CMS-10380 Cycle II - Quarterly Report Template

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template
Report Date

Organization Information
State
Project Title
Grant Project Director
(Name and Title)
Phone/Email
Grant Authorizing
Representative
Phone/Email

Grant Information
Date Grant Awarded
Amount Granted
Project Year
Phase (Phase I or Phase
II)
Project Reporting Period
(Example Quarter 1
10/1/2011-12/31/2011)
The purpose of the Cycle II Quarterly Grant Reports are to:
•
•
•

Provide the Rate Review Grant Program with a better understanding of the States’
Department of Insurance Rate Review Program and the rate review initiatives funded through
this grant program
Provide the Rate Review Grant Program with Quarterly Rate Filing Data
Provide the States participating in the Rate Review Grant Program with the opportunity to
share information, highlight successes and reflect upon the progress of their programs

1
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template
Grant Performance Period-Cycle II: Date of award through September 30, 2014
Section 1003 of the Affordable Care Act requires the Secretary of the Department of Health and
Human Services (HHS), in conjunction with the States, to establish a process for the annual
review of health insurance premiums to protect consumers from unreasonable, unjustified and/or
excessive rate increases. Section 2974 of the Public Health Service Act (PPACA Section 1003)
provides for a program of grants that enable states to improve the health insurance rate review
and reporting processes.
The goals of the Cycle II Rate Review Grant Program include:
•

Establishing or enhancing a meaningful and comprehensive effective rate review program
that is transparent to the public, enrollees, policyholders and to the Secretary, and under
which rate filings are thoroughly evaluated and, to the extent permitted by applicable State
law, approved or disapproved; as well as

•

Developing an infrastructure to collect, analyze, and report to the Secretary critical
information about rate review decisions and trends, including, to the extent permitted by
applicable State law, the approval and disapproval of proposed rate increases.

States are required to submit quarterly progress reports to CCIIO’s Rate Review Grant Program.
The quarterly progress report describes significant advancements towards the State’s goal of
improving its current health insurance rate review and reporting process beginning from the time
of approval through completion of the grant period.
Each quarterly report is due thirty days following the end of the Federal fiscal quarter. For
example the first Cycle II quarterly report is due by January 31, 2012. All quarterly reports must
be submitted electronically through the Health Insurance Oversight System (HIOS).
The following reporting guidelines are intended as a framework and can be modified when
agreed upon by the CCIIO Rate Review Grant Program and the State. A complete quarterly
progress report must detail how grants funds were utilized, describe program progress, barriers
and provide an update on the measurable objectives of the grant program.

2
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template
PART I: NARRATIVE REPORT FORMAT
Introduction:
Provide an overview of the project describing the proposed rate review enhancements and/or
development of an Effective Rate Review Program.
Program Implementation Status:
Include an update on progress towards the following:
1. Quarterly Accomplishments to Date: Describe achieved implementation milestones and
outcomes during the current quarter, include progress toward each stated goal, objective
and milestone outlined in the Rate Review Work Plan. Please quantify, for example:
“Objective 1 was to expand prior approval to the small group market.” “We worked
throughout quarter 1 and quarter two to draft such legislation.” Please also feel free to use
charts and graphs to highlight progress.
2. Quarterly Progress as, or toward, an Effective Rate Review Program: States that
currently do not have effective rate review programs in the individual and/or small group
market must achieve status as an effective rate review program by the end of the first year
of the grant program. Please discuss in detail, progress over the last grant quarter toward
an effective rate review program in the relevant market/s and include progress toward
meeting each of the criteria of an “effective rate review program. States that have not
achieved status as an Effective Rate Review Program in either or both markets must
describe the barriers and challenges faced. Per #1 above, include detailed progress
toward each stated goal, objective and milestone outlined in the original grant application
and the proposed Rate Review Work Plan toward an Effective Rate Review Program.
HHS may restrict future grant funds for certain grant activities if proposed milestones are
not met.
3. Challenges and Responses faced this year: Provide a detailed description of any
challenges encountered in implementing your program, the response and the outcome.
What, if any proposed grant activities were not completed during the prior twelve
months? Describe future plans to complete the originally proposed grant activities.
4. Describe any required variations from the original Rate Review Work Plan and
companion timeline.
Significant Activities: Undertaken and Planned
Discuss activities that occurred during the quarter, or anticipated to occur in the near future, that
3
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template
affect the progression of comprehensive rate review for your state. For States proposing
legislative enhancements to expand the scope of rate review activities, please provide a detailed
status update on the progress of all proposed grant activities undertaken in support of new
legislation. Please also describe any products produced during this reporting cycle, for example
an update to the DOI website, consumer materials, and/or any developed legislative materials.
Operational/Policy Developments/Issues
Identify all significant program developments/issues/problems that have occurred in the current
quarter, including legislative activity and proposed ways to rectify the barriers.
Public Access Activities
Summarize activities and/or promising practices undertaken during the previous quarter working
towards increased public access to rate review information for your state. Identify all barriers
associated with increasing public access to rates and rate filing information and proposed ways to
rectify the barriers.
Collaborative efforts
Describe any collaborative efforts in place that that are advancing the objectives of the Rate
Review Program in your state.
Lessons Learned
Provide additional information on lessons learned and any promising practices.
Updated Budget
Provide a detailed account of expenditures to date and describe whether the current allocation of
funds follows the progression of the detailed budget provided in your original application. Also
provide any unforeseen expense and a brief description of the event that led to its occurrence.
Attach an updated detailed budget, including an updated SF 424 as necessary, with the State’s
quarterly report submission.
Updated Rate Review Work Plan and Timeline
If necessary, provide an updated Rate Review Work Plan and timeline to reflect the events of the
previous quarter. Highlight any additional time frames or items that were not included on the
State’s original submission as well as completion of milestones.
Data Collection and Analysis
The required rate filing data due on a quarterly basis are described in Part II: Health Insurance
Rate Data Collection, as part of the quarterly report narrative, please discuss the following:
1. Highlight important trends in the quarterly reported data
4
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template
2. Provide additional context for any denied rate filings, for example if a rate filing was
initially denied,or renegotiated please discuss the rate review process and final rate filing
disposition, and
3. If using SERFF, describe any discrepancies between the SERFF reported data and state
rate filing collection, review and approval data for the quarter.

