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Page 2 – Steve Ford States are responsible for following all applicable federal law and regulations when they claim and use federal Medicaid funds and must fully comply with all applicable Medicaid statutes and regulations under a section 1115 demonstration, except where specific provisions have been expressly waived or identified as not applicable for that demonstration. This obligation includes all requirements in Title XIX of the Social Security Act and implementing regulations governing provider screening and enrollment activities, pre- and post-payment review claiming, payment methodologies and rate-setting, utilization controls, and program integrity including processes to identify, investigate, and refer suspected fraud, and methods to receive complaints and identify questionable practices. States must maintain effective systems and safeguards to prevent, detect, and address any fraud, waste, or abuse (FWA) in the delivery of and payment for Medicaid services, including referrals to law enforcement when appropriate. States should have heightened monitoring and oversight mechanisms in place featuring robust internal controls to identify and remediate all vulnerabilities (including, but not limited to, FWA and beneficiary access issues) inherent in service areas approved as part of a demonstration. At any time, CMS may request that the state provide a plan detailing the state’s systems and safeguards to prevent, detect, and address any FWA relative to this demonstration. Failure to meet program integrity obligations under federal statutes and regulations or under the terms and conditions of this demonstration approval may result in compliance actions or other enforcement measures that could include requirements to develop and implement corrective action plans, withholdings, deferrals, disallowances, and termination of demonstration authority. Extent and Scope of Demonstration Renewal and Amendment With this renewal approval, under the demonstration, Virginia will continue to provide authority for SUD treatment services to individuals who are short-term residents in residential treatment facilities that meet the definition of an IMD and extend eligibility for Medicaid benefits for out of state former foster care youth (FFCY) who are under age 26, who turned age 18 on or before December 31, 2022, who aged out of foster care under the responsibility of another state or tribe and were enrolled in Medicaid while in foster care, currently reside in Virginia, and are not otherwise eligible for Medicaid. Section 1002(a) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act, Pub L. No. 115-271), created a new Former Foster Care Children (FFCC) Medicaid state plan eligibility group, providing coverage for individuals who were receiving Medicaid while in foster care under the responsibility of any state; however, the new requirements apply exclusively to those who turn 18 on or after January 1, 2023. As a result, Virginia will still need section 1115 demonstration authority to continue coverage for individuals who turned 18 years old before January 1, 2023. Additionally, this approval will sunset the expenditure authority for the High Needs Supports component of the demonstration that was not implemented. This approval will amend the demonstration to add the SMI demonstration initiative, to allow Virginia to receive federal financial participation (FFP) for services furnished to Medicaid beneficiaries during short term stays for acute care in psychiatric hospitals or residential treatment facilities that qualify as IMDs. The SMI component of the amendment will expand the settings which are eligible for reimbursement for clinically appropriate short term stays for acute