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Demonstration Approval Period: October 1, 2024 through September 30, 2029 Page 36 of 43

Table A. Example Design Table for the Evaluation of the Demonstration Research Question Outcome measures used to address the research question Sample or population subgroups to be compared Data Sources Analytic Methods Hypothesis 1 Research question 1a -Measure 1 -Measure 2 -Measure 3 -Sample e.g. All attributed Medicaid beneficiaries -Beneficiaries with diabetes diagnosis -Medicaid fee- for-service and encounter claims records -Interrupted time series Research question 1b -Measure 1 -Measure 2 -Measure 3 -Measure 4 -sample, e.g., PPS patients who meet survey selection requirements (used services within the last 6 months) -Patient survey Descriptive statistics Hypothesis 2 Research question 2a -Measure 1 -Measure 2 -Sample, e.g., PPS administrators -Key informants Qualitative analysis of interview material

D. Methodological Limitations – This section provides detailed information on the limitations of the evaluation. This could include the design, the data sources or collection process, or analytic methods. The state should also identify any efforts to minimize the limitations. Additionally, this section should include any information about features of the demonstration that effectively present methodological constraints that the state would like CMS to take into consideration in its review.

E. Special Methodological Considerations- CMS recognizes that there may be certain instances where a state cannot meet the rigor of an evaluation as expected by CMS. In these instances, the state should document for CMS why it is not able to incorporate key components of a rigorous evaluation, including comparison groups and baseline data analyses. Examples of considerations include: 1) When the state demonstration is: a. Long-standing, non-complex, unchanged, or b. Has previously been rigorously evaluated and found to be successful, or c. Could now be considered standard Medicaid policy (CMS published regulations or guidance)

2) When the demonstration is also considered successful without issues or concerns that would require more regular reporting, such as: a. Operating smoothly without administrative changes; and