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

Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0
Medicaid Section 1115 Serious Mental Illness and Serious
Emotional Disturbance Demonstrations
Monitoring Report Instructions
PRA Disclosure Statement - This information is being collected to assist the Centers for Medicare & Medicaid Services in
program monitoring of Medicaid Section 1115 Serious Mental Illness and Serious Emotional Disturbance Demonstrations.
This mandatory information collection (42 CFR § 431.428) will be used to support more efficient, timely and accurate review
of states’ monitoring report submissions of Medicaid Section 1115 Serious Mental Illness and Serious Emotional
Disturbance Demonstrations, and also support consistency in monitoring and evaluation, increase in reporting accuracy,
and reduction in timeframes required for monitoring and evaluation. Under the Privacy Act of 1974 any personally
identifying information obtained will be kept private to the extent of the law. According to the Paperwork Reduction Act of
1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is 0938-1148 (CMS-10398 #59). The time required to complete this
information collection is estimated to average 29 hours per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the information collection. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0
Table of Contents
A. Instructions for completing a quarterly or annual monitoring report
1. Customize the tools for use in quarterly and annual monitoring reports
2. Use the customized tools to complete each quarterly and annual monitoring report
3. Submit Parts A, B, and C to PMDA
B. Instructions for completing a retrospective monitoring report
1. Use the state’s customized template for Parts A and B
2. Complete Parts A and B for the retrospective monitoring report
3. Submit Parts A and B to PMDA
APPENDIX A: Reporting Medicaid section 1115 SMI/SED demonstration monitoring metrics and
narrative information
APPENDIX B: Calculating percent change for Medicaid section 1115 SMI/SED demonstration
monitoring metrics

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Medicaid Section 1115 SMI/SED Demonstrations
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A. Instructions for completing a quarterly or annual monitoring report
1. Customize the template for use in quarterly and annual monitoring reports.
1a) Customize Part A: Monitoring Report Workbook (Excel file, “SMI-SED metrics” tab).
The state should align the content of the tab named “SMI-SED metrics” with information
provided in its approved monitoring protocol, including: (1) populating the required health
IT metrics (metric name, description, reporting category, data source, and measurement
period); (2) adding rows at the bottom of the tab for any additional state-specific metrics;
and (3) adding columns for any additional subpopulations to the end of the workbook. The
state should note that cells containing standard information (i.e., milestone or reporting
topic, metric type, reporting category, metric number, metric name, metric description, data
source, and measurement period) for CMS-provided metrics are locked for editing and
cannot be altered by the state.
1b) Customize Part B: Monitoring Report Template (Word document). Complete Section 1
(Title page) of the template using the title page from Part B of the monitoring protocol.
1c) Customize Part C: Budget Neutrality Workbook (Excel file). At the time of
demonstration approval, CMS will work with the state to confirm the appropriate workbook
for this demonstration. The state should work with its CMS demonstration team on
developing the Budget Neutrality Workbook.
2. Complete Parts A, B, and C of the customized template as summarized in Table 1 and
according to the instructions below:
Note: If a state’s section 1115 SMI/SED demonstration is part of a broader demonstration, CMS
will work with the state to ensure there is no duplication in the reporting requirements for
different components of the demonstration. For example, CMS may work with the state to avoid
duplication in selecting metrics within Part A and selecting reporting topics within Part B (for
example, SMI/SED demonstration operations and policy, budget neutrality, SMI/SED
demonstration and evaluation update, other SMI/SED demonstration reporting, and notable state
achievements and/or innovations).
2a) Complete Part A: Monitoring Report Workbook. CMS requires each state with an
SMI/SED demonstration to provide data on monitoring metrics for different milestones and
reporting topics (see Table 1). Appendix A contains detailed guidance for reporting
monitoring metrics and narrative information. For each quarterly and annual monitoring
report, the state should create a new copy of the “SMI-SED metrics” tab and the “SMI-SED
reporting issues” tab within Part A. For each annual monitoring report, the state should
create a new “Annual Avail Assessment” tab within Part A. The instructions for these tabs
are presented below according to the order of the columns listed in each tab.
 “SMI-SED metrics” tab: Report metrics values using the Medicaid Section 1115
SMI/SED Demonstrations: Technical Specifications for Monitoring Metrics (hereafter
referred to as “technical specifications manual”) provided by CMS. The technical
specifications manual and the supplemental materials (such as associated value sets) that

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accompany this manual can be accessed on the Performance Management Database and
Analytics (PMDA) system on the “Reference Materials” page.1 The link to the
“Reference Materials” page is available on the right side of the state's demonstration
dashboard. If the state did not propose reporting a given metric in its approved
monitoring protocol, or if the reporting schedule in Part A (“SMI-SED reporting
schedule” tab) of a state’s approved protocol indicates a metric is not scheduled for
reporting, the state should leave the remaining cells in that row blank. Similarly, if a
state does not plan to report a metric by subpopulation, it should leave the cells in those
columns blank.
− The state should fill out the following header information below (columns B and C
above the metrics table). This information will populate the headers of the
“SMI/SED reporting issues” tab.


