The Center for Consumer Information & Insurance Oversight
Maine Rate Review Grants Award List
Cycle I Grant Application Summary
Maine Grantee: The Maine Bureau of Insurance
Award Date: August 16, 2010
Award Amount: $1,000,000
- Expand the Scope of the Review Process: Currently, Maine has prior approval review authority for all individual and small group market products. Carriers may elect to meet a three-year average medical loss ratio guarantee (meaning they will spend a certain percentage of premium dollars on medical care rather than overhead or profits) and avoid prior approval in the small group. Maine will expand its current practice of health insurance premium review by collecting and analyzing small group market data from carriers electing the loss ratio to inform the Department if additional statutory authority is needed.
- Improve the Review Process: At present, Maine’s informational filings lack sufficient detail to determine full compliance with the law. The State plans to collect additional information on small group rates. Additionally, Maine will collect historical and projected cost and utilization trend data to establish benchmarks.
- Increase Transparency and Accessibility: Maine posts extensive rate filing information on its website, and encourages consumer participation in the rate filing process by hosting field hearings in addition to formal hearings. Maine will encourage increased participation of consumer advocacy groups in rate hearings and will compile submitted rate filing information into a consumer-friendly format for posting on its website.
- Develop and Upgrade Technology: Maine will upgrade its systems to improve efficiency and aid in the health insurance premium review process. The State will also establish a data center to compile and publish fee schedule information.
Cycle III Grant Application Summary
Maine Grantee: Maine Health Data Organization
Award Date: September 23, 2013
Total Award Amount: $2,621,098
Base Award Amount: $2,000,000
Workload Total Amount: $621,098
- Enhance Health Pricing Transparency: Currently, Maine publishes pricing data on common medical procedures on the “HealthCost” website. Through Cycle III funding, the State plans to expand the number of “shopable” procedures from 30 to at least 200 procedures. In addition, Maine plans to enhance the user interface and usability of the HealthCost website. Among other changes, the state may establish user-specific interfaces, designed to support consumers, providers, employers, and researchers.
- Improve Data Analysis: Using Cycle III funding, Maine plans to: 1) develop more powerful tools for online analysis; 2) improve methodologies for determining and presenting average payments of procedures for insured residents; 3) refine methodologies for determining and presenting pricing data for uninsured residents; and 4) evaluate the feasibility of incorporating Medicare and Medicaid data into its analyses. In addition, Maine plans to work collaboratively with stakeholders in order to identify additional needs for analytic capacity.
- Integrate Price and Quality Information: Maine will use Cycle III funding to integrate cost and quality data in order to develop more meaningful information for consumers and businesses alike.
- Enhance Consumer Outreach: Maine plans to expand outreach and public engagement in order to raise awareness of how the HealthCost website can be used as a resource.
- IT upgrades: Maine will evaluate the feasibility of implementing a more flexible web infrastructure, including a new content management system.
Cycle IV Grant Application Summary
Maine Grantee: Maine Health Data Organization
Award Date: September 19, 2014
Total Award: $1,179,000
- Data Dissemination and Transparency: The Maine Health Data Organization plans to work with stakeholders to develop an online data request system to collect information required for data releases and to streamline the release process. Maine plans to research and make recommendations on options for self-service access to data and the best data payment model options that promote access and sustainability. Maine also plans to increase the number of procedures and non-hospital facilities displayed, enhance the consumer website experience on computers, tablets, and mobile devices, enhance the procedure search function, and enhance data display.
- Enhance Data Quality: Maine intends to further integrate and enhance its cost and quality data to provide more comprehensive and useful information to consumers, providers, employers, and other key stakeholders.
- November 5, 2019 FAQ: Quality Rating Information Bulletin’s (Quality Bulletin’s) Display Guidelines for Direct Enrollment (DE) Entities
- 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