Review of individual and small group health insurance rate filings



Download 201.58 Kb.
Date conversion09.01.2017
Size201.58 Kb.
Work Plan Summary – Rate Review Grant, Cycle IV

Project Title

Health Insurance Rate Filing Reviews

Outcomes

  1. Review of individual and small group health insurance rate filings



Project Title

Health Care Reform Audits

Outcomes

  1. Standardized interrogatories for conducting an annual audit of individual market business

  2. Standardized interrogatories for conducting an annual audit of small group market business

  3. Standardized data call for individual market business

  4. Standardized data call for small group market business

  5. Standardized audit guide for performing an audit review of individual market business

  6. Standardized audit guide for performing an audit review of small group market business

  7. Best practices for writing exceptions and report findings for individual market business

  8. Best practices for writing exceptions and report findings for small group market business







Project Title

State of the Market Report

Outcomes

  1. Annual health insurance State of the Market Report, including multiple-year trend analysis of the individual and small group markets and assessment of the market transition from grandfathered and non-ACA-compliant, non-grandfathered products to fully ACA-compliant products.



Project Title

Rate Review Policy and Procedure Manual

Outcomes

  1. Annual review of manual based on “lessons learned”

  2. Annual updates/revisions to the manual and data templates

  3. Written procedure for monitoring changes to state and federal requirements and timely updating the manual, as appropriate



Project Title

Internal and External Communication

Outcomes

  1. Written procedure for timely and effectively communicating to appropriate internal staff, insurance companies, consumers and other interested parties relevant information regarding state and federal requirements



Project Title

Market Analysis System Enhancements

Outcomes

  1. Data in Market Analysis System accurately reflects most current state and federal requirements and rate review procedures

  2. Data in Market Analysis System meets the needs of rate review staff with respect to data analysis and business intelligence



Project Title

Data Analysis and Business Intelligence

Outcomes

  1. Data collected through the rate review program is fully accessible to staff in the Division of Regulation and Enforcement (as appropriate) through a business intelligence tool

  2. Staff in the Division of Regulation and Enforcement are able to independently, with IT support, produce data reports and visualizations with drill-down functionality using a business intelligence tool



 

Health Insurance Rate Filing Reviews

Title:

Health Insurance Rate Filing Reviews

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application and federal Effective Rate Review requirements under 45 CFR Part 154

Description:

Review of individual and small group comprehensive health insurance rate filings in accordance with review procedures established in the internal Rate Review Policy and Procedure Manual.

Outcome Measures:

All individual and small group comprehensive health insurance rate filings will be reviewed and closed within a reasonable timeframe.

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

Iterative Process







Rate Filing Received

IG

2







Regulatory Review - Initial Review

IG

3







Regulatory Review - Review Stage

EL/MB

4







Actuarial Review (if required)

Consultants

5







Rate Filing Closed

IG/EL/MB

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett, Ian Gort

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown = On Hold



 

Health Care Reform Audits

Title:

Health Care Reform Audits

Organization:

Regulation & Enforcement

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application

Description:

In 2014, the rate review team (RR) and staff in the OCI Bureau of Market Regulation (MR) drafted interrogatories, drafted audit guides, and performed test audits of six (6) health insurance companies. Using lessons learned through the 2014 test audits, in 2015, RR and MR staff will develop and implement a process for performing annual audits for compliance with market-wide federal Affordable Care Act (ACA) requirements.

Outcome Measures:

1) Standardized interrogatories for conducting an annual audit of individual market business
2) Standardized interrogatories for conducting an audit of small group market business
3) Standardized data call for individual market business
4) Standardized data call for small group market business
5) Standardized audit guide for performing an audit review of individual market business
6) Standardized audit guide for performing an audit review of small group market business
7) Best practices for writing exceptions and report findings for individual market business
8) Best practices for writing exceptions and report findings for small group market business

