Enforcement of Budget Neutrality. CMS must enforce budget neutrality over the life of the demonstration rather than on an annual basis. However, if the state’s expenditures exceed the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the demonstration years, the state must submit a corrective action plan to CMS for approval. Demonstration Year Cumulative Expenditure Cap Definition Percentage
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration rather than on an annual basis. However, if the State exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %
Enforcement of Budget Neutrality. CMS will enforce budget neutrality over the life of the Demonstration, rather than annually. However, no later than 6 months after the end of each DY, or as soon thereafter as data are available, the State will calculate annual expenditure targets for the IPC component of the Demonstration for the completed year. This amount will be compared with the actual claimed FFP for Medicaid. Using the schedule below as a guide, if the State exceeds these targets, it will submit a corrective action plan to CMS for approval. The State will subsequently implement the corrective action plan. Year Cumulative Target Expenditures Percentage 2011 DY 1 budget limit amount +4 percent 2012 DY 1 and 2 combined budget limit amount +2 percent 2013 DYs 1 through 3 combined budget limit amount +0 percent
Enforcement of Budget Neutrality. CMS will enforce budget neutrality over the life of the demonstration, rather than annually. However, no later than 6 months after the end of each DY or as soon thereafter as the data are available, the state will calculate annual expenditure targets for the completed year. This amount will be compared with the actual claimed FFP for Medicaid. Using the schedule below as a guide, if the state exceeds these targets, it will submit a corrective action plan to CMS for approval. The state will subsequently implement the approved corrective action plan. DY 2015 DY 4 budget limit amount +2 percent DY 2016 DYs 4 through 5 combined budget limit amount +1.5 percent DY 2017 DYs 5 through 6 combined budget limit amount +0 percent
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the demonstration rather than on an annual basis, by combining the annual limits calculated following paragraph 64 into lifetime limits for the demonstration. The following describes how budget neutrality will be enforced.
a. Test A consists of application of the combined annual Limits A to demonstration spending reported on the following schedules, as defined in paragraph 55(d) and 55(f): “HHW Caretakers,” “HHW Children,” “HHW Pregnant Women,” “HIP Adults,” “ESP Adults Adm.”
b. Test B consists of application of the combined annual Limits B to demonstration spending reported on the “HIP Caretakers” and “ESP Caretakers Adm” schedule.
c. If Test A expenditures exceed Limit A, the state must refund excess expenditures from Test A to CMS. Test B savings cannot be used to offset excess expenditures from Test A.
d. If Test B expenditures exceed Limit B and Test A shows savings, a second test is performed by combining Tests A and B. The state must refund excess expenditures (if any) from the combined test to CMS.
e. If both Tests A and B show excess expenditures, the state must refund the excess expenditures from both tests to CMS.
f. If the demonstration is terminated prior to the end of the budget neutrality agreement, an assessment of the state’s compliance with these requirements shall be based on the time elapsed through the termination date.
Enforcement of Budget Neutrality. CMS shall enforce the budget neutrality agreement over the life of the demonstration as adjusted July 1, 2008, rather than on an annual basis. However, if the Commonwealth exceeds the calculated cumulative budget neutrality expenditure limit by the percentage identified below for any of the demonstration years, the Commonwealth must submit a corrective action plan to CMS for approval. DY 18 Cumulative budget neutrality limit plus: 2.0percent DY 18 through DY 19 Cumulative budget neutrality limit plus: 1.5 percent DY 18 through DY 20 Cumulative budget neutrality limit plus: 1.0 percent DY 18 through 21 Cumulative budget neutrality limit plus: .5 percent DY 18 through 22 Cumulative budget neutrality limit plus: 0 percent In addition, the Commonwealth may be required to submit a corrective action plan if an analysis of the expenditure data in relationship to the budget neutrality expenditure cap indicates a possibility that the demonstration will exceed the cap during this extension.
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration rather than on an annual basis. However, if the State’s expenditures exceed the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan to CMS for approval. Year 15 Cumulative budget neutrality limit plus: 1,0 percent Years 16 through 18 Cumulative budget neutrality limit plus: 0.5 percent Year 19 and 20 Cumulative budget neutrality limit plus: 0 percent In addition, the State may be required to submit a corrective action plan if an analysis of the expenditure data in relationship to the budget neutrality expenditure cap indicates a possibility that the Demonstration will exceed the cap during this extension.
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration rather than on an annual basis. DY 18 expenditures, which will consist only of DSHP expenditures in support of the H-MH and PPR demonstrations, will be included in the budget neutrality test for the demonstration. The State may receive FFP for these expenditures to the extent that sufficient accumulated budget neutrality savings are available from prior DYs.
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of this demonstration extension approval period. No later than 90 days after the end of each demonstration year, the state will calculate and report to CMS an annual cumulative expenditure target for the completed year as part of the Annual Monitoring Report described in STC 31. This amount will be compared with the actual cumulative amount the state has claimed for FFP through the completed year. If cumulative spending exceeds the cumulative target by more than the indicated percentage, the state will submit a corrective action plan to CMS for approval. The state will subsequently implement the approved plan. Year Cumulative Target Expenditures Percentage 47. Exceeding Budget Neutrality. The state, whenever it determines that the demonstration is not budget neutral or is informed by CMS that the demonstration is not budget neutral, must immediately collaborate with CMS on corrective actions, which includes submitting a corrective action plan to CMS within 21 days of the date the state is informed of the problem.
Enforcement of Budget Neutrality. CMS shall enforce budget neutrality on an annual basis. If the state exceeds the annual budget neutrality expenditure limit in any given DY, the state must submit a corrective action plan to CMS for approval and will repay (without deferral or disallowance) the federal share of the amount by which the budget neutrality agreement has been exceeded.
