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Approval Period: April 1, 2019 through December 31, 2028 Page 19 of 28

46. Enforcement of Budget Neutrality. CMS will enforce budget neutrality over the life of the demonstration, rather than annually. However, no later than 6 months after the end of each DY or as soon thereafter as the data are available, the state will calculate annual expenditure targets for the completed year. This amount will be compared with the actual claimed FFP for Medicaid. Using the schedule below as a guide, if the state exceeds these targets, it will submit a corrective action plan to CMS for approval. The state will subsequently implement the approved corrective action plan.

Year Cumulative Target Expenditures

Percentage DY 8 DY 8 budget limit amount

+2.0 percent DY 9 DYs 8 and 9 combined budget limit amount +1.5 percent DY 10 DYs 8 through 10 combined budget limit amount +1.0 percent DY 11 DYs 8 through 11 combined budget limit amount +0.5 percent DY 12 DYs 8 through 12 combined budget limit amount +0 percent DY 13 DYs 8 through 13 combined budget limit amount +0 percent DY 14 DYs 8 through 14 combined budget limit amount +0 percent DY 15 DYs 8 through 15 combined budget limit amount +0 percent DY 16 DYs 8 through 16 combined budget limit amount +0 percent DY 17 DYs 8 through 17 combined budget limit amount +0 percent

Failure to Meet Budget Neutrality Goals. The state, whenever it determines that the demonstration is not budget neutral or is informed by CMS that the demonstration is not budget neutral, must immediately collaborate with CMS on corrective actions, which must include submitting a corrective action plan to CMS within 21 days of the date the state is informed of the problem. While CMS will pursue corrective actions with the state, CMS will work with the state to set reasonable goals that will ensure that the state is in compliance.

X. EVALUATION

47. Cooperation with Federal Evaluators. As required under 42 CFR §431.420(f), the state shall cooperate fully and timely with CMS and its contractors’ in any federal evaluation of the demonstration or any component of the demonstration. This includes, but is not limited to, commenting on design and other federal evaluation documents and providing data and analytic files to CMS, including entering into a data use agreement that explains how the data and data files will be exchanged, and providing a technical point of contact to support specification of the data and files to be disclosed, as well as relevant data dictionaries and record layouts. The state shall include in its contracts with entities who collect, produce or maintain data and files for the demonstration, that they shall make such data available for the federal evaluation as is required under 42 CFR §431.420(f) to support federal evaluation. The state may claim administrative match for these activities. Failure to comply with this STC may result in a deferral being issued as outlined in STC 24.

48. Draft Evaluation Design. The draft Evaluation Design must be developed in accordance with attachments B of these STCs. The state must submit, for CMS comment and approval,