciates the challenge of forecasting the need for
and use of SUD treatment by type of care over the course of the demonstration. State officials
are the most knowledgeable about the specific needs of their Medicaid demonstration
populations and potential for their demonstration and other state initiatives to result in shifts in
treatment use. Thus, CMS is not prescribing data sources or the approach for setting directional
goals and targets. The state should take into account the following sources of information when
developing these estimates:
•

Projections for state Medicaid spending and/or managed care payment shares associated with
SUD treatment services;

•

Recent state trends in Medicaid enrollment and SUD prevalence within the Medicaid
population;

•

Recent trends from the state’s Medicaid program on SUD service use, length of stay and
retention in treatment by level of care;

•

Findings from evaluations of similar changes in coverage and service delivery in best
practice settings or other states or populations;

•

Provider capacity constraints; and

•

Projected impacts associated with other state programs addressing the opioid epidemic or
affecting Medicaid enrollment and the prevalence of SUDs and SUD treatment use among
Medicaid enrollees.

Since factors influencing trends in Metrics #3 through #12 have the potential to counteract one
another, the state should report its best forecast for the directional targets and go als.
STCs for section 1115 SUD demonstrations include provisions for CMS to defer funds if a state
does not demonstrate sufficient progress toward achieving goals and targets. However, when
assessing progress toward goals CMS will consider trends in Medicaid enrollment and treatment
need (e.g., the prevalence of opioid use disorders and emergency department visits for drug
overdose) that may counter a state’s efforts to influence treatment use through the demonstration.
For example, a state may target decreased use of residential and inpatient services, but fail to
achieve this goal because of continued increases in drug overdose rates. In this case CMS would
consider data on trends drug overdose rates provided by that state as a mitigating factor when it
reviews the state’s progress. Likewise, a state may target increased use of partial hospitalization
and intensive outpatient services, but fail to achieve the target because of declines in Medicaid
enrollment or treatment need among those enrolled. CMS would consider data presented by that

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

state on these trends as a mitigating factor when reviewing the state’s progress under the
demonstration.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

APPENDIX D
COMPLETING THE “SUD REPORTING SCHEDULE” TAB FOR A STATE WITH
SUD DEMONSTRATION YEAR 1 SHORTER THAN 12 MONTHS

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

This appendix provides instructions for how a state with a SUD DY1 less than 12 months long
should populate Table 1 and Table 2 in the “SUD reporting schedule” tab. These are alternative
instructions to the standard instructions described in the “‘SUD reporting schedule’ tab” section
for several cells in Table 1. For all the remaining parts of Table 1 and the columns in Table 2,
the state should follow the standard instructions mentioned above. Following the instructions, a
specific example case is provided.
Please note, for a state where the first SUD DY is less than 12 months, the state should report the
12 months preceding the end of SUD DY1 as its baseline reporting period, including months before
the start of the SUD demonstration. (Chapter I Section B of the technical specifications manual
contains instructions for defining baseline reporting periods.)

•

Instructions for completing Table 1. Substance Use Disorder Demonstration Reporting
Periods Input Table
− Dates of first SUD demonstration year (SUD DY1):
▪

Start date (MM/DD/YYYY) (row 12): The state should enter the start date of its
demonstration period.

▪

End date (MM/DD/YYYY) (row 13): The state should enter the end date of its
demonstration period.

− Dates of first quarter of the baseline reporting period for CMS-constructed metrics:
▪

Reporting period (SUD DY and Q) (Format DY#Q#; e.g., DY1Q1) (row 15): The
state should always enter “DY1Q1” regardless of the start date of its baseline
reporting period.

▪

Start date (MM/DD/YYYY) (row 16): The state should enter the start date of the
first Q of the baseline reporting period for CMS-constructed metrics. Note that
this start date will not align with the start date of the SUD demonstration (entered
in row 12). Instead, this start date should align with the date twelve months prior
to the end of the state’s DY1, even if that date falls outside of the state’s SUD
demonstration period.

