Form CMS-10380 Cycle III - Final Report Template

Health Insurance Rate Review Grant Program
Cycle III Final 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: Final Report
10/1/2013-9/30/2015)

The purpose of the Final Grant Reports is to:
•
•
•
•

Summarize the rate review initiatives funded through the grant program over the course of
Cycle III
Describe the establishment and enhancement of an Effective Rate Review Program over the
course of Cycle III
Describe new pricing transparency initiatives at the Data Center over the course of Cycle III
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 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 Final 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 the health insurance rate review
and reporting processes.
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 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.

•

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 a final progress report to CCIIO’s Rate Review Grant Program.
The final progress report summarizes the significant advancements made towards the State’s
goal of improving its current health insurance rate review and reporting process, including
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 Final Report Template
progress toward an effective rate review program, over the course of the Cycle III Grant
Program.
The final report is due ninety days following the end of the Cycle III Rate Review Grant
Program. For example, for awardees completing grant activity by September 30, 2015 the final
Cycle III report is due by December 31, 2015. All final reports must be submitted electronically
through the Health Insurance Oversight System (HIOS). In the final grant year, this 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 final progress
report must detail how grants funds were utilized, describe program progress, and 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 Final Report Template
PART I: FINAL NARRATIVE REPORT FORMAT
Introduction:
The Final Narrative Report represents the culmination of activity and accomplishments
throughout the Cycle III Grant Program. 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 Program Implementation Status: Include a thorough discussion and update on progress
towards the following:

1. Final Accomplishments: Describe achieved implementation milestones and outcomes,
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 achieved this objective in Cycle III, Year One
when the legislation drafted in part by the DOI, passed both the House and Senate in
March 2012 and was signed by the Governor.” “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.
2. Challenges and Responses: 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 months? Describe future
plans to complete the originally proposed grant activities.
3. Describe any required variations from the original Rate Review Work Plan and
companion timeline.
Significant Activities: Undertaken and Planned:
Highlight the significant activities and major grant achievements accomplished. For states who
proposed 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. Please also describe activities, if any,
that you plan to continue after the completion of the grant program.
Public Access Activities:
Summarize activities and/or promising practices undertaken during Cycle III working towards
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 Final Report Template
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.

Materials Produced:
Discuss all materials produced and/or developed during over Cycle III, including website
upgrades, consumer materials, reports/studies, drafted legislation, and any other relevant
documents. 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).
Final Impact of the Cycle III Rate Review Grant Program:
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 your State.
Include data on 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.
Data Center (if funded for Data Center activities)
Summarize the overall impact Cycle III grant funds had on pricing transparency in the State over
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; furthered data dissemination; 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; efforts to
integrate multiple data sets. .
Do you plan on continuing any of these collaborations after the completion of the grant
program?
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 Final Report Template
Final 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? Which
practices will you continue to employ after completion of the grant program?

Final Budget:
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 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
final report submission. For States receiving new “Performance” funds please update the
programmatic budget accordingly.
Data Collection and Analysis:
Please provide concluding remarks on themes generated from the data collected throughout the
Cycle III Grant program: including, but not limited to:
1. Highlight important trends in the reported data over the course of Cycle I (if applicable)
and Cycle III
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, and
3. Describe the impact of the program on rising health insurance rates
4. Please elaborate on any other relevant themes that have emerged from the data over the
course of the Cycle III Rate Review Grant Program
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 Final Report Template
Final Evaluation:
Please attach a copy of the final evaluation. If the State requires more time to complete the final
evaluation of the grant program please provide an update on the progress toward a final
evaluation and timeline for submission.
Final Report Summary Statistics:
Please fill in the data as available below for all grant activity occurring during Cycle I (if
applicable) and Cycle III.
• 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)
• Money saved for consumers through rate review during the federal fiscal year: (Number,
if available)
• 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)
o Pricing data on Website: (Yes/No)
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

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 Final Report Template
Future Plans:
Describe the future plans of your State’s Rate Review Program and Data Center, including
current and future plans to work with the State’s Exchange Program, if applicable.

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.