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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 12 of 43

legislative updates; and descriptions of any public forums held. In addition, Annual Monitoring Reports should describe key achievements, as well as conditions and efforts to which these successes can be attributed. The Annual Monitoring Reports should also include a summary of all public comments received through post-award public forums regarding the progress of the demonstration.

b) Performance Metrics. The performance metrics will provide data to demonstrate how the state is progressing toward meeting the demonstration’s goals. Per 42 CFR 431.428, the Annual Monitoring Reports must document the impact of the demonstration in providing insurance coverage to beneficiaries and the uninsured population, as well as the impact of the demonstration on beneficiaries’ utilization of services, outcomes of care, quality and cost of care, and access to care. This may also include the results of beneficiary satisfaction or experience of care surveys, if conducted, as well as grievances and appeals. .

The state and CMS will work collaboratively to finalize the list of metrics to be reported in the Annual Monitoring Reports. The required monitoring and performance metrics must be included in the Annual Monitoring Reports and will follow the CMS framework provided by CMS to support federal tracking and analysis. The reporting of the monitoring metrics must also be stratified by key demographic subpopulations of interest (e.g., by sex, age, race/ethnicity, primary language, disability status, sexual orientation and gender identity, and geography) and by demonstration component, to the extent feasible. Subpopulation reporting will support identifying any existing shortcomings or disparities in quality of care and health outcomes and help track whether the demonstration’s initiatives help improve outcomes for the state’s Medicaid population, including the narrowing of any identified disparities.

c) Budget Neutrality and Financial Reporting Requirements. Per 42 CFR 431.428, the Annual Monitoring Reports must document the financial performance of the demonstration. The state must provide an updated budget neutrality workbook with every Annual Monitoring Report that meets all the reporting requirements for monitoring budget neutrality set forth in the General Financial Requirements section of these STCs, including the submission of corrected budget neutrality data upon request. In addition, the state must report quarterly and annual expenditures associated with the populations affected by this demonstration on the Form CMS-64. Administrative costs should be reported separately on the Form CMS-64.

d) Evaluation Activities and Interim Findings. Per 42 CFR 431.428, the Annual Monitoring Reports must document any results of the demonstration to date per the evaluation hypotheses. Additionally, the state shall include a summary of the progress of evaluation activities, including key milestones accomplished, as well as challenges encountered and how they were addressed.

25. Corrective Action Plan Related to Monitoring. If monitoring indicates that demonstration features are not likely to assist in promoting the objectives of Medicaid,