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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 15 of 61 24. Demonstration Delivery System. The demonstration delivery system varies by population as described below:

a. FAMIS MOMS and Postpartum Extension - Health care services are delivered primarily through one of the Managed Care Organizations (MCOs) contracted by DMAS to provide Medicaid and FAMIS (CHIP) benefits. Initially, benefits are provided on a fee-for-service basis until the pregnant individual is enrolled in an MCO. Dental services are provided by the contracted Smiles for Children service provider.

b. FAMIS Select Premium Assistance. For families who select premium assistance, health care services are delivered through the private or employer- sponsored plan of choice.

VIII. GENERAL REPORTING REQUIREMENTS

25. Deferral for Failure to Submit Timely Demonstration Deliverables. CMS may issue deferrals in accordance with 42 CFR part 430 subpart C, in an amount up to $1,000,000 per deliverable (federal share) when items required by these STCs (e.g., required data elements, analyses, reports, design documents, presentations, and other items specified in these STCs) (hereafter singly or collectively referred to as “deliverable(s)”) are not submitted timely to CMS or are found to not be consistent with the requirements approved by CMS. A deferral shall not exceed the value of the federal amount for the current demonstration period. The Commonwealth does not relinquish its rights provided under 42 CFR part 430 subpart C to challenge any CMS finding that the state materially failed to comply with the terms of this agreement.

The following process will be used: 1) Thirty days after the deliverable was due if the state has not submitted a written request to CMS for approval of an extension as described in subsection (b) below; or 2) Thirty days after CMS has notified the Commonwealth in writing that the deliverable was not accepted for being insufficient, or inconsistent with the requirements of this agreement and the information needed to bring the deliverable into alignment with CMS requirements:

a. CMS will issue a written notification to the state providing advance notification of a pending deferral for late or non-compliant submissions of required deliverable(s).

b. For each deliverable, the Commonwealth may submit to CMS a written request for an extension to submit the required deliverable that includes a supporting rationale for the cause(s) of the delay and the Commonwealth’s anticipated date of submission. Should CMS agree to the Commonwealth’s request, a corresponding extension of the deferral process can be provided. CMS may agree to a corrective action plan submitted by the Commonwealth as an interim step before applying the deferral, if the Commonwealth proposes a corrective action plan in the state’s written extension request.