Common use of SCHEDULE OF STATE DELIVERABLES DURING THE DEMONSTRATION Clause in Contracts

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. 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. March 1, 2013 Submission of draft Evaluation Design STC # 28(a) September 30, 2015 Written Notice of State’s Intent to Extend the Demonstration Under 1115 March 31, 2016 Complete Demonstration Extension Application (1115) and CRS and SMI Integration Evaluation Report (STC #28(f)) 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 Date Deliverable 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. 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. March 1, 2013 Submission of draft Evaluation Design STC # 28(a) September 30, 2015 Written Notice of State’s Intent to Extend the Demonstration Under 1115 March 31, 2016 Complete Demonstration Extension Application (1115) and CRS and SMI Integration Evaluation Report (STC #28(f)) 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