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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 25 of 61 expenditures related to dates of service during the operation of the demonstration.

47. Standard CHIP Funding Process. The standard CHIP funding process will continue to be used during the demonstration. Virginia will continue to estimate matchable CHIP expenditures on the quarterly Form CMS-21B. On a separate CMS-21B, the Commonwealth shall provide updated estimates of expenditures for the demonstration populations. CMS will make federal funds available based upon the Commonwealth’s estimate, as approved by CMS. Within 30 days after the end of each quarter, the Commonwealth must submit the Form CMS-21 quarterly CHIP expenditure report. CMS will reconcile expenditures reported on the Form CMS-21 with federal funding previously made available to the Commonwealth, and include the reconciling adjustment in the finalization of the grant award to the Commonwealth.

48. Title XXI Administrative Costs. Administrative costs will not be included in the allotment neutrality limit, but the Commonwealth must separately track and report additional administrative costs that are directly attributable to the demonstration, using Forms CMS- 64.10 Waiver and/or 64.10P Waiver, with waiver name “ADM”.

49. Limit on Title XXI Funding. Virginia will be subject to a limit on the amount of federal title XXI funding that the Commonwealth may receive on current eligible CHIP state plan populations and the demonstration populations described in STC 17 during the demonstration period. Federal title XXI funds for the Commonwealth's CHIP program (i.e., the approved title XXI state plan and this demonstration) are restricted to the Commonwealth's available allotment and reallocated funds. Title XXI funds (i.e., the allotment or reallocated funds) must first be used to fully fund costs associated with CHIP state plan populations. Demonstration expenditures are limited to remaining funds.

50. Exhaustion of Title XXI Funds. If the Commonwealth exhausts the available title XXI federal funds in a federal fiscal year during the period of the demonstration, the Commonwealth must continue to provide coverage to the approved title XXI state plan separate child health program population and the demonstration populations described in STC 17 with Commonwealth funds.

XIII. MONITORING BUDGET NEUTRALITY

51. Expenditures Subject to the Budget Neutrality Agreement. For the purpose of this section, the term “expenditures subject to the budget neutrality limit” will include all medical assistance expenditures made on behalf of Medicaid pregnant and postpartum individuals enrolled in the 12-month postpartum extension component of the demonstration.

52. Title XIX Administrative Costs. Administrative costs will not be included in the budget neutrality limit, but the Commonwealth must separately track and report additional administrative costs that are directly attributable to the demonstration, using separate CMS- 64.10 waiver and 64.10 waiver forms, with waiver name “ADM”.

53. Calculation of the Budget Neutrality Limit and How It Is Applied. For the purpose of