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

10/1/2014







Post-mortem on Plan Year 2014 ACA Audits

EL/MB/MR Staff

2

11/1/2014







Identify Changes to Federal Guidance and Regulations

EL/MB/MR Staff

3

11/15/2014







Finalize Plan Year 2015 Interrogatories

EL/MB/MR Staff

4

12/1/2014







Finalize Plan Year 2015 Data Calls

EL/MB/MR Staff

5

12/15/2014







Finalize Plan Year 2015 Audit Guides

EL/MB/MR Staff

6

1/15/2015







Draft Best Practices Documents

EL/MB/MR Staff

7

3/1/2015







Issue Exam Reports for Companies Offering Plans on Exchange in 2015

EL/MB/MR Staff

8

10/1/2015







Post-mortem on Plan Year 2015 ACA Audits

EL/MB/MR Staff

9

11/1/2015







Identify Changes to Federal Guidance and Regulations

EL/MB/MR Staff

10

11/15/2015







Finalize Plan Year 2016 Interrogatories

EL/MB/MR Staff

11

12/1/2015







Finalize Plan Year 2016 Data Calls

EL/MB/MR Staff

12

12/15/2015







Finalize Plan Year 2016 Audit Guides

EL/MB/MR Staff

13

1/15/2016







Draft Best Practices Documents

EL/MB/MR Staff

14

3/1/2016







Issue Exam Reports for Companies Offering Plans on Exchange in 2016

EL/MB/MR Staff

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold

 

State of the Market Report

Title:

State of the Market Report

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application and federal Effective Rate Review requirements under 45 CFR Part 154

Description:

In 2012, the rate review team drafted the first State of the Market Report. The report is an internal document that summarized the state of the statewide and regional health insurance markets. For the purpose of regional analysis, the state is divided into six (6) market analysis regions. The report drafted in 2012 reflects one year of data. The rate review team has since accumulated several years of data. Future iterations of the report will reflect trend data for the key indicators (market concentration and enrollment/market share), and will reflect the market transition from grandfathered and non-ACA-compliant, non-grandfathered products to fully ACA-compliant products.

Outcome Measures:

Annual health insurance State of the Market Report, including (1) multiple-year trend analysis of the individual and small group markets, and (2) an assessment of the market transition from grandfathered and non-ACA-compliant, non-grandfathered products to fully ACA-compliant products.

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

2/1/2015







Complete Dashboard for Analysis of Data Required for Market Report

MB

2

3/15/2015







Finalize 2014 Market Survey Data

IG

3

4/1/2015







Complete 2014 Data Analysis

EL

4

5/1/2015







Finalize 2014 Market Report

EL

5

3/15/2015







Finalize 2015 Market Survey Data

IG

6

4/1/2015







Complete 2015 Data Analysis

EL

7

5/1/2015







Finalize 2015 Market Report

EL

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold



 

Rate Review Policy & Procedure Manual

Title:

Rate Review Policy & Procedure Manual

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application and federal Effective Rate Review requirements under 45 CFR Part 154

Description:

In 2014, the rate review team finalized its policies, procedures and filing requirements for single risk pool rate filings with effective dates from July 2014 through April 2015. As federal requirements are clarified, appended to and changed, the policy and procedure manual and filing requirements must be updated accordingly. During each filing season (May through December), the rate review team will note any required or recommended changes to the policies and procedures. During spring of each year the team will discuss the recommended changes and make appropriate revisions to the policy and procedure manual and filing requirements.

Outcome Measures:

1) Annual review of manual based on “lessons learned”
2) Annual updates/revisions to the manual and data templates
3) Written procedure for monitoring changes to state and federal requirements and timely updating the manual, as appropriate

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

1/1/2015







Complete 2014 Plan Year post-mortem

EL/MB/IG

2

2/1/2015







Finalize 2015 Plan Year Policy and Procedure Manual

EL/MB/IG

3

2/15/2015







Finalize 2015 Plan Year Filing Requirements

EL/MB/IG

4

2/16/2015







Post 2015 Plan Year Filing Requirements to OCI Website

EL/MB/IG

5

2/16/2015







Email Notice of 2015 Plan Year Requirements to Rate Review Contact List

EL/MB/IG

6

1/1/2016







Complete 2016 Plan Year post-mortem

EL/MB/IG

7

2/1/2016







Finalize 2016 Plan Year Policy and Procedure Manual

EL/MB/IG

8

2/15/2016







Finalize 2016 Plan Year Filing Requirements

EL/MB/IG

9

2/16/2016







Post 2016 Plan Year Filing Requirements to OCI Website

EL/MB/IG

10

2/16/2016







Email Notice of 2016 Plan Year Requirements to Rate Review Contact List

EL/MB/IG

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett, Ian Gort

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold



 

