VT Global Commitment to Health 1115 Extension Request 2015
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VT Global Commitment to Health 1115 Extension Request 2015
State of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 2015/31/2021)Submitted 12/31/20150Vermont Global Commitment to Health Section Ills Demonstration Extension Request 12/31/1STable of Contents1115(e) Application Certification Statement................................2Appendix A: Historical Summary of the Demonstration........................4Appendix B: VT Global Commitment to Health 1115 Extension Request 2015Budget Neutrality Assessment and Projections..................12Appendix C: Interim Evaluation of the Overall Impact of the Demonstration.28Appendix DVT Global Commitment to Health 1115 Extension Request 2015
: Summary of EQRO Reports and Quality Assurance Monitoring......31Appendix E: Compliance with Public Notice Process.........................35AttachmeState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 2015nt Global Commitment to Health Section Ills Demonstration Extension Request 12/31/1SVermont Application Certification statement - Section 1115(e) Five Year ExtensionThis document, together with Appendices A through D. constitutes Vermont’s application to the Centers lor Medicare & Medicaid Sen ices VT Global Commitment to Health 1115 Extension Request 2015(CMS) to extend its demonstration entitled. Global Commitment to Health. Project Number II-W-00I94/I. without any programmatic changes pursuant to secVT Global Commitment to Health 1115 Extension Request 2015
tion 1115(c) of the Social Security Act. rhe slate is requesting CMS' approval for a 5-ycar extension of the demonstration subject to the same approveState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 20152016.CMS’ expedited review and assessment of the stale’s request to continue the demonstration without any substantive program changes is conditioned upon the state’s submission and CMS' assessment of the below items that are necessary to ensure that the demonstration is operating in accordance with VT Global Commitment to Health 1115 Extension Request 2015 the objectives of title XIX and 'or title XXI as originally approved. The state’s application will only be considered complete for purposes of initiaVT Global Commitment to Health 1115 Extension Request 2015
ling federal review and federal-level public notice when the state provides the information as requested in the below appendices.•Appendix A: A historState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 2015how these objectives have or have not been met. and the fiinire goals of the program.•Appendix B: Budget neutrality assessment, and projections for the projected 5-year extension period. The state will present an analysis of budget allotment neutrality for the current demonstration approval period, VT Global Commitment to Health 1115 Extension Request 2015including status of budget .'allotment neutrality to date based on the most recent expenditure and member month data, and projected through the end ofVT Global Commitment to Health 1115 Extension Request 2015
the current approval period. CMS will also review the state’s Medicaid and Children's Health Insurance Program Budget and Expenditure System (MBES/CBState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 2015s actual expenditures inclined over the period from initial approval through the current expiration date, together with (he projected costs for the requested 5-ycar extension period, must comply with CMS budget allotment neutrality requirements outlined in the STCs.•Appendix C: Interim evaluation of VT Global Commitment to Health 1115 Extension Request 2015 the overall impact of the demonstration that includes evaluation activities and findings to dale, in addition to plans for evaluation activities overVT Global Commitment to Health 1115 Extension Request 2015
the 5-year extension period. The interim evaluation should provide CMS with a clear analysis of the state's achievement in obtaining the outcomes expState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/ VT Global Commitment to Health 1115 Extension Request 2015ix D: Summaries of External Quality Review Organization (F.QRO) reports, managed care organization and slate quality assurance monitoring, and any other documentation of the quality of and access to care provided under the demonstration.2Vermont Global Commitment to Health Section Ills Demonstration VT Global Commitment to Health 1115 Extension Request 2015 Extension Request 12/31/1S♦ Appendix E: Documentation of the state's compliance with the public notice process set forth in 42 CFR 431.408 and 431.42VT Global Commitment to Health 1115 Extension Request 2015
0.The state attests that it has abided by all provisions of the approved STCs and will continuously operate the demonstration in accordance with the rState of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/State of VermontAgency of Human ServicesGlobal Commitment to Health ll-W-00194/1Section 1115(e) Demonstration Extension Request to CMS (1/1/2017 — 12/Gọi ngay
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