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Medicaid Section 1115 SUD Demonstrations Monitoring Protocol (Part A) - Reporting Schedule (Version 7.0) State Wisconsin Demonstration Name BadgerCare Reform blank row Column A Demonstration reporting periods/dates Dates of first SUD demonstration year (SUD DY1) blank Start 01/01/2021 End 12/31/2021 Dates of first quarter of the baseline period for CMS-constructed metrics blank Repo rting DY4Q1 Start 01/01/2024 End 03/31/2024 Broader section 1115 demonstration reporting period corresponding with the first SUD reporting quarter, if applicable. If there is no broader demonstration, fill in the first SUD reporting period. (Format DY#Q#; e g DY3Q1) First SUD monitoring report due date (per STCs) (MM/DD/YYYY) 05/30/2024 First SUD monitoring report in which the state plans to report annual metrics that are established quality measures (EQMs) blank Basel ine CY2021 SUD DY and Q DY2Q2 SUD DY 04/01/2022 SUD DY 06/30/2022 Dates of last SUD reporting quarter: blank Start 10/01/2029 End 12/31/2029 end of table SUD reporting quarter start date (MM/DD/YYYY) SUD reporting quarter end date (MM/DD/YYYY) Monitoring report due (per STCs) (MM/DD/YYYY) Broader section 1115 reporting period, if applicable; else SUD reporting period (Format DY#Q#; e g DY1Q3) SUD reporting period (Format DY#Q#; e g DY1Q3) Reporting category For each reporting category, measurement period for which information is captured in monitoring report per standard reporting schedule (Format DY#Q#; e.g., DY1Q3)b SUD Deviation from standard reporting schedule (Y/N/n a ) Explanation for deviations (if column H="Y") Proposed deviation in measurement period from standard reporting schedule in column G (Format DY#Q#; e g DY1Q3) 01/01/2024 03/31/2024 05/30/2024 DY4Q1 Narrative information DY4Q1 blank blank blank blank blank Grievances and appeals DY4Q1 blank blank blank blank blank Other monthly and quarterly metrics blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 04/01/2024 06/30/2024 08/29/2024 DY4Q2 Narrative information DY4Q2 blank blank blank blank blank Grievances and appeals DY4Q2 blank blank blank blank blank Other monthly and quarterly metrics DY4Q1 Y 6 month claims lag for all planned blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 07/01/2024 09/30/2024 11/29/2024 DY4Q3 Narrative information DY4Q3 blank blank blank blank blank Grievances and appeals DY4Q3 blank blank blank blank blank Other monthly and quarterly metrics DY4Q2 Y 6 month claims lag for all planned DY4Q1 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 10/01/2024 12/31/2024 03/01/2025 DY4Q4 Narrative information DY4Q4 blank blank blank blank blank Grievances and appeals DY4Q4 blank blank blank blank blank Other monthly and quarterly metrics DY4Q3 Y 6 month claims lag for all planned DY4Q2 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 01/01/2025 03/31/2025 05/30/2025 DY5Q1 Narrative information DY5Q1 blank blank blank blank blank Grievances and appeals DY5Q1 blank blank blank blank blank Other monthly and quarterly metrics DY4Q4 Y 6 month claims lag for all planned DY4Q3 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics DY4 Y 6 month claims lag for all planned N/A 04/01/2025 06/30/2025 08/29/2025 DY5Q2 Narrative information DY5Q2 blank blank blank blank blank Grievances and appeals DY5Q2 blank blank blank blank blank Other monthly and quarterly metrics DY5Q1 Y 6 month claims lag for all planned DY4Q4 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics Y 6 month claims lag for all planned DY4 07/01/2025 09/30/2025 11/29/2025 DY5Q3 Narrative information DY5Q3 blank blank blank blank blank Grievances and appeals DY5Q3 blank blank blank blank blank Other monthly and quarterly metrics DY5Q2 Y 6 month claims lag for all planned DY5Q1 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 10/01/2025 12/31/2025 03/01/2026 DY5Q4 Narrative information DY5Q4 blank blank blank blank blank Grievances and appeals DY5Q4 blank blank blank blank blank Other monthly and quarterly metrics DY5Q3 Y 6 month claims lag for all planned DY5Q2 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 01/01/2026 03/31/2026 05/30/2026 DY6Q1 Narrative information DY6Q1 blank blank blank blank blank Grievances and appeals DY6Q1 blank blank blank blank blank Other monthly and quarterly metrics DY5Q4 Y 6 month claims lag for all planned DY5Q3 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics DY5 Y 6 month claims lag for all planned N/A 04/01/2026 06/30/2026 08/29/2026 DY6Q2 Narrative information DY6Q2 blank blank blank blank blank Grievances and appeals DY6Q2 blank blank blank blank blank Other monthly and quarterly metrics DY6Q1 Y 6 month claims lag for all planned DY5Q4 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics Y 6 month claims lag for all planned DY5 07/01/2026 09/30/2026 11/29/2026 DY6Q3 Narrative information DY6Q3 blank blank blank blank blank Grievances and appeals DY6Q3 blank blank blank blank blank Other monthly and quarterly metrics DY6Q2 Y 6 month claims lag for all planned DY6Q1 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 10/01/2026 12/31/2026 03/01/2027 DY6Q4 Narrative information DY6Q4 blank blank blank blank blank Grievances and appeals DY6Q4 blank blank blank blank blank Other monthly and quarterly metrics DY6Q3 Y 6 month claims lag for all planned DY6Q2 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 01/01/2027 03/31/2027 05/30/2027 DY7Q1 Narrative information DY7Q1 blank blank blank blank blank Grievances and appeals DY7Q1 blank blank blank blank blank Other monthly and quarterly metrics DY6Q4 Y 6 month claims lag for all planned DY6Q3 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics DY6 Y 6 month claims lag for all planned N/A 04/01/2027 06/30/2027 08/29/2027 DY7Q2 Narrative information DY7Q2 blank blank blank blank blank Grievances and appeals DY7Q2 