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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 20 of 38

Per 42 CFR 431.424(c), the state will publish the approved final Evaluation Design within 30 days of CMS approval. The state must implement the Evaluation Design and submit a description of its evaluation implementation progress in each Annual Monitoring Report as required by STC 29, including any required rapid cycle assessments specified in these STCs. Once CMS approves the Evaluation Design, if the state wishes to make changes, the state must submit a revised Evaluation Design to CMS for approval.

50. Evaluation Questions and Hypotheses. Consistent with CMS' guidance entitled, "Developing the Evaluation Design" (see Appendix B) and "Preparing the Evaluation Report" (see Appendix C), the evaluation documents must include a discussion of the evaluation questions and hypotheses that the state intends to test. Each demonstration component should have at least one evaluation question and hypothesis. The hypothesis testing should include, where possible, assessment of both process and outcome measures. Proposed measures should be selected from nationally recognized sources and national measures sets, where possible. Measures sets could include CMS’ Core Set of Health Care Quality Measures for Children in Medicaid and CHIP, Consumer Assessment of Health Care Providers and Systems (CAHPS), the Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults and/or measures endorsed by National Quality Forum (NQF).

51. Interim Evaluation Report. The state must submit an Interim Evaluation Report for the completed years of the demonstration, and for each subsequent extension of the demonstration, as outlined in 42 CFR 431.412(c)(2)(vi). When submitting an application for extension, the Evaluation Reports should be posted to the state’s website with the application for public comment.

a) The Interim Evaluation Report will discuss evaluation progress and present findings to date as per the approved evaluation design.

b) For any demonstration authority that expires prior to the overall demonstration’s expiration date, the interim evaluation report must include an evaluation of the authority as approved by CMS.

c) The state must provide a draft Interim Evaluation Report for the corresponding years, no longer than one year after completion of the measurement period, as described in subpart “i.” and “ii” below. The state must submit a final Interim Evaluation Report for each measurement period sixty calendar days after receiving CMS comments on the draft Interim Evaluation Report and post the final Interim Evaluation Report for this period on the state's website.

i. A draft Interim Evaluation Report for the period from January 2019 through December 2022 will be due no later than December 31, 2023. ii. A draft Interim Evaluation Report for the period from January 2023 through December 2025 will be due no later than December 31 2026, with reference to analysis of the previous interim evaluation report. d) If the state is seeking to extend the demonstration, the last draft Interim Evaluation report,