Common use of PFS Project Reporting Clause in Contracts

PFS Project Reporting. 1. Reports will take the forms provided for in the Appendix hereto, and will be delivered in accordance with the table below: Appendix 1: Sample Program Output Summary Report Annex G - Description of PFS Outcome Metrics Outcome Definition Data Source Measurement Participant- Level Measurement Preterm birth Live xxxxxxxxx birth where the obstetric estimate of gestation in completed weeks is less than 37. For births without an obstetric estimate of gestation, gestation will be calculated from the self- reported date of last menses. Birth Certificate Obstetric estimate of gestation < 37 weeks Binary – Yes or No (i.e. birth was preterm or birth was not preterm) Child Injury Child emergency department visits (outpatient) and hospitalizations (inpatient) of the index birth due to acute injury within the 24 month period following the first child’s date of birth Inpatient and Emergency Department hospital claims from all hospitals in South Carolina’s Medicaid Service Area (all-payer database) Number of unique hospital admissions with a claim containing one or more of the following Any of T01 to T35; T51 to T78; or T36 to T50 if the intent code is between 1 and 4; (for example, only if the sixth character of the 7-character code is between 1 and 4 such as T36.xx4x); or any S code in the first 3 diagnoses positions of the record; or any of the ICD-10 codes above in any position when an ICD10 external cause of injury code is indicated on the record. Should codes be updated differently than anticipated or again during the project period, the Independent Evaluator will consult with an expert mutually agreed to by the Parties and propose a revised definition, which may be approved by the Executive Committee without requiring an amendment to this Agreement. Numerical - # of unique admissions Healthy Birth Interval No subsequent live births observed within 24 months of the index birth, where subsequent multiple births only count as one birth. Birth Certificate No subsequent live birth occurring 24 months or less from the initial child’s date of birth Binary – Yes or No (i.e. there was a subsequent delivery within 24 months or there was not a subsequent delivery within 24 months) Coverage in LIZCs Primary residential address within a LIZC at the time of enrollment into the NFP Program as reported by a PFS Participant Participant roster retained by PFS Evaluator Total Number of PFS Study Participants with a primary residential address within a LIZC / Total Number of PFS Study Participants Binary – Yes or No (i.e. participant resided in a LIZC at the time of enrollment or participant did not reside in a LIZC at the time of enrollment)

PFS Project Reporting. 1. Reports will take the forms provided for in the Appendix hereto, and will be delivered in accordance with the table below: Appendix 1: Sample Program Output Summary Report Annex G - Description of PFS Outcome Metrics Outcome Definition Data Source Measurement Participant- Level Measurement Preterm birth Live xxxxxxxxx birth where the obstetric estimate of gestation in completed weeks is less than 37. For births without an obstetric estimate of gestation, gestation will be calculated from the self- reported date of last menses. Birth Certificate Obstetric estimate of gestation < 37 weeks Binary – Yes or No (i.e. birth was preterm or birth was not preterm) Number of unique hospital admissions with a claim containing one or more of the following Any of T01 to T35; T51 to T78; or T36 to T50 if the intent code is between 1 and 4; (for example, only if the sixth character of the 7-character code is Child Injury Child emergency department visits (outpatient) and hospitalizations (inpatient) of the index birth due to acute injury within the 24 month period following the first child’s date of birth Inpatient and Emergency Department hospital claims from all hospitals in South Carolina’s Medicaid Service Area (all-payer database) Number of unique hospital admissions with a claim containing one or more of the following Any of T01 to T35; T51 to T78; or T36 to T50 if the intent code is between 1 and 4; (for example, only if the sixth character of the 7-character code is between 1 and 4 such as T36.xx4x); or any S code in the first 3 diagnoses positions of the record; or any of the ICD-10 codes above in any position when an ICD10 external cause of injury code is indicated on the record. Should codes be updated differently than anticipated or again during the project period, the Independent Numerical - # of unique admissions Evaluator will consult with an expert mutually agreed to by the Parties and propose a revised definition, which may be approved by the Executive Committee without requiring an amendment to this Agreement. Numerical - # of unique admissions Healthy Birth Interval No subsequent live births □O□birtLh□s Y observed within 24 months of the index birth, where subsequent multiple births only count as one birth. Birth Certificate No subsequent live birth occurring 24 months or less from the initial child’s date of birth Binary – Yes or No (i.e. there was a subsequent delivery within 24 months or there was not a subsequent delivery within 24 months) Coverage in LIZCs Primary residential address within a LIZC at the time of enrollment into the NFP Program as reported by a PFS Participant Participant roster retained by PFS Evaluator Total Number of PFS Study Participants with a primary residential address within a LIZC / Total Number of PFS Study Participants Binary – Yes or No (i.e. participant resided in a LIZC at the time of enrollment or participant did not reside in a LIZC at the time of enrollment)

