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Demonstration Approval: November 1, 2023, through October 31, 2028 21

successful; or b. Could now be considered standard Medicaid policy (CMS published regulations or guidance). 2. When the demonstration is also considered successful without issues or concerns that would require more regular reporting, such as: a. Operating smoothly without administrative changes; b. No or minimal appeals and grievances; c. No state issues with CMS-64 reporting or budget neutrality; and d. No Corrective Action Plans for the demonstration.

E. Attachments

1. Evaluation Budget. A budget for implementing the evaluation shall be provided with the draft Evaluation Design. It will include the total estimated costs, as well as a breakdown of estimated staff, administrative, and other costs for all aspects of the evaluation. Examples include, but are not limited to: the development of all survey and measurement instruments; quantitative and qualitative data collection; data cleaning and analyses; and reports generation. A justification of the costs may be required by CMS if the estimates provided do not appear to sufficiently cover the costs of the draft Evaluation Design, if CMS finds that the draft Evaluation Design is not sufficiently developed, or if the estimates appear to be excessive.

2. Timeline and Major Milestones. Describe the timeline for conducting the various evaluation activities, including dates for evaluation-related milestones, including those related to procurement of an outside contractor, if applicable, and deliverables. The final Evaluation Design shall incorporate milestones for the development and submission of the Interim and Summative Evaluation Reports. Pursuant to 42 CFR 431.424(c)(v), this timeline should also include the date by which the Final Summative Evaluation Report is due.