Updated Evaluation Plan
Please provide an updates to the evaluation plan originally described in the Cycle II Rate Review
Grant application, including updates to the established measurable objectives, key indicators, and
methods to monitor progress. If planning to contract for a Cycle II evaluation, please provide a
quarterly update.
Quarterly Report Summary Statistics:
Please provide the data as available below include activities new this quarter and occurring to
date with Rate Review Grant Funds:
• Total Funds Expended to date: (Insert Number)
• Total Staff Hired (new this quarter and hired to date with grant funds): (Insert Number)
• Total Contracts in Place (new this quarter and established to date): (Insert Number)
• Introduced Legislation: (Yes/No)
• Enhanced IT for Rate Review: (Yes/No)
• Submitted Rate Filing Data to HHS: (Yes/No)
• Enhanced Consumer Protections: (Yes/No)
o Consumer-Friendly Website: (Yes/No)
o Rate Filings on Website: (Yes/No)
Enclosures/Attachments
Identify by title any attachments along with a brief description of what information the
documents contain.

5
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template

PART II: HEALTH INSURANCE RATE DATA COLLECTION
The data for Tables A-E (provided below) and the Rate Filing Detailed Data Elements will be
submitted through the Health Insurance Oversight System (HIOS). The rate filing data can
either be downloaded through the SERFF system or uploaded directly by the States (for states
not employing SERFF) into the HIOS system. States do not need to also input the data into the
programmatic narrative report template displayed here.
Tables A-E: Rate Volume Tables
If using SERFF to import your data into the HIOS System, please discuss any discrepancies
between the imported data and State records.

Table A. Rate Review Volume
State
Quarter 1
Number of
submitted rate
filings
Number of
policy rate
filings requesting
increase in
premiums
Number of
filings reviewed
for approval,
denial,
acceptance etc.
Number of
filings approved
Number of
filings denied
Number of
filings deferred

Quarter 2

Quarter 3

Quarter 4

Annual Total

6
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template

Table B. Number and Percentage of Rate Filings Reviewed – Individual Group
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Annual Total
Product Type
(PPO, HMO,
etc.)
Number of
Policy
Holders
Number of
covered lives
affected
Table C. Number and Percentage of Rate Filings Reviewed – Small Group
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Product Type
(PPO, HMO,
etc.)
Number of
Policy
Holders
Number of
covered lives
affected
Table D. Number and Percentage of Rate Filings Reviewed – Large Group
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Product Type
(PPO, HMO,
etc.)
Number of
Policy
Holders
Number of
covered lives
affected

Annual Total

Annual Total

7
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Health Insurance Rate Review Grant Program
Cycle II Quarterly Report Template

Table E. (SERFF Users): Number and Percentage of Rate Filings Reviewed –Combined
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Annual Total
Product Type
(PPO, HMO,
etc.)
Number of
Policy
Holders
Number of
covered lives
affected
Rate Filing Detailed Data Elements: Please refer to the Enclosure for the updated Rate Filing
Detailed Data Elements. Please note all the data collected for the Rate Filing Detailed Data
Elements will be collected at the level of the rate filing.

8
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0938-1121. The time required to complete this information collection is estimated to average 24 hours per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.