PFS Project Reporting. 1. Reports will take the forms provided for in the Appendix hereto, and will be delivered in accordance with the table below: Appendix 1: Sample Program Output Summary Report Annex G - Description of PFS Outcome Metrics Outcome Definition Data Source Measurement Participant- Level Measurement Preterm birth Live xxxxxxxxx birth where the obstetric estimate of gestation in completed weeks is less than 37. For births without an obstetric estimate of gestation, gestation will be calculated from the self- reported date of last menses. Birth Certificate Obstetric estimate of gestation < 37 weeks Binary – Yes or No (i.e. birth was preterm or birth was not preterm) Child Injury Child emergency department visits (outpatient) and hospitalizations (inpatient) of the index birth due to acute injury within the 24 month period following the first child’s date of birth Inpatient and Emergency Department hospital claims from all hospitals in South Carolina’s Medicaid Service Area (all-payer database) Number of unique hospital admissions with a claim containing one or more of the following Any of T01 to T35; T51 to T78; or T36 to T50 if the intent code is between 1 and 4; (for example, only if the sixth character of the 7-character code is between 1 and 4 such as T36.xx4x); or any S code in the first 3 diagnoses positions of the record; or any of the ICD-10 codes above in any position when an ICD10 external cause of injury code is indicated on the record. Should codes be updated differently than anticipated or again during the project period, the Independent Evaluator will consult with an expert mutually agreed to by the Parties and propose a revised definition, which may be approved by the Executive Committee without requiring an amendment to this Agreement. Numerical - # of unique admissions Healthy Birth Interval No subsequent live births observed within 24 months of the index birth, where subsequent multiple births only count as one birth. Birth Certificate No subsequent live birth occurring 24 months or less from the initial child’s date of birth Binary – Yes or No (i.e. there was a subsequent delivery within 24 months or there was not a subsequent delivery within 24 months) Coverage in LIZCs Primary residential address within a LIZC at the time of enrollment into the NFP Program as reported by a PFS Participant Participant roster retained by PFS Evaluator Total Number of PFS Study Participants with a primary residential address within a LIZC / Total Number of PFS Study Participants Binary – Yes or No (i.e. participant resided in a LIZC at the time of enrollment or participant did not reside in a LIZC at the time of enrollment)) Funds from the PFS Success Fund shall be used to make PFS Success Payments for the PFS Project. The amount of PFS Success Payments shall be determined by the PFS Impact Estimates for each of the four (4) PFS Outcome Metrics and the number of Project Participants. The PFS Impact Estimates for the four (4) PFS Outcome Metrics shall be calculated by the Independent Evaluator in accordance with the methodology outlined in Annex E. The four (4) PFS Outcome Metrics are: 1. Preterm Birth 2. Healthy Birth Interval 3. Child Injury 4. Coverage of LIZCs Two (2) PFS Success Payments, PFS Success Payment 1 and PFS Success Payment 2, shall be made in accordance with the timeline set forth in Articles V and VI of this Annex H. The maximum aggregate amount of PFS Success Payments for the PFS Project shall not exceed $7,500,000. Even if the sum of PFS Success Payment 1 and PFS Success Payment 2 exceeds $7,500,000, the total PFS Success Payment shall equal $7,500,000. The inputs to calculate the amount of the PFS Success Payment 1 and PFS Success Payment 2 shall be (a) the PFS Outcome Metric benefit (“Metric Benefit”) for each PFS Outcome Metric in accordance with Article II of this Annex and (b) SCDHHS’s share of the HV Pilot Waiver expenditures (“SCDHHS Waiver Expenditures”) in accordance with Article III of this Annex. For the purpose of calculating the SCDHHS Waiver Expenditures to determine the PFS Success Payments, SCDHHS’s share of the total HV Pilot Waiver expenditures shall be held constant at 28.92 percent of the total HV Pilot Waiver expenditures.

PFS Project Reporting. 1. Reports will take the forms provided for in the Appendix hereto, and will be delivered in accordance with the table below: Appendix 1: Sample Program Output Summary Report Annex G - Description of PFS Outcome Metrics Outcome Definition Data Source Measurement Participant- Level Measurement Preterm birth Live xxxxxxxxx birth where the obstetric estimate of gestation in completed weeks is less than 37. For births without an obstetric estimate of gestation, gestation will be calculated from the self- reported date of last menses. Birth Certificate Obstetric estimate of gestation < 37 weeks Binary – Yes ±Yes or No (i.e. birth was preterm or birth was not preterm) Child Injury Child emergency department visits (outpatient) and hospitalizations (inpatient) of the index birth due to acute injury within the 24 month period following the first child’s date of birth Inpatient and Emergency Department hospital claims from all hospitals in South Carolina’s Medicaid Service Area (all-payer database) Number of unique hospital admissions with a claim containing one or more of the following Any of T01 to T35; T51 to T78; or T36 to T50 if the intent code is between 1 and 4; (for example, only if the sixth character of the 7-character code is Child Injury Child emergency department visits (outpatient) and hospitalizations (inpatient) of the index birth due to acute injury within the 24 month period following the first FKLOG¶ofVbirthGDW Inpatient and Emergency Department hospital claims from all hospitals in South Carolina¶V Medicaid Service Area (all-payer database) between 1 and 4 such as T36.xx4x); or any S code in the first 3 diagnoses positions of the record; or any of the ICD-10 codes above in any position when an ICD10 external cause of injury code is indicated on the record. Should codes be updated differently than anticipated or again during the project period, the Independent Numerical - # of unique admissions Evaluator will consult with an expert mutually agreed to by the Parties and propose a revised definition, which may be approved by the Executive Committee without requiring an amendment to this Agreement. Numerical - # of unique admissions Healthy Birth Interval No subsequent live births □O□birtLh□s Y observed within 24 months of the index birth, where subsequent multiple births only count as one birth. Birth Certificate No subsequent live birth occurring 24 months or less from the initial child’s OHVV IURP WK date of birth Binary – Yes ±Yes or No (i.e. there was a subsequent delivery within 24 months or there was not a subsequent delivery within 24 months) Coverage in LIZCs Primary residential address within a LIZC at the time of enrollment into the NFP Program as reported by a PFS Participant Participant roster retained by PFS Evaluator Total Number of PFS Study Participants with a primary residential address within a LIZC / Total Number of PFS Study Participants Binary – Yes ±Yes or No (i.e. participant resided in a LIZC at the time of enrollment or participant did not reside in a LIZC at the time of enrollment)