The Center for Consumer Information & Insurance Oversight
New York Rate Review Grants Award List
Cycle I Grant Application Summary
New York Grantee: New York State Insurance Department
Award Date: August 16, 2010
Award Amount: $1,000,000
- Expand the Scope of the Review Process: The grant program will be used to implement the new prior approval law passed in 2010. Under the new law all health insurance premiums will be subject to prior approval which includes adding large group review to the existing individual and small group review.
- Improve the Review Process: Effective 2010, all new forms and revised rates are subject to the prior approval of the Department. Health insurance premiums that are determined to be unreasonable, excessive, inadequate or unfairly discriminatory cannot be approved. New York will also standardize and streamline rate filings, develop a checklist for material to be submitted in connection with future rate filings, develop specifications for more detailed market segment reporting and develop a more standardized structure for reporting claims experience.
- Increase Transparency and Accessibility: Currently New York only posts health insurance premium rates on its website. New York plans to update its website to provide general information on the rate filing process in addition to providing a public forum in which consumers can comment on rate increases.
- Develop and Upgrade Technology: New York will modify its existing systems and expand its data management and internal database to capture newly generated data and increase reporting functionality and establish a data center to compile and publish fee schedule information.
Cycle II Grant Application Summary
New York Grantee: New York State Insurance Department
Award Date: September 20, 2011
Total Award: $4,469,996
Baseline Award: $3,000,000
Workload Award Amount: $869,996
Performance Award Amount: $600,000
- Expand scope of rate review: New York proposes to expand data used in reviewing rate applications to analyze information submitted by insurers and help compare data across lines of business and across insurers.
- Improve rate filing requirements: New York will revise rate applications to include information regarding rates for Qualified Health Plans offered through the Exchange. A contractor will also audit rate applications to ensure rates are based on accurate financial and actuarial data.
- Improve transparency and consumer interfaces: New York proposes improvements to its consumer webpage.
- Hire new staff: New York will create 2 new positions with the Cycle II grant funding; these positions are in addition to the 1 new position supported with Cycle I funds.
- Improve IT: New York proposes improving its web portal to allow insurers to submit loss ratio reports and will work with an IT consultant to build databases to capture a wide variety of relevant data to be reviewed with analyzing rate filings.
Cycle III Grant Application Summary
New York Grantee: Health Research Inc.
Award Date: September 23, 2013
Total Award: $4,528,747
Baseline Award: $2,000,000
Workload Award Amount: $2,128,747
Performance Award Amount: $400,000
- Incorporate health pricing data into rate review: New York plans to improve the quality of their rate review by incorporating health pricing data and benchmarks into the review process. New York proposes to develop a “Financial Transparency and Rate Setting Module,” which will allow the Department of Financial Services to access health pricing datasets for data analysis, research, and report development.
- IT and other technology based improvements: New York will develop enhancements to its All Payer Claim Database, which include: analytical tools for web-based data visualization, analytics, robustness, report generation, and mobile business intelligence capabilities.
- Improve transparency and consumer interfaces: New York will create an interactive web-based query tool that will provide consumers, providers, and payers access to cost, quality, and premium information in an easy to use format.
- 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