SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. Date Deliverable April 1, 2012 Submission of draft Evaluation Design STC # 28(a) July 1, 2012 Submission of revised Evaluation Design STC # 28(a) July 1, 2012 Transition Plan. September 30, 2015 Written Notice of State’s Intent to Extend the Demonstration Under 1115 March 31, 2016 Complete Demonstration Extension Application (1115) January 1, 2017 Submit Draft Evaluation Report - STC # 29 March 1, 2017 Final Evaluation Report - STC #29. Final Report - STC# 40. End of Demonstration Period. Monthly Deliverables Monthly call - STC# 34 Date Deliverable Monthly Childless Adult Enrollment Report – STC # 35 Quarterly Deliverables Requirements for Quarterly Reports – STC # 37 Quarterly Budget Neutrality Reports – STC # 33 Expenditure Reports CMS 64 and CMS21 - STC# 44 and STC# 53 Member Months Report - STC# 46 SEDS Enrollment Data - STC# 23(h) Annual Deliverables Requirement for Annual Report - STC# 38 Requirement for annual HCBS Report on March 31st - STC# 20 (f)(iv) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – STC # 58 (b) Attachment A – Approved Childless Adult Phase-out Plan under Demonstration #11-W-0003/09 and 21-W-0009/9 Childless Adults Freeze Implementation Milestones Phase Out Plan and Corresponding Enrollment Freeze Effective July 8, 2011
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. Timeline Deliverable STC Reference Within 120 days from the award of the demonstration Submit Draft Evaluation Design Section IX, STC 44 Within 60 days receipt of CMS comments Submit Final Evaluation Plan Section IX, STC 45 Annually within 90 days following the end of the 4th quarter for each DY Submit Annual Report Section VI, STC 28 Quarterly within 60 days following the end of each quarter Submit Quarterly Operational Reports Section VI, STC 27 Within 180 days after the expiration of the demonstration Submit Draft Final Report Section VI, STC 28 60 days receipt of CMS comments Submit Final Report Section VI, STC 28 APPENDIX A: Template for Quarterly Operational Report [Insert Name of Demonstration] Section 1115 Quarterly Report Demonstration Year, Quarter X Fiscal Quarter Date Submitted Introduction Narrative on a brief introduction of demonstration, provide historical background from previous demonstration years and trends. Executive Summary • Brief description of demonstration populations • Goal of demonstration (list out) Demonstration Year (DY) Begin Date End Date Quarterly Report Due Date (60 days following end of quarter) Quarter 1 Quarter 2 Quarter 3 Quarter 4 • Program highlights (e.g. summary of benefits provided to the demonstration population) (Fill in chart- Indicate when each quarter begins and when it ends, see example below) • Significant program changes ▪ Narrative describing any administrative and operational changes to the demonstration, such as eligibility and enrollment processes, eligibility redetermination processes (including the option to utilize administrative redetermination), systems, health care delivery, benefits, quality of care, anticipated or proposed changes in payment rates, and outreach changes; and ▪ Narrative on any noteworthy demonstration changes, such as changes in enrollment, service utilization, education and outreach, and provider participation. Discussion of any action plan if applicable. • Policy issues and challenges ▪ Narrative providing an overview of any policy issues the state is considering, including pertinent legislative/budget activity and potential demonstration amendments; and ▪ Discussion of any action plans addressing any policy, administrative or budget issues identified, if applicable.
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Complete Demonstration Extension Application (1115) and interim evaluation report March 31, 2016 Submit Interim Evaluation Report - Paragraph 30 August 1, 2016 Final Evaluation Report – Paragraph 31; Final Report - Paragraph 40. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 Quarterly Budget Neutrality Reports – Paragraph 35 Expenditure Reports CMS 64 and CMS 21 - Paragraph 44 and Paragraph 54 Member Months Report – Paragraph 46 Annual Deliverables Requirement for Annual Report – Paragraph 38 Requirement for annual HCBS Report on March 31st – Paragraph 22 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 (b) Attachment A - Quarterly Report Guidelines As written in STC paragraph 37, the state is required to submit quarterly progress reports to CMS. The purpose of the quarterly report is to inform CMS of significant demonstration activity from the time of approval through completion of the demonstration. The reports are due to CMS 30 days after the end of each quarter. The following report guidelines are intended as a framework and can be modified when agreed upon by CMS and the state. A complete quarterly progress report must include the budget neutrality monitoring workbook. An electronic copy of the report narrative and the Microsoft Excel budget neutrality monitoring workbook is provided. NARRATIVE REPORT FORMAT: TITLE Title Line One – Arizona Health Care Cost Containment System -- AHCCCS, A statewide Approach of Cost Effective Health Care Financing Title Line Two - Section 1115 Quarterly Report Demonstration/Quarter Reporting Period: Example: Demonstration Year: 5 (5/01/04 - 4/30/05) Federal Fiscal Quarter: 4/2004 (7/04 - 9/04) INTRODUCTION: Information describing the goal of the demonstration, what it does, and key dates of approval /operation. (This should be the same for each report.) ENROLLMENTINFORMATION: Please complete the following table that outlines all enrollment activity under the demonstration. The state should indicate “N/A” where appropriate. If there was no activity under a particular enrollment category, the stat...
SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION. The state is held to all reporting requirements outlined in the STCs; this schedule of deliverables should serve only as a tool for informational purposes only. Date Deliverable September 30, 2015 Complete Demonstration Extension Application (1115) and interim evaluation report March 31, 2016 Submit Interim Evaluation Report - Paragraph 30 August 1, 2016 Final Evaluation Report – Paragraph 31; Final Report - Paragraph 40. End of Demonstration Period. Monthly Deliverables Monthly call – Paragraph 36 Quarterly Deliverables Requirements for Quarterly Reports – Paragraph 37 Quarterly Budget Neutrality Reports – Paragraph 35 Expenditure Reports CMS 64 and CMS 21 - Paragraph 44 and Paragraph 54 Member Months Report – Paragraph 46 Annual Deliverables Requirement for Annual Report – Paragraph 38 Requirement for annual HCBS Report on March 31st – Paragraph 22 (h)(iii) Comparison of Costs for the DES Interagency Agreement, including how any excess revenues are spent, and for ADHS/BHS. Both reports will be due by January 15 – Paragraph 58 (b) Attachment B – Evaluation Guidelines Section 1115 demonstrations are valued for information on health services, health services delivery, health care delivery for uninsured populations, and other innovations that would not otherwise be part of Medicaid programs. CMS encourages states with demonstration programs to conduct or arrange for evaluations of the design, implementation, and/or outcomes of their demonstrations. The CMS also conducts evaluation activities. The CMS believes that all parties to demonstrations; states, Federal Government, and individuals benefit from state conducted self-evaluations that include process and case-study evaluations— these would include, but are not limited to: 1) studies that document the design, development, implementation, and operational features of the demonstration, and 2) studies that document participant and applicant experiences that are gathered through surveys, quality assurance activities, grievances and appeals, and in-depth investigations of groups of participants and applicants and/or providers (focus groups, interviews, other). These are generally studies of short-term experiences and they provide value for quality assurance and quality improvements programs (QA/QI) that are part of quality assurance activities and/or demonstration refinements and enhancements. Benefit also derives from studies of intermediate and longer-term investigations of the impact of the demonstration on ...