blank blank blank blank blank Other monthly and quarterly metrics DY7Q1 Y 6 month claims lag for all planned DY6Q4 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics Y 6 month claims lag for all planned DY6 07/01/2027 09/30/2027 11/29/2027 DY7Q3 Narrative information DY7Q3 blank blank blank blank blank Grievances and appeals DY7Q3 blank blank blank blank blank Other monthly and quarterly metrics DY7Q2 Y 6 month claims lag for all planned DY7Q1 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 10/01/2027 12/31/2027 02/29/2028 DY7Q4 Narrative information DY7Q4 blank blank blank blank blank Grievances and appeals DY7Q4 blank blank blank blank blank Other monthly and quarterly metrics DY7Q3 Y 6 month claims lag for all planned DY7Q2 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 01/01/2028 03/31/2028 05/30/2028 DY8Q1 Narrative information DY8Q1 blank blank blank blank blank Grievances and appeals DY8Q1 blank blank blank blank blank Other monthly and quarterly metrics DY7Q4 Y 6 month claims lag for all planned DY7Q3 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics DY7 Y 6 month claims lag for all planned N/A 04/01/2028 06/30/2028 08/29/2028 DY8Q2 Narrative information DY8Q2 blank blank blank blank blank Grievances and appeals DY8Q2 blank blank blank blank blank Other monthly and quarterly metrics DY8Q1 Y 6 month claims lag for all planned DY7Q4 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics Y 6 month claims lag for all planned DY7 07/01/2028 09/30/2028 11/29/2028 DY8Q3 Narrative information DY8Q3 blank blank blank blank blank Grievances and appeals DY8Q3 blank blank blank blank blank Other monthly and quarterly metrics DY8Q2 Y 6 month claims lag for all planned DY8Q1 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics 10/01/2028 12/31/2028 03/01/2029 DY8Q4 Narrative information DY8Q4 blank blank blank blank blank Grievances and appeals DY8Q4 blank blank blank blank blank Other monthly and quarterly metrics DY8Q3 Y 6 month claims lag for all planned DY8Q2 blank blank blank blank blank Annual metrics that are established quality measures blank blank blank blank blank Other annual metrics [Add rows for all additional demonstration reporting quarters] blank blank blank blank blank blank blank blank blank end of worksheet

a SUD demonstration start date: For monitoring purposes, CMS defines the start date of the demonstration as the effective date listed in the state’s STCs at time of SUD demonstration approval. For example, if the state’s STCs at the time of SUD demonstration approval note that the demonstration is effective January 1, 2020 – December 31, 2025, the state should consider January 1, 2020 to be the start date of the demonstration. Note that that the effective date is considered to be the first day the state may begin its SUD demonstration. In many cases, the effective date is distinct from the approval date of a demonstration; that is, in certain cases, CMS may approve a section 1115 demonstration with an effective date that is in the future. For example, CMS may approve an extension request on December 15, 2020, with an effective date of January 1, 2021 for the new demonstration period. In many cases, the effective date also differs from the date a state begins implementing its demonstration. To generate an accurate reporting schedule, the start date as listed in Table 1 of the “SUD reporting schedule tab” should align with the first day of a month. If a state’s SUD demonstration begins on any day other than the first day of the month, the state should list its start date as the first day of the month in which the effective date occurs. For example, if a state’s effective date is listed as January 15, 2020, the state should indicate "01/01/2020" as the start date in Table 1 of the “SUD reporting schedule” tab. Please see Appendix A for more information on determining demonstration quarter timing. b The auto-populated reporting schedule in Table 2 outlines the data the state is expected to report for each demonstration year and quarter. However, states are not expected to begin reporting any metrics data until after monitoring protocol approval. The state should see Section B of the Monitoring Report Instructions for more information on retrospective reporting of data following protocol approval. Instructions: blank Table 1. Substance Use Disorder Demonstration Reporting Periods Input Table (1) In the reporting periods input table (Table 1), use the prompt in column A to enter the requested information in the corresponding row of column B. All monitoring report names and reporting periods should use the format DY#Q# or CY# and all dates should use the format MM/DD/YYYY with no spaces in the cell. The information entered in these cells will auto- populate the SUD demonstration reporting schedule in Table 2. All cells in the input table must be completed in entirety and in the correct format for the standard reporting schedule to be accurately auto-populated. (2) Review the state's reporting schedule in the SUD demonstration reporting schedule table (Table 2). For each of the reporting categories listed in column F, select Y or N in column H, "Deviation from standard reporting schedule (Y/N)" to indicate whether the state plans to report according to the standard reporting schedule. If a state's planned reporting does not match the standard reporting schedule for any quarter and/or reporting category (i.e., column H=“Y”), the state should describe these deviations in column I, "Explanation for deviations (if column H="Y")" and use column J, “Proposed deviations from standard reporting schedule,” to indicate the SUD measurement periods with which it wishes to overwrite the standard schedule (column G). All other columns are locked for editing and should not be altered by the state. Table 2. Substance Use Disorder Demonstration Reporting Schedule