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Building and Transforming Coverage, Services and Supports for a Healthier Virginia Approval Period: August 1, 2026 through December 31, 2031 Page 16 of 51

3. States should review the ASTP/ONC’s Interoperability Standards Advisory (https://www.healthit.gov/isa/) for information on additional non-proprietary standards and implementation specifications developed by consensus-based standards development organizations not included in 45 CFR part 170, Subpart B that can support health IT investments. 21. Unallowable Expenditures Under the SUD Expenditure Authority. The state may not receive FFP for room and board costs for residential treatment service providers unless they qualify as inpatient facilities under section 1905(a) of the Act.

VI. SERIOUS MENTAL ILLNESS (SMI)/SERIOUS EMOTIONAL DISTURBANCE (SED) PROGRAM AND BENEFITS 22. SMI/SED Program Benefits. Under this demonstration, beneficiaries will have access to the full range of otherwise covered Medicaid services, including SMI/SED treatment services provided in residential and inpatient treatment settings that qualify as an IMD, which are not otherwise matchable expenditures under section 1903 of the Act. These SMI/SED services will range in intensity from short-term acute care in inpatient settings for SMI/SED, to ongoing chronic care for such conditions in cost-effective community- based settings. The state will work to improve care coordination and care for co-occurring physical and behavioral health conditions. The state must achieve a statewide average length of stay of no more than 30 days for beneficiaries receiving treatment in an IMD treatment setting through this demonstration’s SMI/SED Program, to be monitored pursuant to STC 35. 23. SMI/SED Implementation Plan. a. The state must submit the SMI/SED Implementation Plan within 90 calendar days after approval of the demonstration for CMS review and comment. If applicable, the state must submit a revised SMI/SED Implementation Plan within 60 calendar days after receipt of CMS’s comments. The state may not claim FFP for services provided to beneficiaries residing in IMDs primarily to receive treatment for SMI/SED under expenditure authority until CMS has approved the SMI/SED Implementation Plan and the SMI/SED financing plan described in STCs 23(d). After approval of the required Implementation Plan and Financing Plan, FFP will be available prospectively, but not retrospectively. b. Once approved, the SMI/SED Implementation Plan will be incorporated into the STCs as Attachment C, and once incorporated, may be altered only with CMS approval. Failure to submit an SMI Implementation Plan, within 90 calendar days after approval of the demonstration, will be considered a material failure to comply with the terms of the demonstration project as described in 42 CFR 431.420(d) and, as such, would be grounds for termination or suspension of the SMI program under this demonstration. Failure to progress in meeting the milestone goals agreed upon by the state and CMS will result in a funding deferral as described in STC 32.