Form CMS-10380 Rate Review Program Quarterly Report

Report Date

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template

OMB control no: 0938-1121
Expiration date: XX/XX/XXXX

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 Quarter 1
10/1/2014-12/31/2014)
The purpose of the Cycle IV Quarterly Grant Reports is to:
•
•
•
•

Provide the Rate Review Grant Program with a better understanding of the States’ rate
review and medical pricing transparency initiatives funded through this grant program
Provide the Rate Review Grant Program with Quarterly Rate Filing Data
Describe medical new pricing transparency initiatives at the funded Data Center
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 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.

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template
Grant Performance Period-Cycle IV: 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 establish Data Centers that provide medical price information to the public.
The statute indicates that the program serves the following purposes:
(1) Establish or enhance rate review programs, referred to in the Cycle IV 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 IV 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 IV FOA.
The goals of the Cycle IV 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 medical pricing data in a transparent,
user-friendly 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.

A Data Center, established under subsection (c)(1)(C) of section 2794, must: (A) develop fee
schedules and other database tools that fairly and accurately reflect market rates for medical
services and the geographic differences in those rates; (B) use the best available statistical
methods and data processing technology to develop such fee schedules and other database tools;
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 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.

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template

(C) regularly update such fee schedules and other database tools to reflect changes in charges for
medical services; (D) make health care cost information readily available to the public through
an Internet website that allows consumers to understand the amounts that health care providers in
their area charge for particular medical services; and (E) regularly publish information
concerning the statistical methodologies used by the center to analyze health charge data and
make such data available to researchers and policy makers.
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/or establishing a Data Center from the
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 IV quarterly report is due by January 30, 2015. 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.

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 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.

Health Insurance Rate Review Grant Program
Cycle IV 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.” “Objective 2 was to
establish a value report, presenting medical 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. Quarterly 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
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 Work Plan and companion timeline.
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 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.

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template
Significant Activities: Undertaken and Planned
Discuss activities that occurred during the quarter, or anticipated to occur in the near future, that
affect the progression of comprehensive rate review 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 that
related to the new legislation or regulation. Please also describe any products produced during
this reporting cycle, for example an update to the website, consumer materials, and/or any
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 and medical price information for your state.
Identify all barriers associated with increasing public access to rates and medical price
information and proposed ways to rectify the barriers.
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 data collection standards; and efforts to integrate datasets.
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.
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 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.

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template
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
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.
Pricing Data Collection and Analysis
Please provide an overview of the analysis performed on medical claims data collected by the
state.
1. Identify medical claims/price data sets 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.
Updated Evaluation Plan
Please provide an updates to the evaluation plan originally described in the Cycle IV 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 IV 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)
• 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)
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 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.

•

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template

Enhanced Consumer Protections in Rate Review Processes: (Yes/No)
o Consumer-Friendly Rate Review Website: (Yes/No)
o Rate Filings on Website: (Yes/No)
o Medical 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
Numbers for: 1) New Hires; and 2) To-Date Hire Total. )
• Enhanced IT for Data Center: (Yes/No)
• Gained access to new or more comprehensive data sets: (Yes/No)
• Enhanced public availability of price data for medical services: (Yes/No)
o Provided new data regarding the prices of medical services on website: (Yes/No)
o Integrated medical 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 (Provide dates for the period from which the new visitor
count was taken): Number
 Total (Provide dates): Number
 New visitors (Provide dates for the period from which the new visitor
count was taken from): Number
Enclosures/Attachments
Identify by title any attachments along with a brief description of what information the
documents contain.

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 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.

Health Insurance Rate Review Grant Program
Cycle IV 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
products with
rate information
Number of
products
requesting
increase in
premiums
Number of
products
reviewed for
approval, denial,
acceptance etc.
Number of
products
approved
Number of
products denied
Number of
products deferred

Quarter 2

Quarter 3

Quarter 4

Annual Total

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 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.

Health Insurance Rate Review Grant Program
Cycle IV Quarterly Report Template
Table B. Number and Percentage of Products 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 Products Reviewed – Small Group
State
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Number of
covered lives
affected
Table D. Number and Percentage of Products 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 Products 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.

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 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.