CMS-10380 Cycle 1 - Final report template

Health Insurance Rate Review Grant Program
Cycle I Final Report Template

Submission Date:
State:
Project Title:
Project Reporting Period:
Example: Final Report (08/09/2010-9/30/2011)
Grant Project Director (name and title):
Email:
Phone:
Grant Authorizing Representative:
Email:
Phone:

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 40 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 I Final Report Template

Grant Performance Period-Cycle I: August 9, 2010 to September 30, 2011

Reporting Period:
Quarterly Report 1:
Quarterly Report 2:
Quarterly Report 3:
Quarterly Report 4:
Final Report:
Timeframe for Delivery:

August 9, 2010 through December 31, 2010
January 1, 2011 through March 31, 2011
April 1, 2011 through June 30, 2011
July 1, 2011 through September 30, 2011
August 9, 2010 through September 30, 2011
January 31, 2011-February, 28, 2011
April 30, 2011
July 31, 2011
October 31, 2011
December 31, 2011

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.
States are required to submit quarterly progress reports and a final report to OCIIO. The final
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.
The final report must be submitted by December 31, 2011 and 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 OCIIO grant project officer and the State. A complete final 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 40 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 I Final Report Template
PART I: FINAL NARRATIVE REPORT FORMAT
Introduction:
The Final Narrative Report represents the culmination of Cycle I activity and accomplishments.
In the Final Narrative Report please support your explanations of grant progress with
quantitative data when available and other evidence to support the success of your Rate Review
Program.
Final Progress Summary:
Please provide final information on the below categories.
• Total Funds Expended: (Insert Number)
• Total Staff Hired: (Insert Number)
• Total Contracts in Place: (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)

Program Implementation Status:
As relevant to your project, include a discussion and update on progress towards:
1. Accomplishments of Cycle I: List the objectivities originally established in grant
application and describe the extent to which you achieved the established objectives and
goals in Cycle I (please refer back to your original application submission and describe in
detail). Describe how you measured your success for each objective, including the
indicators established to track your progress.
2. Challenges and Responses: Describe major challenges in implementing Cycle I grant
activities and responses to such challenges.
Significant Activities Undertaken:
Discuss activities that occurred during Cycle I that affected the progression of comprehensive
rate review for your state. For States that proposed 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.

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 40 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 I Final Report Template
Significant Activities Unmet:
Discuss activities that were originally planned in the Cycle I grant application and were not
achieved during Cycle I. Identify whether the State plans to continue to strive to meet such
activities through the use of a no-cost extension, Cycle II grant funds, or not at all.

Operational/Policy Developments/Issues:
Identify all significant program developments/issues/problems that occurred during Cycle I,
including an explanation of why certain activities may not have been met and how you plan (if
applicable) to overcome these obstacles through the use of a No Cost Extension or Cycle II grant
funds.
Final Rate Filing Data Summary:
Highlight important trends in the reported rate filing data from Cycle I, for example as part of the
final report narrative, please discuss the following:
1. Increase/s in the number of rate filings accepted, reviewed and reported
2. Provide additional context for any denied rate filings over the past twelve months, for
example if a rate filing was initially denied, or renegotiated please discuss the process
and final disposition
3. Describe the impact of the program on rising health insurance rates

Public Access Activities:
Summarize activities and/or promising practices undertaken during Cycle I 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 established during Cycle I that advanced the objectives of the
Rate Review Program in your State.
Materials Produced During Cycle I:
Discuss any materials produced or developed during Cycle I, including website upgrades,
consumer materials, reports/studies, drafted legislation, and any other relevant products. Please
provide detail where available. For example, if a new website or rate review webpage was
developed, please provide the link, date the website went live, number of visitors to the website
(total or monthly).

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 40 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 I Final Report Template
Impact:
Summarize the overall impact of Cycle I grant funds on the rate review process in your State.
Include how the grant program enhanced the public’s understanding of the rate review process,
the impact of the program on the number of filings reviewed, the degree to which the state
established a more meaningful and comprehensive rate review process, and finally, how the
grant funds improved and enhanced the overall mission of the Department of Insurance. Provide
evidence when available. Examples may include personal stories, anecdotal evidence, media
articles/mentions, etc.
Lessons Learned:
Provide additional information on lessons learned and any practices that would enable continued
enhancement of the Rate Review program.
Final Budget Summary:
Provide a detailed account of expenditures to date and describe whether the current allocation of
funds followed the progression of the detailed budget provided in your original application. Also
provide any unforeseen expenses and a brief description of the event that led to its occurrence.
Attach a final detailed budget with the State’s final report submission.
Final Work Plan and Timeline:
Provide a final work plan and/or timeline reflecting events that took place during Cycle I and
when such activities were completed. Note planned events that were not completed.
Enclosures/Attachments:
Identify by title any attachments along with a brief description of what information the document
contains.

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 40 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 I Final 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 working with SERFF) into the HIOS system. States do not need to also input the data into
the programmatic narrative report template displayed here.
If using SERFF to import your data into the HIOS System, please discuss any discrepancies
between the imported data and State records.
Tables A-D: Rate Volume Tables
Table A. Rate Review Volume
State
Quarter 1

Quarter 2

Quarter 3

Quarter 4

Annual
Total

Number of
submitted rate
filings
Number of
policy rate
filings
requesting
increase in
premiums
Number of
filings reviewed
for
approval/denial,
etc.
Number of
filings
approved
Number of
filings denied
Number of
filings deferred
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 40 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 I Final Report Template
Table B. Number and Percentage of Rate Filings Reviewed – Individual Group
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Annual Total
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
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
Number of
covered lives
affected

Annual Total

Annual Total

Table E. (SERFF Users): Number and Percentage of Rate Filings Reviewed –Combined
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Annual Total
Number of
covered lives
affected

Rate Filing Detailed Data Elements: Please refer to the Enclosure for the updated Rate Filing
Detailed Data Elements (originally Attachment C the “Data Dictionary”).

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 40 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.