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outcomes for its beneficiaries. To support the evaluation, the state is required to develop a robust Evaluation Design, including reframing and refocusing as needed the evaluation hypotheses and research questions for policies being extended to account for areas it can reasonably expect continued improvements.

Consideration of Public Comments

The federal comment period for the BTCSSHV demonstration renewal application was open from August 5, 2024, through September 4, 2024, and CMS received two comments that were applicable to the demonstration. Both comments were supportive of Virginia’s demonstration renewal, focusing on the state’s request to maintain coverage for SUD services at facilities classified as an IMD.

The federal comment period for the SMI amendment application was open from January 16, 2025, through February 15, 2025, and CMS received four comments. All four comments were supportive of the state’s request to add the SMI opportunity to the demonstration. One commentor urged the state to incorporate Medicaid coverage of inpatient psychiatric services for individuals under the age of 21 into its SMI program.

CMS has concluded that renewing the BTCSSHV Section 1115(a) demonstration is likely to promote the objectives of Medicaid.