CMS-10657 State Flexibility Grant Final Report Template

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

The State Flexibility to Stabilize the Market Cycle II Grant Program
Final 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 Reporting Period
(Example: Final Report
9/15/2021-9/14/2023)

Organization Information

Grant Information

The purpose of the Final 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 Final 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 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 pre-selected market reform
provisions under Part A of title XXVII of the PHS Act.
States are required to submit a final progress report to CMS’s State Flexibility to Stabilize the
Market Cycle II Grant Program. 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 Cycle II 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 120 days following the end of the State Flexibility to Stabilize the Market
Cycle II Grant. For example, for awardees completing grant activity by September 14, 2023, the
final report is due by January 12, 2024. 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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OMB control number: 0938-1366/Expiration date: XX/XX/XXXX

The State Flexibility to Stabilize the Market Cycle II 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 explanations of
grant progress with quantitative data when available and other evidence to support the success of
your State Flexibility to Stabilize the Market Cycle II 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.
Final Program Implementation Status: Include a thorough discussion and update on progress
towards the following:
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The State Flexibility to Stabilize the Market Cycle II Grant Program Final Report
Template
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 Cycle II Grant Work Plan. Please also
describe activities, if any that you plan to continue after the completion of the grant
program.

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 prior twelve months. Please
include Progress Metrics for each activity not completed. Describe future plans to
complete the originally proposed grant activities.
3. Variations of Work Plan and Timeline: List any required variations from the original
State Flexibility to Stabilize the Market Cycle II Grant Work Plan and companion
timeline. Provide explanation for variations and provide Progress Metrics measurements
where necessary.
Public Access Activities
Summarize activities and/or promising practices undertaken during the previous twenty-four
months, 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.
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 Cycle II Grant Program
Summarize the overall impact that the State Flexibility to Stabilize the Market Cycle II 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.
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?
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The State Flexibility to Stabilize the Market Cycle II Grant Program Final Report
Template

Final Budget Expenditures
Please use the below chart to provide a detailed account of expenditures for each of the grant
Activities/Projects the 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
the entire grant period. 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.

Budget Category
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual

Construction
Other

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

Activity/Project

Consultant Fee for study of Reinsurance Program
and Geographic Tiering and Funding Options
Consultant Fee for Network Design Study
Consultant Fee for Study of Expansion of
Catastrophic Plan Eligibility
N/A
Data and Hosting Costs (Obtaining claims data form
APCD)

Total

Amount
Budgeted in
Application
$0
$0
$0
$0
$0
$22,000

Total
Amount
Spent to
Date

$5,000

$30,000

$10,000

$20,000

$5,000

$0
$15,000
$87,000

$20,000

Final State Flexibility to Stabilize the Market Cycle II 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 Cycle II Grant Program.

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

Final
Statistics

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

FFY22
Quarter
1

FFY22
Quarter
2

FFY22 FFY22 FFY23
Quarter Quarter Quarter
3
4
1

FFY23 FFY23 FFY23
Quarter Quarter Quarter
2
3
4

Total

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