CMS-10605 Quarterly Report Template

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I 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
Cycle
Project Reporting Period
(Example Quarter 1
10/1/2016-12/30/2016)

The purpose of the Cycle I Quarterly Grant Reports is to:




Provide the Health Insurance Enforcement and Consumer Protections Grant Program with a
better understanding of the States’ progress towards planning and/or implementing several of
the Affordable Care Act (ACA) market reforms under Part A of Title XXVII of the Public
Health Service Act (PHS) funded through this grant program
Provide States participating in the Health Insurance Enforcement and Consumer Protections
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-NEW.The time required to complete this information collection is estimated to average 26 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.
Exp. Date: xx/xxxx

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I Quarterly Report Template
Grant Performance Period-Cycle I: October 19, 2016 - October 18, 2018
The provisions in Part A of title XXVII of the Public Health Service (PHS) Act include marketwide reforms in the group and individual private health insurance markets intended to protect
consumers, increase transparency, and regulate health insurance industry practices.
One of the goals of the Cycle I Health Insurance Enforcement and Consumer Protections Grant
Program is to provide States with the opportunity to ensure their laws, regulations, and
procedures are in line with Federal law and that they are able to effectively enforce the preselected market reform provisions under Part A of title XXVII of the PHS Act.
States are required to submit quarterly progress reports to CCIIO’s Health Insurance
Enforcement and Consumer Protections Grant Program. The quarterly progress report describes
significant advancements towards the State’s goal of planning and/or implementing the preselected ACA market reform activities at the beginning from the time of approval through
completion of the grant period.
Funding under the Health Insurance Enforcement and Consumer Protections Grant Program,
Cycle I was made available to States for activities related to planning and/or implementing the
following pre-selected provisions of Part A of title XXVII of the PHS Act:
I.
II.
III.
IV.
V.

Section 2707 - Non-discrimination under Comprehensive Health Insurance Coverage
(Essential Health Benefits Package)
Section 2713 - Coverage of Preventive Health Services
Section 2718 - Bringing down the Cost of Health Care Coverage (MLR)
Section 2719 - Appeals Process
Section 2726 - Parity in Mental Health and Substance Use Disorder Benefits

Each quarterly report is due thirty days following the end of the Federal fiscal quarter. For
example the first Cycle I quarterly report is due by January 30, 2017. 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 Health Insurance Enforcement and Consumer Protections Grant
Program and the State. A complete quarterly progress report must detail how grants funds are
being 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-NEW. The time required to complete this information collection is estimated to average 26 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.

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I Quarterly Report Template
PART I: NARRATIVE REPORT FORMAT
Introduction:
Provide an overview of the project describing the proposed planning and/or implementing of the
pre-selected market reforms activities under Part A of Title XXVII of the PHS Act.
In answering the questions below, clearly articulate the quarterly progress made under the grant,
towards the goals, measurable objectives, and milestones for each proposed enhancement of the
market reforms under Part A of Title XXVII of the Public Health Service (PHS) Act.
In order to provide metrics for CMS to monitor the progress of each activity, grantees are
required to report quantitative measurements using the following Progress Metrics Guide:
Level of Stages

Description of Stages

Stage 0

No work has begun on stated goal.

Stage 1

Project Plan has been created and staff has
been assigned to task. The work on achieving
the goal has initially begun.

Stage 2

Goal of the Project Plan is underway, and any
refinements or adjustments to original Project
Plan were made.

Stage 3

Goal of the Project Plan is half way complete
and continuously being worked on.

Stage 4

Deliverables are beginning to finalize and
proposed goals are nearly completed.

Stage 5

100% of stated goal has been completely
achieved.

EXAMPLE: “We worked throughout quarter 1 and quarter 2 to hire staff. We hired one new
staff member, and are continuing to look for a second hire. Objective 1: Stage 3.”

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-NEW.The time required to complete this information collection is estimated to average 26 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.

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I Quarterly Report Template
Please use this guide when answering the following questions. In addition, please use charts
and graphs to highlight progress when appropriate.
Program Implementation Status:
Include an update on progress towards the following:
1. Accomplishments to Date: Describe achieved implementation milestones and outcomes
during the current quarter, include the above Progress Metrics towards each stated goal,
objective and milestone outlined in the Health Insurance Enforcement and Consumer
Protections Grant Work Plan.
2. Progress as, or towards, becoming or maintaining an active enforcement role of the ACA
Market Reforms: For States that are currently enforcing the ACA market reforms, the
States must discuss how the grant is helping them maintain their active enforcement role
for the ACA market reforms. A State that is not currently enforcing the ACA market
reforms under Part A of Title XXXVII of the PHS Act must transition to an active
enforcement role for all ACA market reforms by the end of the first year and a half of the
grant program and must describe the barriers and challenges faced. Please discuss in
detail, progress over the past quarter towards transitioning to an active enforcement role
for all ACA market reforms. Per the instructions given in question #1 above, please
include detailed progress towards each stated goal, objective and milestone outlined in
the original grant application and the proposed Health Insurance Enforcement and
Consumer Protections Grant Work Plan. In your explanation, please include the above
Progress Metrics guide (where necessary) to indicate progress. HHS may restrict future
grant funds for certain grant activities if proposed milestones are not met.
3. Challenges faced this quarter: Provide a detailed description of any challenges
encountered in implementing your program, the response and the outcome. Please
include a list of any proposed grant activities that were not completed during the quarter,
or are behind schedule. Please include Progress Metrics for each activity that was not
completed or is behind schedule. Describe future plans to complete the originally
proposed grant activities.
4. Variations of Work Plan and Timeline: List any required variations from the original
Work Plan and companion timeline. Provide explanation for variations and provide
Progress Metrics where necessary.
Significant Activities: Undertaken and Planned
Please list the most significant activities that occurred during the quarter, or are anticipated to
occur in the near future, that affect the progression of implementing the pre-selected ACA
market reforms for your State. Please include Progress Metrics to illustrate any progress.
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-NEW. The time required to complete this information collection is estimated to average 26 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.

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I Quarterly Report Template

Public Activities
Summarize activities and/or promising practices undertaken during the previous quarter working
towards increased public access and awareness from the pre-selected ACA market reforms
activities for your State. To illustrate progress, please include Progress Metrics for each activity
or practice.
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-424A as necessary, with the State’s
quarterly report submission.
Work Plan and Timeline with Progress Metrics
Provide the Work Plan and Timeline with updated Progress Metrics 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. Please continue to use the
Progress Metric guide, and assign a measurement to each objective outlined in the work plan.
Updated Evaluation Plan
Please provide any updates to the Evaluation Plan originally described in the Cycle I Health
Insurance Enforcement and Consumer Protections Grant application, including updates to the
established measurable objectives, key indicators, and methods to monitor progress. If planning
to contract for a Cycle I evaluation, please provide a quarterly update.
Quarterly Report Summary Statistics:
Please provide the data below:
Quarterly
Statistics

FFY17
Quarter
1

FFY17
Quarter
2

FFY17
Quarter
3

FFY17
Quarter
4

FFY18
Quarter
1

FFY18
Quarter
2

FFY18
Quarter
3

FFY18
Quarter
4

Total

Funds
Expended
Number of
Staff
Hired with
Grant
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-NEW. The time required to complete this information collection is estimated to average 26 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.

The Health Insurance Enforcement and Consumer Protections Grant Program
Cycle I Quarterly Report Template
Funds
Number of
Contracts
in place
with Grant
Funds
Number of
ACA
Market
Reforms
Provision
Funded by
Grant. List
Provisions

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-NEW. The time required to complete this information collection is estimated to average 26 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.