CMS-10657 State Flexibility Grant Final Report Template

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

OMB control number: 0938-NEW
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 Reporting Period
(Example: Final Report
8/20/2018-8/19/2020)
The purpose of the Final Grant Reports is to:
•
•

Summarize the initiatives of the Patient Protection Affordable Care Act (PPACA) market
reform provisions funded through the 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

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The State Flexibility to Stabilize the Market Grant Program
Final Report Template
Grant Performance Period: Date of award through August 20, 2018- August 19, 2020
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 State Flexibility to Stabilize the Market Grant 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 a final progress report to CMS. The final progress report
summarizes the significant advancements made towards the State’s goal of planning and/or
implementing the pre-selected market reforms provisions under Part A of Title XXVII of the
PHS Act over the course of the Grant Program.
Funding under the State Flexibility to Stabilize the Market Grant Program is available to States
for activities related to planning and implementing the following provisions of Part A of title
XXVII of the PHS Act:
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)
The final report is due ninety days following the end of the State Flexibility to Stabilize the
Market Grant. For example, for awardees completing grant activity by August 19, 2020, the final
report is due by November 19, 2020. All final 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 final 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.

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The State Flexibility to Stabilize the Market Grant Program
Final Report Template
PART I: FINAL NARRATIVE REPORT FORMAT
Introduction:
The Final Narrative Report represents the culmination of activities and accomplishments
throughout the Grant Program. In the Final Narrative Report, please support your explanation of
grant progress with quantitative data when available and other evidence to illustrate the success
of your State Flexibility to Stabilize the Market Grant Program.
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: Objective 1 was to hire additional staff to conduct formulary reviews: “We worked
throughout the past 24 months to hire two clinicians to conduct formulary review. We achieved
this objective when we were able to successfully hire two clinicians. Objective 1: Stage 5”.
Please use this guide when answering the following questions. In addition, please use charts
and graphs to highlight progress when appropriate.

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

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 Metrics towards each stated goal, objective and milestone outlined in
the State Flexibility to Stabilize the Market Grant Work Plan.
2. Challenges: Provide a detailed description of any encountered challenges in
implementing your program, the response and the outcome. Please include a list of any
proposed grant activities that were not completed during the grant period. Please include
Progress Metrics for each activity not completed.
3. Variations of Work Plan and Timeline: List any required variations from the original
State Flexibility to Stabilize the Market Grant Work Plan and companion timeline.
Provide explanation for variations and provide Progress Metrics measurements where
necessary.
Significant Activities: Undertaken and Planned
Highlight the most significant activities and major grant achievements accomplished. Please
include Progress Metrics to illustrate progress. Please also describe activities that you plan to
continue after the completion of the grant program, if any.
Public Access Activities
Summarize activities and/or promising practices undertaken during the previous twenty-four
months, working towards increased public access and awareness of the pre-selected PPACA
market reforms activities for your State. To illustrate progress, please include Progress Metrics
for each activity or practice.
Materials Produced
Discuss all materials produced and/or developed during the Grant Program, including website
upgrades, consumer materials, reports/studies, and any other relevant documents. Please provide
detail where available. For example, if a new website related to the pre-selected PPACA market
reforms was developed, please provide the link, date the website went live, number of visitors to
the website (total or monthly). Additionally, please include Progress Metrics for each material
produced or developed.
Final Impact of the State Flexibility to Stabilize the Market Grant Program
Summarize the overall impact that the State Flexibility to Stabilize the Market Grant Program
had on planning and/or implementing the pre-selected PPACA market reforms in your State over
the past twenty-four months. Include data on how the grant program enhanced the public’s
understanding of the pre-selected PPACA market reforms. Provide evidence when available.
Examples may include dollar amounts, statistics, personal stories, anecdotal evidence, media
articles/mentions, etc.

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The State Flexibility to Stabilize the Market Grant Program
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-424A as necessary, with the State’s
final report submission.
Final State Flexibility to Stabilize the Market Grant Program Work Plan and Timeline
with Progress Metrics
Provide a final Work Plan and Timeline with updated Progress Metrics to reflect the events and
progress over the course of the grant. Please continue to use the Progress Metrics guide, and
assign a measurement to each objective outlined in the work plan.
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 below for all grant activity occurring during the State Flexibility to
Stabilize the Market Grant Program.
Final
Statistics

FFY18
Quarter
4

FFY19
Quarter
1

FFY19
Quarter
2

FFY19
Quarter
3

Funds
Expended
Number of
Staff
Hired with
Grant
Funds
Number of
Contracts
in place
with Grant
Funds
Number of
PPACA
Market
5

FFY19
Quarter
4

FFY20
Quarter
1

FFY20
Quarter
2

FFY20
Quarter
3

Total

Reforms
Provision
Funded by
Grant. List
Provisions

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

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