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Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021 Page 5 of 61 3. Changes in Medicaid and CHIP Law, Regulation, and Policy. The Commonwealth must, within the timeframes specified in law, regulation, or policy statement, come into compliance with any changes in federal law, regulation, or policy affecting the Medicaid or CHIP programs that occur during this demonstration approval period, unless the provision being changed is expressly waived or identified as not applicable. In addition, CMS reserves the right to amend the STCs to reflect such changes and/or changes as needed without requiring the state to submit an amendment to the demonstration under STC 7. CMS will notify the state 30 days in advance of the expected approval date of the amended STCs to allow the state to provide comment. Changes will be considered in force upon issuance of the approval letter by CMS. The state must accept the changes in writing.

4. Impact of Changes in Federal Law, Regulation, and Policy on the Demonstration.

a. To the extent that a change in federal law, regulation, or policy requires either a reduction or an increase in federal financial participation (FFP) for expenditures made under this demonstration, the Commonwealth must adopt, subject to CMS approval, a modified budget and/or allotment neutrality agreement for the demonstration as necessary to comply with such change. The modified budget and/or allotment neutrality agreement will be effective upon the implementation of the change. Further, the Commonwealth reserves the right to seek an amendment to the demonstration (as per STC 7) as a result of the change in FFP.

b. If mandated changes in the federal law requires legislation by the Commonwealth, unless otherwise prescribed by the terms of the federal law, the changes must take effect on the day such legislation enacted by the Commonwealth becomes effective, or on the last day such legislation was required to be in effect under federal law, whichever is sooner.

5. State Plan Amendments. The Commonwealth will not be required to submit title XIX or title XXI state plan amendments for changes affecting any populations made eligible solely through the demonstration. If a population eligible through the Medicaid or CHIP state plan is affected by a change to the demonstration, a conforming amendment to the appropriate state plan may be required, except as otherwise noted in these STCs. In all such instances, the Medicaid and CHIP state plans governs.

6. Changes Subject to the Amendment Process. Changes related to demonstration features, such as eligibility, enrollment, enrollee rights, benefits, beneficiary rights, delivery systems, cost-sharing, sources of non-federal share of funding, allotment neutrality, and other comparable program elements must be submitted to CMS as amendments to the demonstration. All amendment requests are subject to approval at the discretion of the Secretary in accordance with section 1115 of the Act. The Commonwealth must not implement or begin operational changes to these elements without prior approval by CMS of the amendment to the demonstration. In certain instances, companion amendments to the Medicaid or CHIP state plan may be required as well. Amendments to the demonstration are not retroactive and no FFP of any kind, including for administrative or service-based