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incurred in the demonstration year for determination of the state's compliance with the budget neutrality limits.

Pharmacy Rebates. Because pharmacy rebates are not included in the base

expenditures used to determine the budget neutrality expenditure limit, pharmacy

rebates are not included for calculating net expenditures subject to budget neutrality.

The state will report pharmacy rebates on form CMS-64.9 BASE, and not allocate

them to any form 64.9 or 64.9P WAIVER.

. Administrative Costs. The state will separately track and report additional

administrative costs that are directly attributable to the demonstration. All

administrative costs must be identified on the forms CMS-64.10 WAIVER and/or

64.10P WAIVER. Unless indicated otherwise on the MEG Charts and in the STCS in section XI, administrative costs are not counted in the budget neutrality tests; however, these costs are subject to monitoring by CMS.

Member Months. Using the Budget Neutrality Monitoring Tool, the state must

report the actual number of “eligible member months” for all demonstration enrollees for all MEGs identified as WOW Per Capita in the Master MEG Chart

table above, and as also indicated in the MEG Detail for Expenditure and Member

Month Reporting table below. The term “eligible member months” refers to the number of months in which persons enrolled in the demonstration are eligible to receive services. For example, a person who is eligible for three months contributes three eligible member months to the total. Two individuals who are eligible for two months, each contribute two eligible member months, for a total of four eligible member months. The state must submit a statement accompanying the annual report certifying the accuracy of this information.

Budget Neutrality Specifications Manual. The state will create and maintain a Budget Neutrality Specifications Manual that describes in detail how the state will

compile data on actual expenditures related to budget neutrality, including methods used to extract and compile data from the state’s Medicaid Management Information

System, eligibility system, and accounting systems for reporting on the CMS-64, consistent with the terms of the demonstration. The Budget Neutrality

Specifications Manual will also describe how the state compiles counts of Medicaid member months. The Budget Neutrality Specifications Manual must be made available to CMS on request.

Table 3. MEG Detail for Expenditure and Member Month Reporting

How MEG ; CMS- | Expena. | Map | RePort | ec | MEG . Detailed : 64.9 Member (Waiver eae Exclusions : Are or Start End Description Line(s) : Months Name) To Use Assigned | ADM (v/N) Date Date to DY Report all Follow SUD medical standard MAP Y 12/15/16 | 12/31/31 assistance CMS Building and Transforming Coverage, Services and Supports for a Healthier Virginia Approval Period: August 1, 2026 through December 31, 2031 Page 34 of 51