CMS-10657 State Flexibility Grant Quarterly Report Template

OMB control number: 0938-1366/Expiration date: XX/XX/XXXX

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

Report Date

State
Project Title
Grant Project Director
(Name and Title)
Phone/Email
Grant Authorizing
Representative
Phone/Email
Date Grant Awarded
Amount Granted
Project Year
Project Reporting Period
(Example: 1/1/2022/3/31/2022)

Organization Information

Grant Information

The purpose of the Quarterly Grant Reports is to:
•

•

Provide the Centers for Medicare and Medicaid Services (CMS) with a better understanding
of the States’ 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 States participating in the State Flexibility to Stabilize the Market Cycle II 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 Cycle II Grant Program
Quarterly Report Template

Grant Performance Period: September 15, 2021- September 14, 2023

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 Cycle II Grant Program is to
provide States with the opportunity to ensure their laws, regulations, and procedures are in line
with Federal requirements and that States are able to effectively oversee and enforce the
identified PHS Act title XXVII Part A market reforms and consumer protections with respect to
health insurance issuers.
States are required to submit four quarterly progress report to CMS’s State Flexibility to
Stabilize the Market Cycle II Grant Program. The quarterly progress report describes significant
advancements towards the State’s goal of planning and/or implementing the pre-selected PPACA
market reform activities at the beginning from the time of approval through completion of the
grant period.
Funding under the State Flexibility to Stabilize the Market Cycle II Grant Program was made
available to States for activities related to planning and/or implementing the following preselected 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 Federal fiscal year quarter.
For example, the first quarterly report is due by January 30, 2022. 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 CMS State Flexibility to Stabilize the Market Cycle II Grant Program 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.

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OMB control number: 0938-1366/Expiration date: XX/XX/XXXX

The State Flexibility to Stabilize the Market Cycle II 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: “Project/Activity 1- Ensure our State’s laws, regulations, and procedures are in line
with Federal law with regard to Section 2702- Guaranteed Availability of Coverage: During
Quarter 1, we worked to hire staff new staff to begin work on this project. We hired one new
staff member, and are continuing to look for a second hire. Stage 3.”
Please use the Progress Metrics 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 Cycle II Grant Program
Quarterly Report Template

Program Implementation Status:
Include an update on progress towards the following:

1. Accomplishments to date towards planning and/or implementing the pre-selected PPACA
Market Reforms: Please discuss in detail, the progress made this quarter towards planning
and/or implementing the pre-selected PPACA market reforms. Please use the above
Progress Metrics Guide to assign a Stage number to each of the grant Projects/Activities
that you outlined in the State Flexibility to Stabilize the Market Cycle II Grant Work
Plan, in order to illustrate the progress made on those Projects/Activities during the
current quarter. If no work was completed on a specific Project/Activity this quarter,
continue to list the Project/Activity, and indicate that no work was completed this quarter
and include a Stage number showing the level of progress made on that Project/Activity
to date. HHS may restrict future grant funds for certain grant activities if proposed
milestones are not met.
2. 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.
3. Variations of Work Plan and Timeline: List any required variations from the original
Work Plan and companion timeline. Provide explanation for variations and provide Stage
numbers from the Progress Metrics Guide where necessary.
Public Activities
Please summarize Activities/Practices undertaken during this quarter that increased public access
and awareness of the pre-selected PPACA market reforms activities for your State. To illustrate
progress, please include Stage numbers from the Progress Metrics Guide for each
Activity/Practice.
Lessons Learned
Provide additional information on lessons learned and any promising practices.
Updated Budget Expenditures
Please use the below chart to provide a detailed account of expenditures for each of the grant
Activities/Projects you originally outlined in the State Flexibility to Stabilize the Market Cycle II
Grant Work Plan, in order to illustrate the funds spent on each Activity/Project during this
quarter, and to date. The total amount in the Amount Budgeted in Application Column should add
up to the total amount of grant dollars you were awarded for the State Flexibility to Stabilize the
Market Cycle II Grant, and should remain unchanged each quarter.

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The State Flexibility to Stabilize the Market Cycle II Grant Program
Quarterly Report Template
Budget Category
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual

Construction
Other

N/A
N/A
N/A
N/A
N/A

Amount
Budgeted in
Application

Activity/Project

Consultant Fee for study of Reinsurance
Program and Geographic Tiering and
Funding Options

$0
$0
$0
$0
$0
$22,000

Amount Spent
this Quarter

Total
Amount
Spent to
Date

$1,000

$5,000

Consultant Fee for Network Design Study

$30,000

$1,000

$10,000

Consultant Fee for Study of Expansion of
Catastrophic Plan Eligibility

$20,000

$1,000

$5,000

N/A
Data and Hosting Costs (Obtaining claims
data form APCD)

$0
$15,000
$3,000

$20,000

Total

$87,000

Work Plan and Timeline with Progress Metrics
Please provide the Work Plan /Timeline, initially submitted with the State Flexibility to Stabilize
the Market Grant Cycle II application, and assign a Stage number from the Progress Metrics
Guide to each Project/Activity in that Work Plan/Timeline in order to illustrate the progress
made on the Work Plan/Timeline this quarter.
Updated Evaluation Plan
Please provide any updates to the Evaluation Plan originally described in the State Flexibility to
Stabilize the Market Cycle II 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 only provide data below for the current quarter and not the total to date. For example, in
the Funds Expended box for Quarter 3, please only provide the funds expended for Quarter 3, not
the total funds expended to date.
Quarterly
Statistics

FFY22
Quarter
1

FFY22
FFY22 FFY22 FFY23 FFY23 FFY23 FFY23
Quarter Quarter Quarter Quarter Quarter Quarter Quarter
2
3
4
1
2
3
4

Funds
Expended

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

Number
of Staff
Hired
with
Grant
Funds
Number
of
Contracts
Awarded
with
Grant
Funds

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