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Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 56 of 90 ADM – administration; DY – demonstration year; MAP – medical assistance payments; MEG – Medicaid expenditure group;

12.18. Demonstration Years. Demonstration Years (DY) for this demonstration are defined in the table below. Table 5: MEG Detail for Expenditure and Member Month Reporting MEG (Waiver Name) Detailed Description Exclusions CMS-64.9 or 64.10 Line(s) To Use How Expend. Are Assigned to DY MAP or ADM Report Member Months (Y/N) MEG Start Date MEG End Date HRSN Services Report all expenditures for approved HRSN initiatives

Follow standard CMS 64.9 or 64.10 Category of Service Definitions Date of service/Date of payment MAP/ ADM N 12/26/24 12/31/29 HRSN Infrastructu re Report all infrastructure expenditures for approved HRSN initiatives

Follow standard CMS 64.10 Category of Service Definitions Date of service/Date of payment ADM N 12/26/24 12/31/29 Reentry Expenditures for reentry services that are otherwise covered under Medicaid provided to qualifying beneficiaries for up to 90 days immediately prior to release from participating facilities. None Follow CMS- 64.9 Based Category of Service Definition Date of service

MAP

Y 12/26/24 12/31/29 Reentry Non- Services Expenditures for allowable planning and non-services for the reentry demonstration initiative. None Follow CMS- 64.10 Base Category of Service Definition Date of payment ADM N 12/26/24 12/31/29