State



Demonstration name



SMI/SED Demonstration Year (DY) (Format: DY1, DY2, DY3, etc.)



Calendar dates for SMI/SED DY (Format: MM/DD/YYYY)



SMI/SED Reporting Period (Format: Q1, Q2, Q3, Q4)



Calendar dates for SMI/SED Reporting Period (Format: MM/DD/YYYY –
MM/DD/YYYY)

If a state has renewed its SMI/SED demonstration or the SMI/SED component of a
broader demonstration, the state should number the SMI/SED DY and Q continuously
from the previous approval period. For example, if a state’s last monitoring report
from the previous approval period was submitted for SMI/SED DY4Q4, the
subsequent report should be named SMI/SED DY5Q1.
− Standard Information. The following columns of the “SMI-SED metrics” tab
(columns A-G and L) contain standard information on CMS-provided metrics:


Number



Metric name



Metric description

1

The technical specifications manual can be accessed on PMDA in the Reference Materials section after completing the
National Measure Stewards Terms and Conditions ‘Point and Click’ Agreement. This agreement should automatically
appear when a state downloads the technical specifications manual.

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

Milestone or reporting topic2



Metric type



Reporting category



Data source



Measurement period

Standard information listed above on CMS-provided metrics cannot be altered by the
state. The state can edit the “SMI-SED metrics” tab starting with column H,
“Approved protocol indicates that reporting matches the CMS-provided technical
specifications manual (Y/N).”
− If the state’s approved monitoring protocol specifies that it will report on additional
state-specific subpopulations, that state should edit the titles of the provided columns
(columns BG-BI), and include additional columns as necessary, to reflect the
approved state-specific subpopulation names.
− The state should follow the guidance below to complete the “SMI-SED metrics” tab:


Alignment with CMS-provided technical specifications manual. The state
should indicate the version of the metrics technical specifications manual used to
report each metric, using the drop-down options (Version 1.0 or Version 2.0) in
column J, “Technical specifications manual version.” The state should consult
the technical specifications manual (Chapter I, “Manual version” section) for
more information regarding the appropriate version for calculating each
monitoring metric. If a state uses a version of the technical specifications that
differs from the expectations outlined in the current technical specifications
manual, it should indicate “Y” in the “Reporting issue (Y/N)” column (column
L) and provide an explanation in the “SMI/SED reporting issues” tab. In
addition, the state should attest that its reporting matches the CMS-provided
technical specifications manual for each metric, using the drop-down option to
select Y or N in column H, “Approved protocol indicates that reporting matches
the CMS-provided technical specifications manual (Y/N).” For metrics where
reporting does not match the CMS-provided specifications, the state should use
column I, “Deviations from CMS-provided technical specifications manual in
approved protocol” to list any deviations that were approved in its protocol. For
state-specific metrics, the state should attest that it is reporting as specified in its
monitoring protocol or list any deviations that were approved in its monitoring
protocol in the provided column.

2

The milestones correspond with those listed in State Medicaid Director Letter #18-011, which announced the SMI/SED
demonstration opportunity. The full letter is available here: https://www.medicaid.gov/sites/default/files/federal-policyguidance/downloads/smd18011.pdf.

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

Presence of data and reporting issues. In the column named “Reporting issue
(Y/N)” (column K), the state should indicate whether any data or reporting issues
affected the state’s ability to report metrics as described in its approved
monitoring protocol (for example, difficulty obtaining necessary data or
calculating a required measure). For any identified issues, the state should
provide further detail in the “SMI-SED reporting issues” tab described below.



Dates covered by measurement period for each metric. The state should use
the column “Dates covered by measurement period” (column M) to provide the
calendar dates associated with the measurement period (data collection
timeframe). See the technical specifications manual for additional guidance on
determining the measurement period for each metric.



Presenting data for counts. The denominator and rate/percentage columns are
shaded grey for any metrics that are reported as counts. For each count metric,
the state should report the numerator (outlined in the corresponding metric’s
technical specification) in the numerator column, leaving the denominator and
the rate/percentage columns grey. The state should report separately for the
overall demonstration and for any subpopulations reported, using the columns
provided.



