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Wyoming Pregnant by Choice CMS Extension Approved: April 7, 2020; Effective through December 31, 2027 Amendment Approved: April 30, 2025 Page 10 of 38

diagnosis and treatment pursuant to a family planning visit such as contraceptive counseling and are reimbursable at the state’s regular Federal Medical Assistance Percentage (FMAP) rate. The specific family planning related services provided under this demonstration are as follows:

a) STI/STD diagnosis pursuant to a family planning visit, such as contraceptive counseling.

21. Minimum Essential Coverage (MEC). The Wyoming family planning demonstration is limited to the provision of services as described in STC 19. Consequently, this demonstration is not recognized as Minimum Essential Coverage (MEC) as indicated by CMS in its February 12, 2016 correspondence from Vikki Wachino to Teri Green, State Medicaid Agent, regarding the designation of MEC for the state's section 1115 demonstration.

22. Primary Care Referrals. Primary care referrals to other social service and health care providers as medically indicated are provided; however, the costs of those primary care services are not covered for enrollees of this demonstration. The state must facilitate access to primary care services for participants, and must assure CMS that written materials concerning access to primary care services are distributed to demonstration participants. The written materials must explain to the participants how they can access primary care services.

23. Delivery of Services. Enrollees will receive family planning demonstration services on a fee-for-service (FFS) basis. Beneficiary freedom of choice of which provider to see for family planning services shall not be restricted.

VI. GENERAL REPORTING REQUIREMENTS 24. Deferral of Payment for Failure to Submit Timely Demonstration Deliverables. CMS may issue deferrals in accordance with 42 CFR part 430 subpart C, in an amount up to $1,000,000 per deliverable (federal share) when items required by these STCs (e.g., required data elements and analyses, reports, design documents, presentations, and other items specified in these STCs (hereafter singly or collectively referred to as “deliverables(s)”) are not submitted timely to CMS or are found to not be consistent with the requirements approved by CMS. A deferral shall not exceed the value of the federal amount for the current demonstration period. The state does not relinquish its rights provided under 42 CFR part 430 subpart C to challenge any CMS finding that the state materially failed to comply with the terms of this agreement.

The following process will be used: 1) Thirty days after the deliverable was due if the state has not submitted a written request to CMS for approval of an extension as described in subsection (b) below; or 2) Thirty days after CMS has notified the state in writing that the deliverable was not accepted for being insufficient, or inconsistent with the requirements of this agreement and the information needed to bring the deliverable into alignment with CMS requirements:

a) CMS will issue a written notification to the state providing advance notification of