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Wisconsin BadgerCare Reform Approval Period: October 29, 2024 through December 31, 2029 Page 15 b. As provided under 42 CFR 447.54, the amount of this co-pay will be $8 for each non- emergent use of the emergency department. c. The individual must receive an appropriate medical screening examination under section 1867—the Emergency Medical Treatment and Labor Act, or EMTALA provision of the Act. d. Providers cannot refuse treatment for nonpayment of the co-payment. e. AI/AN who are currently receiving or who have ever received an item or services furnished by an Indian health care provider or through referral under contract health services are exempt from the copayment requirements outlined above, consistent with section 1916(j) of the Act and 42 CFR 447.56.

7. DELIVERY SYSTEM

7.1. General. Demonstration Population 1 will be enrolled in managed care organizations (MCO) that are currently contracted to provide health care services to the state’s existing Medicaid and BadgerCare programs. As a condition of eligibility, demonstration enrollees will be required to join a MCO, as long as there is at least two MCOs available in their county of residence unless the rural exception is met in accordance with 42 CFR 438.52.(b). If the county has not been granted a rural exception, the state must offer the option of either MCO enrollment or Medicaid fee-for-service. All demonstration eligible beneficiaries must be provided a Medicaid card, regardless of MCO enrollment. MCOs may elect to provide a MCO specific card to MCO enrollees as well. The state must comply with the managed care regulations published at 42 CFR part 438. Capitation rates shall be developed and certified as actuarially sound, in accordance with 42 CFR 438.4, 438.5 and 438.7. No FFP is available for activities covered under contracts and/or modifications to existing contracts that are subject to 42 CFR part 438 requirements prior to CMS approval of this demonstration authority as well as such contracts and/or contract amendments. The state shall submit any supporting documentation deemed necessary by CMS. The state must provide CMS with a minimum of sixty (60) days to review and approve changes. CMS reserves the right, as a corrective action, to withhold FFP (either partial or full) for the demonstration, until the contract compliance requirement is met.

8. MONITORTING AND REPORTING REQUIREMENTS

8.1. Deferral for Failure to Submit Timely Demonstration Deliverables. CMS may issue deferrals in the amount of $5,000,000 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 singularly or collectively referred to as “deliverable(s)”) are not submitted timely to CMS or found to not be consistent with the requirements approved by CMS. The state 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. Specifically: a. The following process will be used: 1) thirty (30) calendar 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 (8.1.3) below; or 2) thirty (30) calendar days after CMS has notified the state in writing that the deliverable was not accepted for being inconsistent with the requirements of this agreement and the information