Form CMS-10380 Cycle III - Annual Reporting Template

Health Insurance Rate Review Grant Program
Cycle III Annual 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
Project Reporting Period
(Example: Annual Report
10/1/2013-9/30/2014)

The purpose of the Annual Grant Report is to:
•
•
•
•

Summarize the Rate Review, Required Rate Reporting and Data Center initiatives funded
through the grant program over the prior year
Describe the establishment and enhancement of an Effective Rate Review Program over the
prior year
Describe new pricing transparency initiatives at the funded Data Center over the prior year
Provide the States participating in Cycle III of the Rate Review and Pricing Transparency
Grant 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 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 III Annual Report Template
Grant Performance Period-Cycle III: TBD
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 health insurance rate review and
increase pricing transparency.
The statute indicates that the program serves the following purposes:
(1) Establish or enhance rate review programs, referred to in the Cycle III Funding
Opportunity Announcement (FOA) as “Rate Review” activities;
(2) Help states to provide data to the Secretary regarding trends in rate increases as well
as recommendations regarding plan participation in the Exchange, denoted as “Required
Rate Reporting” activities in the Cycle III FOA; and
(3) Establish Data Centers that collect, analyze, and disseminate health care pricing data
to the public, denoted as “Data Center” activities in the Cycle III FOA.
The goals of the Cycle III 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.

•

Developing and enhancing Data Centers that provide pricing data in a transparent, userfriendly way to consumers, employers, researchers, entrepreneurs, non-profit organizations,
and other government agencies in order to improve the value of care delivered in the state.

States are required to submit annual progress reports to CCIIO’s Rate Review Grant Program.
The annual progress report describes significant advancements towards the State’s goal of
improving its current health insurance rate review process and/or pricing transparency, over the
prior twelve month period.
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 III Annual Report Template
Each annual report is due sixty days following the end of the Federal fiscal year. The Cycle III
annual report is due by November 30, 2014. All annual reports must be submitted electronically
through the Health Insurance Oversight System (HIOS). For the final grant year, the Cycle III
Final Report will replace the Cycle III Annual Report.
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 annual
progress report must detail how grant funds were utilized, describe program progress, barriers
and provide an update on the measurable objectives of the grant program.

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 III Annual Report Template
PART I: NARRATIVE REPORT FORMAT
Introduction:
Provide an overview of the project describing the proposed rate review enhancements;
development of an Effective Rate Review Program; and/or development or enhancement of a
Data Center. Clearly articulate annual progress toward the goals, measurable objectives, and
milestones for each proposed activity. Provide updates to the original grant proposal where
necessary.
Annual Program Implementation Status: Include an update on progress towards the
following:
1. Annual Accomplishments to Date: Describe achieved implementation milestones and
outcomes, include progress toward each stated goal, objective and milestone outlined in
the 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, which passed both the House and Senate in March 2012.” “Objective 2
was to establish a value report, presenting pricing data in coordination with quality data.”
“We created a value report, displaying the intersection of prices and quality in health care
on our website.” Please also feel free to use charts and graphs to highlight progress. HHS
may restrict future grant funds for certain grant activities if proposed milestones are not
met.
2. Annual Progress as, or toward, an Effective Rate Review Program (Applies only to states
that applied for funds for Rate Review or Required Rate Reporting Activities): 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 year
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 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
encountered challenges in implementing your program, the response and the outcome.
What, if any proposed grant activities were not completed during the prior twelve
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 III Annual Report Template
months? Describe future plans to complete the originally proposed grant activities.
4. Describe any required variations from the original Work Plan and companion timeline.
Significant Activities: Undertaken and Planned
Discuss activities that occurred during the past year and/or anticipated to occur in the near future,
that affect the progression of comprehensive rate review and/or pricing transparency for your
state. For states proposing legislative or regulatory enhancements to expand the scope of rate
review or Data Center activities, please provide a detailed status update on the progress of the
grant activities undertaken in support of the new legislation or regulation.
Operational/Policy Developments/Issues
Identify all significant program developments/issues/problems that have occurred during Cycle
III, including legislative activity and proposed ways to rectify the barriers.
Public Access Activities
Summarize activities and/or promising practices undertaken during Cycle III working towards
increased public access to rate review and/or health pricing data, as appropriate. Identify all
barriers associated with increasing public access to rates, rate filing information, and/or health
pricing data, as appropriate. Identify all proposed ways to rectify the barriers.
Materials Produced:
Discuss any materials produced or developed during over the past year, including website
upgrades, consumer materials, reports, studies, drafted legislation, drafted regulations, and any
other relevant documents. Please provide detail where available. For example, if a new website
or web application was developed, please provide the link, date the website went live, number of
visitors to the website (total or monthly).
Annual Impact:
Rate Review (if funded for Rate Review activities or Required Rate Reporting)
Summarize the overall impact Cycle III grant funds had on the rate review process in the State
over the past twelve months. 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
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.
Data Center (if funded for Data Center activities)
Summarize the overall impact Cycle III grant funds had on pricing transparency in the State over
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 III Annual Report Template
the past twelve months. Include how the grant program enhanced the public’s understanding of
health pricing and costs; created new web-based tools; supported research on health care costs,
pricing, and value; supported the integration and harmonization of data with other public and
private partners; and finally, how the grant funds improved and enhanced the overall mission of
your agency. Provide evidence when available. Examples may include personal stories,
anecdotal evidence, media articles/mentions, etc.

