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Medicaid Section 1115 SUD Demonstrations Protocol (Part A) - Planned Subpopulations (Version 7.0) State Wisconsin Demonstration Name BadgerCare Reform blank Table: Substance Use Disorder Demonstration Planned Subpopulations Pla nned subpo pula tio n repo rting Subpopulation category Pla nned subpo pula tio n repo rting Subpopulations Pla nned subpo pula tio n repo rting Reporting priority Pla nned subpo pula tio n repo rting Relevant metrics Pla nned subpo pula tio n repo rting Subpopulation type Pla nned subpo pula tio n repo rting State will report (Y/N) Subpo pula tio ns Attest that planned subpopulation reporting within each category matches the description in the CMS- provided technical specifications manual (Y/N) Subpo pula tio ns If the planned reporting of subpopulations does not match (i.e., column G = “N”), list the subpopulations state plans to report (Format comma separated)a,b,c Relev a nt m etrics Attest that metrics reporting for subpopulation category matches CMS-provided technical specifications manual (Y/N) Relev a nt m etrics If the planned reporting of relevant metrics does not match (i.e., column I = "N"), list the metrics for which state plans to report for each subpopulation category (Format metric number, comma separated) EXAMPLE: Age group (Do not delete or edit this row) EXAMPLE: Children <18, adults 18–64, and older adults 65+ EXAMPLE: Required EXAMPLE: Metrics #1-3, 6-12, 23, 24, 26, 27 EXAMPLE: CMS-provided EXAMPLE: Y EXAMPLE: N EXAMPLE: Children/Young adults 12-21, Adults 21-65 EXAMPLE: N EXAMPLE: 1, 2, 3 Age group Children <18, adults 18–64, and older adults 65+ Required Metrics #1-3, 6-12, 23, 24, 26, 27 CMS-provided Y Y Y Dual–eligible status Dual-eligible (Medicare-Medicaid eligible), Medicaid only Required Metrics #1-3, 6-12 CMS-provided Y Y Y Pregnancy status Pregnant, Not pregnant Required Metrics #1-3, 6-12 CMS-provided Y Y Y Criminal justice status Criminally involved, Not criminally involved Required Metrics #1-3, 6-12 CMS-provided N N 1 - WI Medicaid does not have access and cannot provide subpopulation breakouts by criminal justice status. WI will research the feasibility of obtaining criminal justice status data and report on the feasability in a future report to CMS. 2 - WI will report data for remaining subpopulation categories and determine subpopulation categories based on the beneficiary characteristics as of the last day of the data period. N OUD population Opioid diagnosis Recommended Metrics #2-12, 23, 24, 26, 27, 36 CMS-provided Y Y Y [Insert row(s) for any state-specific subpopulation(s)] b lan k b lan k b lan k b lan k b lan k b lan k b lan k b lan k b lan k b lan k end of worksheet c If the state is planning to phase in the reporting of any of the subpopulation categories, the state should (1) select N in column G and (2) provide an explanation and the a If the state is not reporting a required subpopulation category (i.e., column F = “N”), enter explanation in corresponding row in column H. b If the state is reporting on the Dual-eligible status, Pregnancy status, Criminal justice status, and OUD population subpopulation categories, the state should use column H to outline its subpopulation identification approach as explained in Version 4.0 of the Medicaid Section 1115 Substance Use Disorder Demonstrations Monitoring Protocol Instructions. Planned subpopulation reporting Alignment with CMS-provided technical specifications manual Subpopulations Relevant metrics b lan k