Presenting data for rates or percentages. The state should populate both the
denominator and numerator columns for metrics that are reported as rates or
percentages. After these values are entered, the “Rate/percentage” cells—which
are locked for editing—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.



Reporting annual metrics. The state should report data for annual metrics
(CMS-constructed and established quality measures) according to the reporting
schedule in Part A in its approved monitoring protocol. The annual metric
reporting columns should remain empty in other quarterly monitoring reports, as
noted within the tab.

 “SMI-SED reporting issues” tab: Report any data or reporting issues associated with
specific metrics as indicated in column K, “Reporting issue (Y/N)” in the “SMI-SED
metrics” tab or associated with any metrics with issues that have been resolved since the
last report in the “SMI-SED reporting issues” tab. A reporting issue is considered any
issue that prevents a state from reporting in alignment with its approved monitoring
protocol. The state may use the filter feature function in column A (“#”) to select the
applicable metrics, if desired.
− New issues. The state should use the “SMI-SED reporting issues” tab to provide
CMS with information on the issue and how it affects reporting. The state should
complete columns D-G for new issues:

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 Summary of issue: The summary should include known or suspected causes of
the issue, if applicable.

 Date and report in which issue was first reported
 Remediation plan and timeline for resolution
 Status
− Updates on previous issues. The state should provide CMS with updates on any
data or reporting issues described in previous reports with status “New” or
“Ongoing.” The state should copy the information entered into columns D-F from the
report in which the issue was first reported into its current report. If any data and
reporting issues described in a previous report are unresolved, the state should select
“Ongoing” from the drop-down in column G, “Status,” and provide CMS with
updates in column H, “Update(s) to issue summary, remediation plan, and/or timeline
for resolution, if issue previously reported.” These updates can include updates to
the remediation plan and timeline, or any other new information the state deems
relevant. For any resolved data and reporting issues, the state should select
“Resolved” from the drop-down in column G, and provide an update on how the issue
was resolved in column H. Please note that a resolved issue should be reported with
“N” in column L, “Reporting issue (Y/N)” in the “SMI-SED metrics” tab. If an issue
was noted as resolved in a previous report, it should not be reported in subsequent
reports.
− Confirmation that there are no issues. For any metric reported as outlined in the
monitoring protocol with no data or reporting issues, the state should not enter any
text in the corresponding row of the “SMI-SED reporting issues” tab.
 “Annual Avail Assessment” tab: Report the state’s Annual Assessment of the
Availability of Mental Health Services as part of each annual monitoring report. The
Annual Availability Assessment contains parallel information to the Initial Assessment of
the Availability of Mental Health Services submitted as part of the state’s application.
The state should use the instructions provided in the “Avail Assessment instructions” tab
to complete the “Annual Avail Assessment” tab. Also, the “Avail Assessment
definitions” tab provides definitions of terms used in the assessment.
2b) Complete Part B: Monitoring Report Template. The instructions below describe the four
sections of the Monitoring Report Template. Please note that embedded objects (for
example, documents, shapes, SmartArt, screenshots, charts, tables) are not permitted in Part
B. If necessary, the state may upload any objects as separate attachments and reference the
attachment within Part B. The Monitoring Report Template sections include:
 Section 1. Title page. The title page is a brief form that the state completed as part of its
monitoring protocol. The state should submit this form as the title page for all
monitoring reports and should match the information from the state’s approved
monitoring protocol, except for the following two rows:

