Standardized data call for individual market business
Standardized data call for small group market business
Standardized audit guide for performing an audit review of individual market business
Standardized audit guide for performing an audit review of small group market business
Best practices for writing exceptions and report findings for individual market business
Best practices for writing exceptions and report findings for small group market business
Project Title
State of the Market Report
Outcomes
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
Annual review of manual based on “lessons learned”
Annual updates/revisions to the manual and data templates
Written procedure for monitoring changes to state and federal requirements and timely updating the manual, as appropriate
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
Data in Market Analysis System accurately reflects most current state and federal requirements and rate review procedures
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
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
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.
= 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
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
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
