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2 Demonstration Approval: November 1, 2023, through October 31, 2028 CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS

NUMBER: 11-W-00319/8

TITLE:

South Dakota Former Foster Care Youth

AWARDEE: South Dakota Department of Social Services

I. PREFACE

The following are the Special Terms and Conditions (STCs) for the South Dakota Former Foster Care Youth section 1115(a) Medicaid demonstration (hereinafter referred to as “demonstration”). The parties to this agreement are the South Dakota Department of Social Services (“South Dakota” or "the state") and the Centers for Medicare & Medicaid Services (CMS). The STCs set forth in detail the nature, character, and extent of federal involvement in the demonstration and South Dakota's obligations to CMS during the life of the demonstration. The STCs are effective November 1, 2023 through October 31, 2028.

The STCs have been arranged into the following subject areas:

I. Preface II. Program Description and Objectives III. General Program Requirements IV. Eligibility and Benefits V. General Monitoring and Reporting Requirements VI. Monitoring Budget Neutrality for the Demonstration VII. General Financial Requirements VIII. Evaluation of the Demonstration IX. Schedule of Deliverables

Attachment A: Developing the Evaluation Design

Attachment B: Preparing the Interim and Summative Evaluation Reports Attachment C: Approved Evaluation Design (reserved)