Collaborative efforts
Describe collaborative efforts in place that that are advancing the objectives of the Rate Review
Program or pricing transparency in your state. Those states funded for pricing transparency
should describe the following (as applicable): efforts to collaborate with state and federal
partners; efforts to support harmonization of data with other datasets and data partners, such as
agencies posting quality data; and efforts to integrate datasets.
Annual Lessons Learned
Provide additional information on lessons learned and any promising practices. For example,
what approaches in your implementation strategy worked/are working and why?
Annual 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
annual report submission. For States receiving new “Performance” funds please update the
programmatic budget accordingly.
Updated Work Plan and Timeline
If necessary, provide an updated Work Plan and timeline to reflect the events of Cycle III.
Highlight any additional time frames or items that were not included on the state’s original
submission as well as completion of milestones.
Pricing Data Collection and Analysis
Please provide an overview of the analysis performed on pricing, cost, and charge data collected
and analyzed by the state.
1. Identify cost, price, and charge data sets and metrics collected.
2. Describe quality control and cleaning methodologies applied to the data.
3. Describe analytical and statistical methodologies applied to the data.
4. Highlight important trends and findings in the reported data.
5. Describe the use of data by external partners.
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 III Annual Report Template
Required Rate Reporting
The required rate filing data due on a quarterly basis are described below in Part II: Health
Insurance Rate Data Collection, as part of the annual report narrative, please discuss the
following:
1. Highlight important trends in the reported data
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. If using SERFF, describe any discrepancies between the SERFF reported data and state
rate filing collection, review and approval data over the past year
Updated Evaluation Plan
Please provide an update to the evaluation plan originally described in the Cycle III application,
including updates to the established measurable objectives, key indicators, and methods and/or
resources to monitor progress. If contracting for an evaluation, discuss progress with the
contract.
Annual Report Summary Statistics:
(In the future, these data may be reported electronically via HIOS)
Please fill in the data as available below for grant activity occurring over the past year.
• Total Funds Expended to date: (Insert Number)
Rate Review and Required Rate Reporting Activities
• Total Staff Hired for Rate Review and Required Rate Reporting (new this quarter and
hired to date with grant funds): (Insert Number)
• Total Contracts in Place for Rate Review and Required Rate Reporting (new this quarter
and established to date): (Insert Number)
• Introduced Legislation for rate review: (Yes/No)
• Money saved for consumers through rate review during the federal fiscal year: (Number,
if available)
• Enhanced IT for Rate Review: (Yes/No)
• Enhanced Consumer Protections: (Yes/No)
o Rate Filings on Website: (Yes/No)
o Pricing data on Website: (Yes/No)

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.

Health Insurance Rate Review Grant Program
Cycle III Annual Report Template
Data Center Activities
• Total Staff Hired for Data Center (new this quarter and hired to date with grant funds):
(Insert Number)
• Total Contracts in Place for Data Center (new this quarter and established to date): (Insert
Number)
• Enhanced IT for Data Center: (Yes/No)
• Gained access to new or more comprehensive data sets: (Yes/No)
• Enhanced availability of pricing data to the public: (Yes/No)
o Provided new pricing data on website: (Yes/No)
o Created new report cards or applications that allow consumers to quickly and
easily access pricing data: (Yes/No)
o Integrated pricing data with other health care data sets: (Yes/No)
o Tested new website applications and reports with consumers and/or through
usability testing: (Yes/No)
o Number of website hits (Annual): Number
 Total (Annual): Number
 New visitors (Number): Number

Enclosures/Attachments
Identify by title any attachments along with a brief description of the information the document/s
contain.

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 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 III Annual 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 rates
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

Note: “Number of filings deferred” refers to rate filings without a final disposition at the
end of the reporting period.

9
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 III Annual 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”).

10
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.