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Attachment D Time-limited Expenditure Authority and Associated Requirements for the COVID-19 Public Health Emergency (PHE) Demonstration Amendment

Expenditure Authority Under the authority of section 1115(a)(2) of the Social Security Act (the Act), expenditures made by the state for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act, shall, for the period from December 14, 2020 through and including June 5, 2022, be regarded as expenditures under the State’s title XIX plan.

COVID-19 Vaccine Administration Payments. Expenditure authority, to the extent necessary, for state payments to providers for the administration of a COVID-19 vaccine for Wisconsin SeniorCare enrollees, from December 14, 2020 through and including June 5, 2022. To the extent necessary, this expenditure authority also applies, notwithstanding section 1903(b)(1) of the Act and implementing regulations at 42 CFR 431.625(d)(3), to state payments to providers for COVID-19 vaccinations that could have been paid for under Medicare Part B, but were not, because the beneficiary was eligible for enrollment in Medicare Part B but was not enrolled in Medicare Part B.

Monitoring and Evaluation Requirements

Evaluation Design and Final Report. Given the unique circumstances and the time-limited nature of this demonstration amendment, and the fact that the entire approval period for this amendment is retroactive, CMS has streamlined the monitoring and evaluation requirements for this amendment. While it is important to gather evidence regarding the operation and effectiveness of this amendment, CMS understands the unusual situation of the COVID-19 PHE and the challenges it presents to data collection and analyses required to comply with the systemic monitoring and robust evaluation requirements for more traditional section 1115 demonstrations. Therefore, the requirements for data collection and analyses for this amendment are structured to be meaningful and productive, and importantly, consistent with the applicable provisions of 42 CFR §§ 431.424 and 431.428, but not unduly burdensome for the state in light of the retroactive approval period for this amendment.

Specifically, the state will be required to develop a Final Report, which will consolidate the amendment’s monitoring and evaluation requirements. To address the requirements in 42 CFR § 431.424(c), the Final Report will include a section clearly outlining the state’s underlying Evaluation Design for the evaluation of the expenditure authority approved in this amendment. The draft Final Report will be due to CMS no later than eighteen months after the state’s receipt of the approval of the amendment. CMS’s section 1115 demonstration evaluation guidance “Preparing the Evaluation Report”2 provides pertinent instructions that would be helpful in preparing the consolidated Final Report. The state should customize the content of the Final Report to align with the specific scope of the demonstration amendment.

2 Available at https://www.medicaid.gov/medicaid/downloads/preparing-the-evaluation-report.pdf.