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h. Information on whether the state will be reporting the assessment on the CMS form

64.11A as required under section 1903(w) of the Act.

48. Extent of Federal Financial Participation for the Demonstration. Subject to CMS approval of the source(s) of the non-federal share of funding, CMS will provide FFP at the applicable federal matching rate for the following demonstration expenditures, subject to the budget neutrality expenditure limits described in the STCs in section XI

a. Administrative costs, including those associated with the administration of the demonstration;

Net expenditures and prior period adjustments of the Medicaid program that are paid in accordance with the approved Medicaid state plan; and

Medical assistance expenditures and prior period adjustments made under section 1115 demonstration authority with dates of service during the demonstration extension period; including those made in conjunction with the demonstration, net of enrollment fees, cost sharing, pharmacy rebates, and all other types of third-party

liability.

49. Program Integrity. The state must have processes in place to ensure there is no duplication of federal funding for any aspect of the demonstration. The state must also ensure that the state and any of its contractors follow standard program integrity principles and practices including retention of data. All data, financial reporting, and sources of non-federal share are subject to audit.

50. Medicaid Expenditure Groups (MEG). Medicaid Expenditure Groups (MEG) are defined for the purpose of identifying categories of Medicaid or demonstration expenditures subject to budget neutrality, components of budget neutrality expenditure limit calculations, and other purposes related to monitoring and tracking expenditures under the demonstration. The Master MEG Chart table provides a master list of MEGs

defined for this demonstration.

Table 2. Master MEG Chart To Which wow MEG BN Test Per sah to! ww Brief Description

Does This Capita Aggregate

Apply? P All expenditures for services provided to an individual while they are a

SUD Hypo 1 x = patient in an IMD for SUD

treatment, described in Section V.

Building and Transforming Coverage, Services and Supports for a Healthier Virginia

Approval Period: August 1, 2026 through December 31, 2031

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