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− SMI/SED demonstration year and quarter. The state will enter the section 1115
SMI/SED demonstration year and quarter associated with the submitted monitoring
report. This should align with the reporting schedule in the state’s approved
monitoring protocol.
− Reporting period. The state will enter the calendar dates for the current reporting
period (i.e., for the quarter or year). This should align with the reporting schedule in
the state’s approved monitoring protocol.
 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 SMI/SED demonstration or SMI/SED
component of a broader section 1115 demonstration. This summary should also identify:
(1) key changes since the last monitoring report, including the implementation of new
program components; (2) programmatic improvements (for example, increased outreach
or any beneficiary or provider education efforts); and (3) highlights of unexpected
changes (for example, unexpected increases or decreases in enrollment or complaints,
etc.), which may include changes related to the 2019 coronavirus (COVID-19) pandemic.
Historical background or general descriptions of the demonstration component should not
be included. The word count should not exceed 500.
 Section 3. Narrative information on implementation, by milestone and reporting
topic. The state should report narrative information in this table following the detailed
prompts for each reporting topic. Any narrative/summary text provided in Section 3
should be brief and not exceed 250 words (2-3 paragraphs). The state should remove the
provided example text from the table and provide a response for each reporting topic.
The narrative information for each reporting topic is organized into two subsections:
− Subsection 1. Metrics trends. The state should discuss any relevant trends that the
data shows related to each milestone or reporting topic, including trends in statespecific metrics. Describe and explain changes (+ or -) greater than two percent. The
state should also describe any changes that are possibly due to the impact of COVID19. The state should insert the metric related to the trend reported in the column
“Related metric(s) (if any).” If the state has not identified any trends in the data, the
state should put an “X” in the “State has no update” column and should not enter any
text in the “State response” column. CMS will continuously review the threshold
(currently +/- 2%) and ensure that it is a helpful threshold for monitoring purposes.
Appendix B contains detailed guidance for calculating the percent change for metrics
trends reporting.
In some instances, the metric specifications for a given metric may have changed
substantially relative to the last time the state reported the metric. Examples of
substantial changes may include the state adding state-specific codes to reflect newly

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covered services,3 or a national measure steward updating the measure rate
calculation for a metric that is an established quality measure. If a metric changed
substantially, the state should describe how the specification change affected the
metrics data relative to the previous report, as well as any anticipated effect on trends
over time.
− Subsection 2. Implementation update. The state should describe concisely but
precisely any changes made in the current reporting period regarding the
demonstration design and operational details since submitting its original
implementation plan, including any changes due to the COVID-19 pandemic. The
state should include within its description the name of the report in which the update
was first reported (DY#Q#). If a state has not made any changes since the last report,
and does not plan to make any changes, or if the implementation prompt does not
apply to the state’s demonstration, the state should put an “X” in the “State has no
update” column, and should not enter any text in the “State response” column.
Grey cells indicate that those cells do not need to be filled out for that row because they
are not applicable.
 Section 4. Narrative information on other reporting topics. The state should report
narrative information in the table on eight other reporting topics: Annual Availability
Assessment, maintenance of effort, financing plan, budget neutrality, demonstration
operations and policy, demonstration evaluation update, other demonstration reporting,
and notable state achievements and/or innovations. Any narrative/summary text provided
in Section 4 should be brief and not exceed 250 words (2-3 paragraphs), with the
exception of the narrative responses for the Annual Availability Assessment. If the state
has no update to report on the requested prompt, the state should put an “X” in the “State
has no trends/update to report” column, and should not enter any text in the “State
response” column in the table indicating that there is no update. For reports that are not
annual monitoring reports, the state should put an “X” in the “State has no trends/update
to report” column for all reporting topics that are only required in annual monitoring
reports.
− Reporting Topic 7. Annual Assessment of the Availability of Mental Health
Services. The state should report on implementation updates related to the Annual
Availability Assessment in each annual monitoring report. The subsection
“Description of changes to baseline conditions and practices” corresponds to the
questions the state provided in its Initial Assessment of the Availability of Mental
Health Services with the exception of topic 7.1.5, which asks the state to describe
whether changes in the availability of mental health services have impacted the state’s
maintenance of effort dollar amount. The subsection “Implementation update”

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If the state plans to make modifications or changes to monitoring metrics, the state should discuss the proposed changes
with the state’s CMS demonstration team. After discussion with CMS, the state should document these changes in its
monitoring protocol and submit to PMDA for reapproval.

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corresponds with the state’s responses related to its Annual Availability Assessment
as part of Milestone 3 of its implementation plan.
− Reporting topic 8. Maintenance of effort (MOE) on funding outpatient
community-based mental health services. The state should report on its MOE as a
dollar amount in each annual monitoring report. The MOE should represent the level
of state appropriations and local funding for outpatient community-based mental
health services for the most recently completed state fiscal year. If the MOE amount
is less than the dollar amount provided in the state’s application materials, the state
should provide an explanation of the change. The state should include in its
explanation confirmation that it did not move resources to increase access to
treatment in inpatient or residential settings at the expense of community-based
services.
− Reporting Topic 9. SMI/SED financing plan. The state should report on efforts to
increase access to mental health providers throughout the state to assess progress on
the financing plan to be implemented by the end of the demonstration. This section
corresponds with “Attachment A: Financing Plan” of the state’s implementation plan.
− Reporting Topic 10. Budget neutrality. The state should provide a detailed
narrative on the current status of budget neutrality and provide an analysis of the
budget neutrality to date.
− Reporting Topic 11. SMI/SED-related demonstration operations and policy.
The state should highlight significant SMI/SED (or if a broader demonstration, then
SMI/SED-related) demonstration operations or policy considerations that could
positively or negatively affect beneficiary enrollment, access to services, timely
provision of services, budget neutrality, or any other provision that has potential for
beneficiary effects. The state should also note any activity that may accelerate or
create delays or impediments in achieving the SMI/SED demonstration’s approved
goals or objectives, if not already reported elsewhere in this document. Such
considerations and activities could include the following, either real or anticipated:


Any changes to SMI/SED populations served, benefits, access, delivery systems,
or eligibility



Legislative activities and state policy changes



Fiscal changes that would result in changes in access, benefits, populations,
enrollment, etc.



Related audit or investigation activity, including findings



Litigation activity



Status and/or timely milestones for health plan contracts



Market changes that may impact Medicaid operations



Any delays or variance with provisions outlined in STCs



Systems issues or challenges that might impact the demonstration [i.e. eligibility
and enrollment (E&E), Medicaid management information systems (MMIS)]
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

Changes in key state personnel or organizational structure



Procurement items that will impact demonstration (i.e. enrollment broker, etc.)



Significant changes in payment rates to providers which will impact
demonstration or significant losses for managed care organizations (MCOs)
under the demonstration



Emergency Situation/Disaster



Other

− Reporting Topic 12. SMI/SED demonstration evaluation update. The state
should report on relevant updates to its SMI/SED demonstration 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 monitoring reports per 42 Code of Federal Regulations (CFR)
431.428, the results/effects of any demonstration programmatic area defined by
CMS that is unique to the demonstration design or evaluation hypothesis

The 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 time
frames 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 its due dates.
− Reporting Topic 13. Other SMI/SED demonstration reporting. The state should
provide a detailed narrative on general SMI/SED reporting requirements not captured
under other reporting topics and any post-award public forums. For annual
monitoring reports, the state should:


Include updates on the results of beneficiary satisfaction surveys, if conducted
during the reporting year, including grievances and appeals from beneficiaries,
per 42 CFR 431.428(a)5; and



Provide an update on the annual post-award public forum, including all public
comments received regarding the progress of the demonstration project, per 42
CFR 431.428(a)11.

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− Reporting Topic 14. Notable state achievements and/or innovations. The state
should provide a detailed narrative on notable state achievements and/or innovations.
2c) Complete Part C: Budget Neutrality Workbook. The budget neutrality reporting topic
incorporates a Budget Neutrality Workbook for the demonstration. This Budget Neutrality
Workbook should be submitted as a separate deliverable as part of each monitoring report.
3. Submit Parts A, B, and C according to the instructions.
3a) The state should name the files according to the following convention:
StateAbbreviation_SMI-DY#Q#_Report_PartofReport_DateofSubmission, where:
 State abbreviation is the two-letter abbreviation for the state name
 DY#Q# is written with the number of the demonstration year and quarter of the reporting
period, no spaces
 Part of report refers to Part A, B or C, written as “Part-[A, B, or C]”
 Date of submission is the date the report is submitted to PMDA in yyyymmdd format
For example, a monitoring report submitted by a state with a standalone SMI/SED
demonstration on May 29, 2020 for SMI/SED DY1Q1 would be comprised of three files
named: XX_SMI-DY1Q1_Report_Part-A_20200529, XX_SMI-DY1Q1_Report_PartB_20200529, and XX_SMI-DY1Q1_ Report_Part-C_20200529 where XX stands for the
state’s 2-letter abbreviation.
If the state’s section 1115 SMI/SED demonstration is part of a broader demonstration, the
state should use the DY and Q of the broader demonstration and replace “SMI” with “1115”
(i.e., XX_1115-DY1Q1_Report_Part-A_20200529, XX_1115-DY1Q1_Report_PartB_20200529, and XX_1115-DY1Q1_ Report_Part-C_20200529. If a file is named with a
Q4 it is understood to be the state’s annual monitoring report.
If the state needs to resubmit Parts A, B, or C after making changes or revisions, the state
should use the same naming convention guidance, but insert “Revised” in front of the file
name. For example, if a state resubmits Part A for its SMI/SED DY1Q1 report on June 2,
2020, the file name would be: Revised_XX_SMI-DY1Q1_Report_Part-A_20200602.
3b) After naming the files using the naming convention above, the state should upload Parts A,
B, and C to PMDA for CMS to review through its state demonstration dashboard. This
dashboard will list all section 1115 demonstrations associated with the state. The state can
upload Parts A, B, and C by navigating to the appropriate demonstration name (name of the
state’s stand-alone SMI/SED demonstration or broader demonstration with an SMI/SED
component) and in the “Actions” column, select “Deliverables” and click “Go” to get to its
“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 appropriate
deliverable (i.e., the corresponding quarterly/annual monitoring report) and click
“Upload/View Docs” under the “Actions” column. Any file named with a Q4 should be
submitted to the “Annual report” deliverable. The state will be able to upload Parts A, B,