▪

End date (MM/DD/YYYY) (row 17): The state should enter the end date of the
first Q of the baseline reporting period for CMS-constructed metrics. This date
should be three months after the baseline reporting period start date.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

− First SUD monitoring report due date (per STCs) (MM/DD/YYYY) (row 19): The state
should enter the date obtained by adding the number of days a state has to submit a
quarterly monitoring report after the end of the reporting period, per the STCs, to the date
in row 17. Please note, that for a state with a DY1 that is less than 12 months long, this
due date may fall prior to the demonstration approval period, which is acceptable. Per
the instructions below, the state will have an opportunity in Table 2 to indicate that it’s
DY1 is less than 12 months, which will explain to CMS why it has a monitoring report
due date that falls prior to demonstration approval.
•

Instructions for completing Table 2. Substance Use Disorder Demonstration Reporting
Schedule
− For any baseline reporting Qs that occurred before the SUD demonstration start date:
▪

Deviation from standard reporting schedule (Y/N): The state should enter “Y” in
this column to indicate that the state will deviate from the standard reporting
schedule for the baseline Qs that occur prior to the demonstration start date.

▪

Explanation for deviations (if column H = “Y”): The state should enter the
following explanation: “SUD DY1 is less than 12 months. The state is aligning
SUD reporting quarters with the broader demonstration. This data is for the
baseline period before the demonstration start date and will be included in
retrospective reporting.” If the state shortened its SUD DY1 to align with a
broader section 1115 DY, the state should include the following in its
explanation: “The state is aligning SUD reporting quarters with the broader
demonstration.”

▪

Proposed deviation in measurement period from standard reporting schedule in
column G (Format DY#Q#; e.g., DY1Q3): The state should enter “n.a. – in
retrospective reporting” in this column.

Please note that the state only needs to enter this information for reporting categories
that have a DY and Q populated in column G.
− For any reporting Qs that occur after the SUD demonstration start date, the state should
complete the columns of Table 2 according to the standard instructions.
Example: The state should start by completing Table 1. Substance Use Disorder Demonstration
Reporting Periods Input Table (see example text in red in Figure D.1). If a state has an 8-monthlong SUD DY1 that began May 1, 2022 and ended December 31, 2022, it would start by entering
these dates into rows 12 and 13 (i.e., “05/01/2022” and “12/31/2022”). In this example, the
baseline reporting period for CMS-constructed metrics should be January 1, 2022 – December
31, 2022. The state should enter “DY1Q1” in row 15, and the first Q of the baseline reporting
period in rows 16 and 17 (i.e., “01/01/2022” and “03/31/2022”).

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

In this example, January 1, 20122 – March 31, 2022 aligns with DY16Q1 of the state’s broader
section 1115 demonstration (row 18). The state’s STCs require the state to submit quarterly
monitoring reports 60 days after a Q ends. To calculate the due date of the first SUD quarterly
monitoring report (row 19), the state should add 60 days to the end date listed in in row 17
(“05/30/2022”).
Next, the state should complete Table 2. Substance Use Disorder Demonstration Reporting
Schedule (see example text in red in Figure D.2). The state is not expected to submit a SUD
monitoring report for baseline reporting Qs that occurred prior to the SUD demonstration start
date, May 1, 2022 in this example. The state should document this as a deviation from the
standard reporting schedule as shown in Figure D.2. Since the state shortened its SUD DY1 to
align with a broader section 1115 DY, the state should include this information as shown in
Figure D.2. The state should still submit a quarterly monitoring report for this Q as required for
its broader section 1115 demonstration.
Figure D.1. Completing Table 1 of the “SUD reporting schedule” tab for a state with a
SUD DY1 less than 12 months and part of a broader section 1115 demonstration*

*Red text in Figure D.1. is an example entry from a figurative state.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Figure D.2. Completing Table 2 of the “SUD reporting schedule” tab for a state with a SUD DY1 less than 12 months (starting
on May 1, 2022) with quarters that contain baseline reporting period months and no SUD DY1 months**

