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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 17 of 61 framework provided by CMS, which is subject to change as monitoring systems are developed/evolve, and must be provided in a structured manner that supports federal tracking and analysis.

a. Operational Updates. The operational updates will focus on progress toward meeting the demonstration’s milestones. Additionally, per 42 CFR 431.428, the Monitoring Reports must document any policy or administrative difficulties in operating the demonstration. The reports shall provide sufficient information to document key challenges, underlying causes of challenges, how challenges are being addressed, as well as key achievements and to what conditions and efforts successes can be attributed. The discussion should also include any issues or complaints identified by beneficiaries; lawsuits or legal actions; unusual or unanticipated trends; legislative updates; and descriptions of any public forums held. The Monitoring Report should also include a summary of all public comments received through post-award public forums conducted in accordance with required by 42 CFR 431.420(c) regarding the progress of the demonstration.

b. Performance Metrics. The performance metrics will provide data to demonstrate how the Commonwealth is progressing towards meeting the demonstration’s goals, and must cover all key policies under this demonstration. Additionally, per 42 CFR 431.428, the Monitoring Reports must document the impact of the demonstration in providing insurance coverage to beneficiaries and the uninsured population, as well as outcomes of care, quality and cost of care, and access to care. This may also include the results of beneficiary satisfaction surveys, if conducted, and any grievances and appeals. The requiring monitoring and performance metrics must be included in writing in the Monitoring Reports, and will follow the framework provided by CMS to support federal tracking and analysis.

c. Budget and Allotment Neutrality and Financial Reporting Requirements. Per 42 CFR 431.428, the Monitoring Reports must document the financial performance of the demonstration. The Commonwealth must provide an updated budget and allotment neutrality workbook with every Monitoring Report that meets all the reporting requirements for monitoring allotment neutrality set forth in the General Financial Requirements section of these STCs, including the submission of corrected budget and allotment neutrality data upon request. In addition, the Commonwealth must report quarterly expenditures associated with the populations affected by this demonstration on the appropriate Form CMS 64.9 or CMS-21. No later than six months after the end of each demonstration year, or as soon thereafter as data are available, the Commonwealth will calculate and report to CMS annual demonstration expenditures for the completed year. Administrative costs should be reported separately.

d. Evaluation Activities and Interim Findings. Per 42 CFR 431.428, the Monitoring Reports must document any results of the demonstration to date per the evaluation hypotheses. Additionally, the Commonwealth shall include a summary of the progress of evaluation activities, including rapid cycle evaluation assessments, key milestones accomplished, and any challenges encountered and how they were addressed.