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and C. The state should submit revised monitoring reports to the same deliverable as the
original submission. The state should make sure to mark the “Ready for CMS Review”
button in the “Submission Confirmation” section of the “Add a New State File” page and
click the “Update Status” button to complete its submission. For further guidance on
monitoring report submission, the state should review the PMDA state user manual. This
manual can be accessed by clicking the “FAQ” button at the bottom of the state’s
demonstration dashboard. This will take the state to the “Frequently Asked Questions”
page. From here, the state should click on the “Training and Support Materials” link found
on the top right of the page which will take the state to the “Training and Support
Materials” page. This page contains the PMDA state user manual as well as other resources
such as tutorial videos.
B. Instructions for completing a retrospective monitoring report
If the monitoring protocol is approved after one or more of a state’s quarterly monitoring report
submission due date(s), the state will need to report metrics data to CMS retrospectively for any
prior quarters of section 1115 SMI/SED demonstration implementation that precede the monitoring
protocol approval date.4
The state should compile and submit a separate monitoring report (Parts A and B only) for
retrospective data following the steps below. CMS will provide the state with customized templates
for Part A and B of its retrospective reporting.
1. Use the state’s customized template for Parts A and B. The state should use the CMSprovided customized retrospective template for Parts A and B using guidance in Section A
above.
2. Complete Parts A and B for the retrospective monitoring report:
2a) Complete Part A: Monitoring Report Workbook. Using the guidance in Section A,
the state should complete the “SMI-SED metrics” tab for each quarter of retrospective
data. The customized Part A will include one tab per retrospective quarter named:
DY#Q#SMI-SED metrics, where DY#Q# is written with the number of the SMI/SED
demonstration year and quarter of the retrospective reporting period. Retrospective Part
A will also include one “SMI-SED reporting issues” tab for the entire retrospective
reporting period which the state should complete.

4

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 Part B, 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 protocol
approval.

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Medicaid Section 1115 SMI/SED Demonstrations
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2b) Complete Part B: Monitoring Report Template. Using the guidance in Section A, the
state should complete:
 Section 1. Title page
 Section 2. Executive summary
 Section 3. Narrative information on implementation, by milestone and reporting
topic for the entire retrospective reporting period. In these general summaries, the state
should discuss any relevant trends that the data shows related to each milestone or
reporting topic, including trends in state-specific metrics.
Please note, the state does not need to report on implementation updates in Section 3, or
complete Section 4 (Narrative information on other reporting topics) for retrospective
reports.
3. Submit Parts A and B to PMDA:
3a) The state should name retrospective monitoring reports according to the convention:

StateAbbreviation_ RetroDY#Q#_PartofReport_DateofSubmission, where:
 State abbreviation is the two-letter abbreviation for the state name
 RetroDY#Q# refers to the quarter(s) being reported on retrospectively. If a state is
reporting more than one quarter of retrospective data, it should include the range in the
file name by adding a dash (-) between the quarters (see below for an example).
 Part of report refers to Part A or B, written as “Part-[A or B]”
 Date of submission is the date the report is submitted to PMDA in yyyymmdd format
For example, a retrospective report submitted by a state on May 29, 2020 for retrospective
quarters DY1Q1 – DY1Q3 would be comprised of two files named: XX_RetroDY1Q1Q3_Part-A_20200529, XX_ RetroDY1Q1-Q3_Part-B_20200529, where XX stands for a
state’s 2-letter abbreviation.
3b) The state should submit Parts A and B of the retrospective monitoring report along with the
state’s scheduled monitoring report submission.

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Medicaid Section 1115 SMI/SED Demonstrations
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Table 1. SMI/SED monitoring reporting overview, by milestone or reporting topic

Part A.
Monitoring Report Workbook

#
0.
0.
1.

Milestone or reporting topic
Title page
Executive summary
Ensuring Quality of Care in
Psychiatric Hospitals and
Residential Settings (Milestone 1)

-- SMI-SED metrics tab
 SMI-SED reporting issues tab

2.

