The Center for Consumer Information & Insurance Oversight
Maryland Rate Review Grants Award
Cycle I Grant Application Summary
Maryland Grantee: The Maryland Insurance Administration
Award Date: August 16, 2010
Award Amount: $1,000,000
- Improve the Review Process: Currently, Maryland conducts prospective actuarial review of all health insurance premium filings. To build upon its current process, Maryland plans to contract for consulting services to provide recommendations on which data elements should be included in rate filing submissions, which markets should require additional data elements in their rate filings, and the implementation of policies and procedures to carry out a more robust rate review process.
- Increase Transparency and Accessibility: Today, only the portions of health insurance premium filings that exclude confidential information are publicly disclosed. To enhance consumer access to premium information, Maryland will contract for recommendations on how to best present premium increase information to consumers and policymakers.
- Develop and Upgrade Technology: Maryland will improve electronic reporting functions to facilitate the electronic submission of data.
Cycle II Grant Application Summary
Maryland Grantee: Maryland Insurance Administration
Award Date: September 20, 2011
Total Award: $3,961,072
Baseline Award: $3,000,000
Workload Award Amount: $361,072
Performance Award Amount: $600,000
- Introduce legislation: The Maryland Insurance Administration will propose a statutory change to gain authority to disclose a carrier's proposed rate for a new or current policy and the worksheet for the filing and final rate approved by Maryland Insurance Administration.
- Expand scope of rate review: Maryland will work with the Maryland Health Care Commission and Maryland Health Services Cost Review Commission to determine how shared data can or will be useful in the State's rate review process.
- Improve rate filing requirements: Following the Maryland Insurance Administration plan from Cycle I, Maryland plans to require insurers to submit Part I of the Preliminary Justification Worksheet, and will report premium changes over time by market and insurer to the Exchange. Maryland will also identify how to incorporate average actuarial risk in rate review.
- Improve transparency and consumer interfaces: Maryland will continue its efforts from its Cycle I grant to publicly disclose information about rate filings (requiring a statutory change). Maryland will additionally provide information about the rate filing process on its website and through public comment.
- Hire new staff: Maryland will create 3 new positions from this funding, to add to the 4 positions created under Cycle I.
- Improve IT: Maryland plans to enhance its website to allow for public comment and the disclosure of filing information.
Cycle III Grant Application Summary
Maryland Grantee: Maryland Department of Health and Mental Hygiene
Award Date: September 23, 2013
Total Award: $2,896,277
Baseline Award: $2,000,000
Workload Award: $896,277
- Enhance data collection: Maryland currently possesses an All Payer Claims Database (APCD), with medical claims data from private issuers, third party administrators, and Medicare. With Cycle III funds, Maryland plans to improve the timeliness, accuracy and completeness of data submissions. To speed the collection, transfer and analysis of the APCD Data, Maryland plans to develop a high-performance “Extract, Transform & Load” system for collecting data submissions.
- Integrate pricing data into rate review: Maryland will integrate APCD data into the rate review process by developing an APCD Rate Review Analytics Application. Metrics used for rate review will be organized in “Data Marts” that support the most common analytic inquiries, while providing the capacity to drill deeper into the data. By incorporating medical claims data into rate review, the Maryland Insurance Administration will be able to review requested rate increases in the context of the health insurance issuer’s actual claims experience as well as state and local medical trends.
- Enhance pricing transparency: Maryland plans to create a web-based online tool that will permit consumers, employers, and the general public to easily access health prices and insurance rates.
Cycle IV Grant Application Summary
Maryland Grantee: Maryland Health Care Commission
Award Date: September 19, 2014
Total Award: $1,178,287.20
- Establish or Improve Data Collection: The Maryland Health Care Commission will use funds to enhance Data Center credibility by collaborating with the Maryland Insurance Administration and the Health Services Cost Review Commission (HSCRC) to establish consensus standards for data reconciliation and to measure development to support rate review and hospital rate setting. Maryland will build consensus among the HSCRC and major carriers on the definitions for monitoring total cost of care. This collaboration will further establish the Data Center data as a reliable source of information for measuring Maryland’s progress under the new hospital payment model.
- Integration of Data with Other Datasets; Harmonization of Data: The Maryland Health Care Commission will collaborate with the Maryland Insurance Administration and all major carriers in Maryland to identify discrepancies between the data submitted to the Data Center and the actuarial memoranda data submitted to the Maryland Insurance Administration, which will identify logic and reporting inconsistencies between the Data Center and actuarial memorandum data that will be documented, tested, and rectified, resulting in greater confidence in the credibility of the Data Center.
- Data Dissemination and Transparency: Maryland plans to scale up the current web-application development to provide mapping, graphing, and business intelligence dashboards to help industry stakeholders, practitioners, and consumers make informed health care decisions about cost-effective services and providers. Maryland will enhance the Data Center to provide a complete picture of the self-insured market and to add price transparency metrics. Also, Maryland will develop public-facing websites to display utilization and cost/price transparency information for industry stakeholders and specialized portals targeting practitioners and consumers.
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- November 1, 2019 Enhanced Direct Enrollment Approved Partners (Updated)
- September 11, 2019 FAQ: Enhanced Direct Enrollment Participation Requirements for Non-Issuer of a Primary EDE Entity Environment
- August 15, 2019 Quality Rating Information Bulletin for Plan Year 2020 Health Insurance Exchanges Quality Rating System (QRS) for Plan Year (PY) 2019: Results at a Glance
- April 18, 2019 CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020 Final 2020 Letter to Issuers on Federally-facilitated Exchanges Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment
- April 4, 2019 Guidance on Unified Rate Review Timeline: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020
- March 19, 2019 2020 Final Actuarial Value Calculator 2020 Final Actuarial Value Calculator Methodology
- March 6, 2019 CMS-9921-NC: Request for Information Regarding the Sale of Individual Health Insurance Coverage Across State Lines Through Health Care Choice Compacts
- February 28, 2019 Section 1332 Pass-through Funding Tools and Resources