CMS-10657 State Flexibility Grant Quarterly Report Template

The State Flexibility to Stabilize the Market Grant Program OMB control number: 0938-NEW
Quarterly Report Template
Expiration date: XX/XX/XXXX
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: 10/1/201812/31/2018)
The purpose of the Quarterly Grant Reports is to:
•

•

Provide the State Flexibility to Stabilize the Market Grant Program with a better
understanding of the grantee’s progress towards planning and/or implementing
several of the Patient Protection and Affordable Care Act (PPACA) market
reforms under Part A of Title XXVII of the Public Health Service Act (PHS Act)
funded through this grant program.
Provide grantees participating in the State Flexibility to Stabilize the Market
Grant Program with the opportunity to share information, highlight successes and
reflect upon the progress of their programs.

1

The State Flexibility to Stabilize the Market Grant Program
Quarterly Report Template

Grant Performance Period: August 20, 2018 - August 19, 2020.

The provisions in Part A of title XXVII of the PHS Act include market-wide 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 State Flexibility to Stabilize the Market Grant Program is to provide
States with the opportunity to ensure their laws, regulations, and procedures are in line with
Federal law, and enhance the States’ ability to effectively regulate their respective health
insurance markets through innovative measures that support the pre-selected market reforms and
consumer protections under Part A of Title XXVII of the PHS Act.
States are required to submit quarterly progress reports to CMS. The quarterly progress report
describes significant advancements towards the State’s goal of planning and/or implementing the
pre-selected PPACA market reform activities from the time of approval through completion of
the grant period.
Funding under the State Flexibility to Stabilize the Market Grant Program 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.

Section 2702 – Guaranteed Availability of Coverage
Section 2703 – Guaranteed Renewability of Coverage
Section 2707 – Non-discrimination under Comprehensive Health Insurance Coverage
(Essential Health Benefits Package)

Each quarterly progress report is due 30 days following the end of a Federal fiscal year quarter.
For example the first quarterly report is due by October 30, 2018. 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 CMS and the State. A complete quarterly progress report must detail how grant
funds are being utilized, describe program progress, barriers and provide an update on the
measurable objectives of the grant program.

2

The State Flexibility to Stabilize the Market Grant Program
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 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 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.”
Please use this guide when answering the following questions. In addition, please use charts
and graphs to highlight progress when appropriate.

3

The State Flexibility to Stabilize the Market Grant Program
Quarterly Report Template

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 State Flexibility to Stabilize the Market Grant
Work Plan.
2. Progress towards, planning and/or implementing the pre-selected PPACA Market
Reforms: Please discuss in detail, progress over the past quarter towards planning and/or
implementing the pre-selected PPACA market reforms. Please include detailed progress
towards each stated goal, objective and milestone outlined in the original grant
application and the proposed State Flexibility to Stabilize the Market Grant Work Plan. In
your explanation, please include the above Progress Metrics guide (where necessary) to
indicate progress. CMS 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 objectives, 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 this quarter, or anticipated to occur
in the near future, that may affect the progression of implementing activities related to the preselected PPACA market reforms for your State. Please include Progress Metrics to illustrate any
progress.
Public Activities
Summarize activities and/or promising practices undertaken during the previous quarter working
towards increased public access and awareness from the pre-selected PPACA 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
4

The State Flexibility to Stabilize the Market Grant Program
Quarterly Report Template

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 State Flexibility to
Stabilize the Market Grant application, including updates to the established measurable
objectives, key indicators, and methods to monitor progress. If planning to contract for an
evaluation, please provide a quarterly update.
Quarterly Report Summary Statistics:
Please provide the data below:
Quarterly
Statistics

FFY18
Quarte
r4

FFY19
FFY19 FFY19 FFY19 FFY20 FFY20 FY2020
Quarter Quarter Quarter Quarter Quarter Quarter Quarter
1
2
3
4
1
2
3

Funds
Expended
Number of
Staff Hired
with Grant
Funds
Number of
Contracts in
place with
Grant Funds

Number of
PPACA
Market
Reforms
Provision
Funded by
Grant. List
Provisions

5

The State Flexibility to Stabilize the Market Grant Program
Quarterly Report Template

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. T he valid OMB control number for this information collection is 0938-XXXX. T he time
required to complete this information collection is estimated to average 12 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.

6