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expenditure Refer to 64.9 s for STC 21 for | Category services unallowabl of provided to e Service Date of an expenditure | Definitio | Service individual s ms while they are a patient in an IMD for SUD treatment. Report all medical assistance expenditure Follow s for Refer to ees . CMS services STC 28 for rovided to | unallowabl ed SMI/SED La Category | Dateof | MAP Y 08/01/26 | 12/31/31 _ an c of Service individual | expenditure | oi, while they s Deine are a patient ns in an IMD for SMI/SED. Report all Follow additional standard administrativ CMS e costs that 64.10 are directly Category attributable of to the Service Date of ADM demonstratio Definitio ADM N 12/15/16 | 12/31/31 n and are not ns payee described elsewhere and are not subject to budget neutrality

ADM - administration: DY — demonstration year; MAP — medical assistance payments; MEG — Medicaid expenditure group;

52. Demonstration Years. Demonstration Years (DY) for this demonstration are defined in the Demonstration Years table below.

Building and Transforming Coverage, Services and Supports for a Healthier Virginia Approval Period: August 1, 2026 through December 31, 2031 Page 35 of 51