Improving Care Coordination and
Transitions to Community-Based
Care (Milestone 2)

 SMI-SED metrics tab
 SMI-SED reporting issues tab

3.

Increasing Access to Continuum of
Care, Including Crisis Stabilization
Services (Milestone 3)

 SMI-SED metrics tab
 SMI-SED reporting issues tab

4.

Earlier Identification and
Engagement in Treatment,
Including Through Increased
Integration (Milestone 4)
SMI/SED health information
technology (health IT)

 SMI-SED metrics tab
 SMI-SED reporting issues tab

6.

Other SMI/SED-related metrics

 SMI-SED metrics tab
 SMI-SED reporting issues tab

7.

Annual Assessment of the
Availability of Mental Health
Services

 Annual Avail Assessment tabc

8.

Maintenance of effort (MOE) on
funding outpatient communitybased mental health services

--

9.

SMI/SED financing plan

--

5.

 SMI-SED metrics tabb
 SMI-SED reporting issues tab b

10. Budget neutrality

--

11. SMI/SED-related demonstration
operations and policy

--

12. SMI/SED demonstration
evaluation update

--

13

Part B.
Monitoring
Report Templatea

Part C.
Budget
Neutrality
Workbook

Section 1
Section 2
Section 3:
 Metrics trends
 Implementation update
Section 3:
 Metrics trends
 Implementation update
Section 3:
 Metrics trends
 Implementation update
Section 3:
 Metrics trends
 Implementation update

----

Section 3:
 Metrics trends
 Implementation update
Section 3:
 Metrics trends
 Implementation update
Section 4:
 Description of changes to
baseline conditions and
practices
 Implementation update
Section 4:
 MOE dollar amount
 Narrative information
Section 4:
 Implementation update
Section 4:
 Current status and analysis
 Implementation update
Section 4:
 SMI/SED-related
demonstrations operations
and policy
 Implementation update
Section 4:
 SMI/SED demonstration
evaluation update

--

--

--

--

--

--

--

-Submit
completed
workbook
--

--

Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0

#
Milestone or reporting topic
13. Other demonstration reporting

14. Notable state achievements and/or
innovations

Part A.
Monitoring Report Workbook
--

--

a

Part B.
Monitoring
Report Templatea
Section 4:
 General reporting
requirements
 Post-award public forum
Section 4:
 Notable state
achievements and/or
innovations

Part C.
Budget
Neutrality
Workbook
--

--

See detailed instructions for guidance on narrative reporting, which varies by milestone or reporting topic.
There are no CMS-provided metrics for the health IT topic; the state must identify relevant health IT metrics according to
the guidance provided in the SMI/SED Monitoring Protocol Instructions.
c
The state is required to complete only the “Annual Avail Assessment” tab for annual monitoring reports.
b

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0

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

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0
This appendix provides reporting guidance applicable to section 1115 SMI/SED demonstration
monitoring metrics and other monitoring information. See Chapter 1 Section B of the technical
specifications manual for additional guidance.
The state should report data to CMS in accordance with the schedule and format agreed upon in its
approved monitoring protocol. Because of the dynamic nature of Medicaid data, metrics should be
produced at the same time in each measurement period throughout the SMI/SED demonstration. 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:
− For a state with an SMI/SED demonstration year that ends January 31 or February 28: in the first
quarterly monitoring report of the next SMI/SED demonstration year
− For a state with an SMI/SED demonstration year that ends March 31 through November 30: in
the annual monitoring report
− For a state with an SMI/SED demonstration year that ends December 31: in the second quarterly
monitoring report of the next SMI/SED demonstration year



All other annual metrics should be reported for the past demonstration year in the first quarterly
monitoring report of the next 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.



Each annual monitoring report should include the state’s Annual Assessment of the Availability of
Mental Health Services.

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

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0
Table A.1. Reporting in quarterly and annual section 1115 SMI/SED monitoring reports

Report name:

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

DY1Q1
report

DY1Q2
report

DY1Q3
report

DY1Q4
(annual)
report**

DY2Q1
report

DY2Q2
report

Due 60
days after
quarter
ends

Due 60
days after
quarter
ends

Due 60
days after
quarter
ends

Due 90 days
after quarter
ends

Due 60
days after
quarter
ends

Due 60 days
after quarter
ends

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

DY2Q2

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

DY2Q2

n.a.

DY1Q1

DY1Q2

DY1Q3

DY1Q4

DY2Q1

A state with
a DY
ending 3/31
– 11/30:
CY1
n.a.

