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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 13 of 38

transmitted diseases, beneficiaries who obtained a cervical cancer screening, and beneficiaries who received a pelvic and/or clinical breast exam. The required monitoring and performance metrics must be included in writing in the Annual Monitoring Report, and will follow the framework provided by CMS to support federal tracking and analysis.

c) Budget Neutrality and Financial Reporting Requirements – Per 42 CFR 431.428, the Annual Monitoring Report must document the financial performance of the demonstration. The state must provide an updated budget neutrality workbook with every Annual Monitoring Report the meets all the reporting requirements for monitoring budget neutrality set forth in the General Financial Requirements section of these STCs, including a total annual member month count for the demonstration population, total annual expenditures for the demonstration population, and the resulting “per member, per month” calculation. The Annual Monitoring Report must also include the submission of corrected budget neutrality data upon request.

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 CMS approved 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.

31. Program Integrity. The state must have processes in place to ensure that there is no duplication of federal funding for any aspect of the demonstration. The state must confirm its process for ensuring there is no duplication of federal funding in each Annual Monitoring Report as specified in STC 29(a).

32. Draft and final Close-out Report. Within 120 days after the expiration of the demonstration, the state must submit a draft Close-out Report to CMS for comments.

a) The draft report must comply with the most current guidance from CMS.

b) The state will present to and participate in a discussion with CMS on the close-out report.

c) The state must take into consideration CMS’ comments for incorporation into the final close out report.

d) The final close-out report is due to CMS no later than 30 days after receipt of CMS’ comments.

e) A delay in submitting the draft or final version of the close-out report may subject the state to penalties described in STC 23. VII. GENERAL FINANCIAL REQUIREMENTS This project is approved for title XIX expenditures applicable to services rendered during the demonstration period. This section describes the general financial requirements for these