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TEAMKY Demonstration

Approval Period: January 1, 2025 through December 31, 2029

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76. Demonstration Years. Demonstration Years (DY) for this demonstration are defined in the table below.

Table 5: Demonstration Years

Demonstration Year 9 January 1, 2025 to September 30, 2025 9 months Demonstration Year 10 October 1, 2025 to September 30, 2026 12 months Demonstration Year 11 October 1, 2026 to September 30, 2027 12 months Demonstration Year 12 October 1, 2027 to September 30, 2028 12 months Demonstration Year 13 October 1, 2028 to September 30, 2029 12 months Demonstration Year 14 October 1, 2029 to December 31, 2029 3 months

77. Budget Neutrality Monitoring Tool. The state must provide CMS with quarterly budget neutrality status updates, including established baseline and member months data, using the Budget Neutrality Monitoring Tool provided through the performance metrics database and analytics (PMDA) system. The tool incorporates the “Schedule C Report” for comparing the demonstration’s actual expenditures to the budget neutrality expenditure limits described in STC XI. CMS will provide technical assistance, upon request.3

78. Claiming Period. The state will report all claims for expenditures subject to the budget neutrality agreement (including any cost settlements) within two years after the calendar quarter in which the state made the expenditures. All claims for services during the demonstration period (including any cost settlements) must be made within two years after the conclusion or termination of the demonstration. During the latter two-year period, the state will continue to identify separately net expenditures related to dates of service during the operation of the demonstration on the CMS-64 waiver forms in order to properly account for these expenditures in determining budget neutrality.

3 Per 42 CFR 431.420(a)(2), states must comply with the terms and conditions of the agreement between the Secretary (or designee) and the state to implement a demonstration project, and 431.420(b)(1) states that the terms and conditions will provide that the state will perform periodic reviews of the implementation of the demonstration. CMS’s current approach is to include language in STCs requiring, as a condition of demonstration approval, that states provide, as part of their periodic reviews, regular reports of the actual costs which are subject to the budget neutrality limit. CMS has obtained Office of Management and Budget (OMB) approval of the monitoring tool under the Paperwork Reduction Act (OMB Control No. 0938 – 1148) and states agree to use the tool as a condition of demonstration approval. to budget neutrality