A state with
a DY
ending on
1/31 or
2/28: CY1
DY1

Annual metrics that are
established quality
measures*

n.a.

n.a.

n.a.

Other annual metrics

n.a.

n.a.

n.a.

A state with
a DY ending
on 12/31:
CY1
n.a.

Note: The state is expected to submit retrospective data in the second monitoring report submission after monitoring
protocol approval.
* Metrics that are established quality measures should be calculated for the calendar year, except for Metric #6 which is
calculated over a 2-year period. All other metrics should be calculated for the SMI/SED demonstration year.
**Per the STCs, the state’s fourth quarterly monitoring report (Q4) is also considered to be its annual monitoring report for
the previous demonstration year. If the state’s SMI/SED 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 the monitoring report).

Technical Assistance. To help states collect, report, and use the section 1115 SMI/SED demonstration
monitoring metrics, CMS offers technical assistance. For technical assistance, contact the section 1115
SMI/SED demonstration monitoring and evaluation mailbox
([email protected]), copying the CMS demonstration team on the message.

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0

APPENDIX B:
CALCULATING PERCENT CHANGE FOR MEDICAID SECTION 1115 SMI/SED
DEMONSTRATION MONITORING METRICS

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Medicaid Section 1115 SMI/SED Demonstrations
Monitoring Report Instructions Version 2.0
The Monitoring Report Instructions direct the state to report on metric trends in Part B of its reports,
including all changes (+ or -) greater than 2%, within each milestone and reporting topic. Tables B.1
and B.2 below provide examples of how to calculate the percent change based on the data reported in
the “SMI-SED metrics” tab of Part A for three metrics. This guidance also applies to state-specific
metrics.
For monthly metrics, including state-specific metrics, the state should first calculate an average monthly
value for the current quarter and an average monthly value for the prior quarter. To determine the
“percent change”, calculate the difference between the metric’s current quarter average value and the
prior quarter average value. Table B.1 illustrates the percentage calculation for a monthly measure,
using Metric #21 “Count of beneficiaries with SMI/SED (monthly)” as an example. The row below the
monthly counts in this table is the average count for the quarter ((A+B+C)/3). The difference between
the average count for quarter 1 (column D) and quarter 2 (column E) is reported in column F, “Count
change” (E - D). Column G, “Percent change”, shows as the difference between the value in the “Count
change” and the average count for quarter 1 (F/D) as a percentage.
Table B.1. Example calculation of percent change for monthly measure
Quarter 1

Metric

Numerator
or count
Denominator
(D)

Quarter 2

Rate/%

Denominator

Numerator
or count
(E)

Rate/ %

Count
change
(F)

Percent
change
(G)

98

1.4%

#21: Count of beneficiaries with SMI/SED (monthly)
Month 1=A

7,000

7,120

Month 2=B

7,035

7,155

Month 3=C

7,120

7,175

Average

7,052

7,150

% = Percentage
*Grey shaded cells represent cells that are greyed out within the Monitoring Report Workbook.
**Yellow shaded cells represent cells that are not a part of the Monitoring Report Workbook and to highlight how to
calculate count and percentage changes.

For quarterly and annual metrics, including state-specific metrics, “percent change” refers to the percent
difference in the metric value between the current and prior quarters or years, respectively. Table B.2
provides two examples of annual metrics, which are expressed as counts or percentages. In this table,
column G reports the difference between metric counts for year 1 and 2 (E-B), or the difference between
the metric rates for year 1 and 2 (F - C). Column H, “Percent change” reports the difference between the
value in the “Count change” column divided by the values for year 1 (G/B for counts and G/C for rates).

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Medicaid Section 1115 SMI/SED Demonstrations
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Table B.2. Example calculation of percent change for annual measure

Metric

Denominator
(A)

Year 1
Numerator
or count
(B)

Rate/%
(C=B/A)

Denominator
(D)

Year 2
Numerator
or count
(E)

Rate/%
(F=E/D)

Count
Change
(G)

Percent
change
(H)

1,170

5.8%

5.1%

13.8%

#20: Beneficiaries with SMI/SED treated in an IMD for mental health
Year

20,100

21,270

#28: Alcohol Screening and Follow-up for People with SMI
Year

7,052

2,600

36.9%

7,150

3,000

42.0%

% = Percentage
*Grey shaded cells represent cells that are greyed out within the Monitoring Report Workbook.
**Yellow shaded cells represent cells that are not a part of the Monitoring Report Workbook and to highlight how to
calculate count and percentage changes.

20