**Red text in Figure D.2. is an example entry from a figurative state. The state should not use the specific entries in the completion of its “SUD reporting
schedule” tab. Columns C-E have been hidden in the figure in order to display columns A and B alongside columns F-J.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

APPENDIX E
COMPLETING THE “SUD REPORTING SCHEDULE” TAB FOR A STATE WITH
APPROVED SUD DEMONSTRATION EXTENSION

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

This appendix provides alternative instructions for how a state with an approved SUD
demonstration extension should populate Table 1 and Table 2 in the “SUD reporting schedule”
tab. These are alternative instructions to the standard instructions described in the “‘SUD
reporting schedule’ tab” section for Table 1. The state should follow the standard instructions
listed above to complete Table 2. Following the instructions, a specific example case is detailed
below.
•

Instructions for completing Table 1. Substance Use Disorder Demonstration Reporting
Periods Input Table
− Dates of first SUD demonstration year (SUD DY1):
▪

Start date (MM/DD/YYYY) (row 12): If a state is approved for a SUD
demonstration extension, the state should enter the start date of its extension
period.

▪

End date (MM/DD/YYYY) (row 13): The state should enter the end date of the
first year of its extension period.

− Dates of first quarter of the baseline reporting period for CMS-constructed metrics:
▪

Reporting period (SUD DY and Q) (Format DY#Q#; e.g., DY1Q1) (row 15): The
state should enter the first SUD DY and Q of the extension period (i.e., the state
should number the SUD DY and Q continuously from the previous approval
period).

▪

Start date (MM/DD/YYYY) (row 16): The state should enter the start date of the
DY and Q listed in row 15.

▪

End date (MM/DD/YYYY) (row 17): The state should enter the end date of the
DY and Q listed in row 15.

− Broader section 1115 demonstration reporting period corresponding with the first SUD
reporting quarter, if applicable. If there is no broader demonstration, fill in the first
SUD reporting period. (Format DY#Q#; e.g., DY3Q1) (row 18): If the state has a
broader demonstration along with a SUD component, the state should enter the broader
DY and Q associated with the SUD DY and Q listed in row 15.
− First SUD monitoring report due date (per STCs) (MM/DD/YYYY) (row 19): The state
should enter due date of the monitoring report associated with the SUD DY and Q listed
in row 15. This is the first monitoring report due date of the extension period.
− First SUD monitoring report in which the state plans to report annual metrics that are
established quality measures (EQMs):
▪

Baseline period for EQMs (Format CY#; e.g., CY2019) (row 21): The state
should enter the calendar year in which the demonstration extension period began.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

▪

SUD DY and Q associated with monitoring report (Format DY#Q#; e.g., DY1Q1)
(row 22): The state should enter the SUD DY and Q associated with the
monitoring report in which EQMs should first be reported for its demonstration
extension, according to the instructions in Appendix A.

▪

SUD DY and Q start date (MM/DD/YYYY) (row 23): The state should enter the
start date of the reporting Q associated with the monitoring report in row 22.

▪

SUD DY and Q end date (MM/DD/YYYY) (row 24): The state should enter the
end date of the reporting Q associated with the monitoring report in row 22.

− Dates of last SUD reporting quarter:

•

▪

Start date (MM/DD/YYYY) (row 26): The state should enter the start date of the
last reporting Q in the SUD demonstration extension.

▪

End date (MM/DD/YYYY) (row 27): The state should enter the end date of the last
reporting Q in the SUD demonstration extension (usually the end date of the
approved demonstration extension period).

Instructions for completing Table 2. Substance Use Disorder Demonstration Reporting
Schedule
− For reporting categories referencing prior measurement periods that occurred before the
SUD demonstration extension start date not reflected in column G:
▪

Deviation from standard reporting schedule (Y/N): The state should enter “Y” in
this column to indicate that the state will deviate from the standard reporting
schedule to reference Qs of data occurring prior to the demonstration extension
start date.

