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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 12 of 38

and other data elements that have been agreed to for reporting and analytics are provided by the state; and,

c) Submit deliverables to the appropriate system as directed by CMS. 29. Monitoring Calls. CMS will convene biannual conference calls with the state in addition to ad hoc communications, as needed. The purpose of these calls is to discuss any significant actual or anticipated developments affecting the demonstration. Areas to be addressed include, but are not limited to, health care delivery, enrollment, cost-sharing, quality of care, access, the benefit package, audits, lawsuits, financial reporting and budget neutrality issues, progress on evaluation, legislative developments, and any demonstration amendments the state is considering submitting. CMS shall provide updates on any amendments or concept papers under review, as well as federal policies and issues that may affect any aspect of the demonstration. The state and CMS shall jointly develop the agenda for the calls.

30. Annual Monitoring Report. No later than 90-days following the end of each demonstration year (i.e., by March 31), the state must submit an “Annual Monitoring Report” that represents the status of the demonstration’s various operational areas and any state analysis of program data collected for the demonstration year. The Annual Monitoring Report will include all elements required by 42 CFR 431.428 and as listed below, and should not direct readers to links outside the report. Additional links not referenced in the document may be listed in a Reference/Bibliography section. The state must submit the Annual Monitoring Report through CMS’ designated system using the framework incorporated in these STCs as “Appendix A,” which is subject to change as monitoring systems are developed and/or evolve, and will be provided in a structured manner that supports federal tracking and analysis. Each Annual Monitoring Report must minimally include the following:

a) Operational Updates – Per CFR 431.428, the Annual Monitoring Report must document any policy or administrative difficulties in operating the demonstration. The reports shall provide sufficient information to document key challenges, underlying causes of challenges, how challenges are being addressed, as well as key achievements and to what conditions and efforts successes can be attributed. The discussion should also include any issues or complaints identified by beneficiaries; lawsuits or legal actions; unusual or unanticipated trends; legislative updates; description of the last annual public forum held, and a summary of any program integrity and related audit activities for the demonstration. The Annual Monitoring Report should also include a summary of all public comments received through the post-award public forum required per 42 CFR §431.420(c) regarding the progress of the demonstration.

b) Performance Metrics – Per 42 CFR 431.428, the Annual Monitoring Report must document the impact of the demonstration in providing insurance coverage to beneficiaries and the uninsured population, as well as outcomes of care, quality and cost of care, and access to care. This may also include the results of beneficiary satisfaction surveys (if conducted) and grievances and appeals. The required monitoring and performance metrics will include number of enrollees, beneficiaries with claims (including follow-up claims), contraceptive utilization, beneficiaries tested for sexually