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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 2 of 51

CENTERS FOR MEDICARE & MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS

NUMBER: 11-W-00297/3

TITLE: Building and Transforming Coverage, Services, and Supports for a Healthier Virginia Section 1115(a) Demonstration

AWARDEE: Virginia DMAS

I. PREFACE The following are the Special Terms and Conditions (STC) for the “Building and Transforming Coverage, Services, and Supports for a Healthier Virginia” (BTCSSHV) section 1115(a) Medicaid demonstration (hereinafter “demonstration”), to enable the Commonwealth of Virginia DMAS (referred to herein as the “state”) to operate this demonstration. The Centers for Medicare & Medicaid Services (CMS) has granted expenditure authorities authorizing federal matching of demonstration costs not otherwise matchable, which are separately enumerated. These STCs set forth conditions and limitations on those expenditure authorities, and describe in detail the nature, character, and extent of federal involvement in the demonstration and the state’s obligations to CMS related to the demonstration. These STCs neither grant additional expenditure authorities, nor expand upon those separately granted. The STCs related to the programs for those populations affected by the demonstration are effective from August 1, 2026, through December 31, 2031, unless otherwise specified.

The STCs have been arranged into the following subject areas:

I. Preface II. Program Description and Objectives III. General Program Requirements IV. Eligibility and Enrollment V. Substance Use Disorder (SUD) Program and Benefits VI. Serious Mental Illness (SMI)/Serious Emotional Disturbance (SED) Program and Benefits VII. Cost Sharing VIII. Delivery System IX. Monitoring and Reporting Requirement X. General Financial Requirements XI. Monitoring Budget Neutrality for the Demonstration XII. Evaluation of the Demonstration XIII. Schedule of Deliverables for the Demonstration Period