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Measure I Description, Specifications and Benchmarks: Data for Measure I will come from fee-for-service claims, managed care encounters, enrollment records, and birth registry data to determine eligibility group and prenatal visit utilization. As described above, the dataset will include live, singleton births to FAMIS MOMS during a given calendar year.

Adequate prenatal care will be defined using the Adequacy of Prenatal Care Utilization (APNCU) Index, also known as the Kotelchuck Index. The adequacy of prenatal care received during pregnancy has been associated with lower incidence of poor birth outcomes, such as preterm delivery and low-birth-weight births.* The APNCU Index uses birth certificate information to assess prenatal care in relation to two separate and distinct components. First, it measures at what point in the pregnancy a mother initiated prenatal care. Second, the index considers the number of prenatal visits throughout the pregnancy. The two components are combined into a single prenatal care utilization composite score. Higher composite scores on the APNCU Index are assigned to women who initiate prenatal care early in pregnancy and complete at least 80 percent of the visits expected based on the time frame, adjusted for gestational age at prenatal care initiation and the infant’s gestational age at delivery.°

The table below shows the composite score categories and criteria defining each category.

APNCU Index Criteria for Adequacy of Prenatal Care

Prenatal care initiated by the fourth month of pregnancy and 110% or more of expected visits received

Prenatal care initiated by the fourth month of pregnancy

Adequate Plus

Adequate and 80% to 109% of expected visits received - Prenatal care initiated by the fourth month of pregnancy Intermediate and 50 to 79% of expected visits received Prenatal care initiated after the fourth month of pregnancy Inadequate

or less than 50% of expected visits received

DMAS will use the annual baseline identified in the Healthy People 2030 goal “Increase the proportion of pregnant women who receive early and adequate prenatal care —- MICH-08” — which uses data derived from the CCDC, NCHS, NVSS, for the Births with Early and Adequate Prenatal Care measure — for each year corresponding to the calendar year of the Buth Outcomes Study. Healthy People 2030 published a national baseline in which 76.4 percent of women received early and adequate prenatal care during 2018, with an initial goal of 80.5 percent and a 1 percentage point improvement for each year.© DMAS will compare study indicator findings

4 Kreger PM, Scholl TO. Adequacy of prenatal care and pregnancy outcome. The Journal of the American Osteopathic Association. 2000; 100(8):485—492.

> Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health. 1994; 84(9):1414—-1420.

6 Healthy People 2030. “Increase the proportion of pregnant women who receive early and adequate prenatal care — MICH-08.” U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.

Virginia FAMIS MOMS and FAMIS Select Section 1115 Demonstration Demonstration Period: October 25, 2019 through June 30, 2029; Amended November 18, 2021 Page 50 of 61