▪

Explanation for deviations (if column H = “Y”): The state should enter the
following explanation: “Reporting to continue per previously approved reporting
schedule.”

▪

Proposed deviation in measurement period from standard reporting schedule in
column G (Format DY#Q#; e.g., DY1Q3): The state should enter the
measurement period occurring prior to the demonstration extension start date in
this column.

− For any reporting Qs that occur after the SUD demonstration extension start date, the
state should complete the columns of Table 2 according to the standard instructions.
Example: A state’s original SUD component of its broader demonstration ended on December
31, 2021, which was the SUD DY5Q4 reporting period. The state recently received a 5-year
demonstration extension to begin January 1, 2022 and end on December 31, 2026. The state’s
first SUD DY in this new extension period runs from January 1, 2022 to December 31, 2022.
Therefore, the state should enter “01/01/2022” and “12/31/2022” into rows 12 and 13,

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

respectively. This also means that the first report in the approved extension period would b e
DY6Q1. The state should enter “DY6Q1” in row 15, and the start and end dates of this reporting
period in rows 16 and 17 (i.e., “01/01/2022” and “03/31/2022”). See text in red in Figure E.1
below. The state should also enter the broader section 1115 DY and Q that aligns with SUD
reporting period. In this example, DY6Q1 also aligns with DY16Q1 of the state’s broader
section 1115 demonstration. This broader DY and Q was entered into row 18.
Because the state’s STCs require it to submit quarterly monitoring reports 60 days after a Q
ends, the state should add 60 days to the end date in row 17 to calculate the due date of the first
SUD monitoring report which in this example would be May 30, 2022 (see row 19).
The state’s baseline period for EQMs is the calendar year in which the demonstration extension
period begins. Since the state’s demonstration extension period begins on January 1, 2022, the
state should enter “CY2022” in row 21. Because the first SUD DY and Q of the extension
period is DY6Q1, the first monitoring report in which the state will report EQMs will be DY7Q3
(row 22). The state should then enter the start and end dates of this reporting period in rows 23
and 24 (i.e., “07/01/2023” and “09/30/2023”).
The final two rows of Table 1 ask for the start and end dates of the last SUD reporting quarter.
Since the last quarter of the demonstration extension period will begin October 1, 202 6 and end
December 31, 2026, the state should enter “10/01/2026” and “12/31/2026” in rows 26 and 27.
Next, the state should complete Table 2. Substance Use Disorder Demonstration Reporting
Schedule (see example text in red in Figure E.2). In this example, the state is expected to submit
monthly and quarterly metrics for the DY5Q4 measurement period and other annual metrics for
the DY5 measurement period in the first monitoring report of the demonstration extension (SUD
DY6Q1). In addition, the state is expected to report EQMs for the CY2021 measurement period
in the DY6Q3 monitoring report. The state should document this as a deviation from the
standard reporting schedule as shown in Figure E.2.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Figure E.1. Completing Table 1 of the “SUD reporting schedule” tab for a state with an
approved section 1115 SUD demonstration extension*

*Red text in Figure E.1 is an example entry from a figurative state.

Medicaid Section 1115 SUD Demonstrations
Monitoring Protocol Instructions Version 4.0

Figure E.2. Completing Table 2 of the “SUD reporting schedule” tab for a state with an approved section 1115 SUD
demonstration extension starting on SUD DY6Q1**

**Red text in Figure E.2. is an example entry from a figurative state. The state should not use the specific entries in the completion of its “SUD rep orting
schedule” tab. Columns C-E have been hidden in the figure in order to display columns A and B alongside columns F-J.

File Type	application/pdf
File Title	Section 1115 SUD Monitoring Protocol Instructions (Version 4.0)
Subject	Substance Use Disorder Monitoring
Author	Centers for Medicare & Medicaid Services (CMS)
File Modified	2022-03-15
File Created	2022-03-14