Internal & External Communication

Title:

Internal & External Communication

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application

Description:

Establish and formalize a process and procedure for timely and effectively communicating to appropriate internal staff, insurance companies, consumers and other interested parties relevant information regarding state and federal requirements.

Outcome Measures:

Written policy and procedure for communications

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

2/1/2015







Post-mortem of 2015 Plan Year Communications

EL/MB/IG/ MR

2

3/1/2015







Finalize Process & Procedure for 2016 Plan Year Communications

EL/MB/IG/ MR

3

Iterative Process







Implement Internal & External Communication Policy and Procedure

EL/MB/IG/ MR

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett, Market Regulation Staff (MR)

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold



 

Market Analysis System Enhancements

Title:

Market Analysis System Enhancements

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application and federal Effective Rate Review requirements under 45 CFR Part 154

Description:

Perform enhancements to the Market Analysis System (MAS) database in response to requirement changes and lessons learned. OCI tracks product and plan level data elements, including enrollment, premium and coverage information, in the MAS. As existing requirements are clarified and new requirements are introduced, updates to the MAS are necessary. In addition, as the rate review team uses the MAS it continually discovers ways to improve its validity and usefulness. With the assistance of IT staff, the rate review team continuously works to improve the value and functionality of the MAS.

Outcome Measures:

1) Data in Market Analysis System accurately reflects most current state and federal requirements and rate review procedures
2) Data in Market Analysis System meets the needs of rate review staff with respect to data analysis and business intelligence

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

Iterative Process







Required Enhancement Identified

EL/MB/IG

2







Enhancement Communicated to IT

EL/MB/IG

3







Action Plan Proposed by IT

EL/MB/IG/IT

4







Requirements Clarified

EL/MB/IG/IT

5







Required Functionality Developed

IT

6







Required Functionality in Production

EL/MB/IG

Workgroup
Members:


Gina Frank, Elena LaViolette, Marci Bartlett, Ian Gort, Information Technology Staff (IT)

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold



 

Data Analysis & Business Intelligence

Title:

Data Analysis & Business Intelligence

Sponsor:

Gina Frank

 

 

Strategic Alignment:

Meeting goals stated in federal grant application and federal Effective Rate Review requirements under 45 CFR Part 154

Description:

Using Rate Review Cycle II grant funds, the rate review team worked with IT staff to develop visualizations of data stored in the MAS using a business intelligence tool. Using Cycle IV grant funds, the rate review team will continue to develop visualizations and expand accessibility of the visualizations to Division of Regulation and Enforcement staff outside of the rate review team.

Outcome Measures:

1) Data collected through the rate review program is fully accessible to staff in the Division of Regulation and Enforcement (as appropriate) through a business intelligence tool
2) Staff in the Division of Regulation and Enforcement are able to independently, with IT support, produce data reports and visualizations with drill-down functionality using a business intelligence tool

Milestones:

Date

Schedule

Budget

Risk

Description

Assigned
To


1

Iterative Process







Identify and Communicate Required Visualization

MB

2







Clarify Requirements

MB

3







Define Access Rights to Visualization

MB

4







Develop Visualization

MB

5







Publish Visualization

MB

 

 

 

 

 

 

 

Workgroup
Members:


Gina Frank, Stephanie Cook, Elena LaViolette, Marci Bartlett, Market Regulation Staff (MR)

Key:

 = Completed = On Track ▲= Caution = Alert = Unknown
= On Hold


The database is protected by copyright ©ininet.org 2016
send message

    Main page