The Center for Consumer Information & Insurance Oversight
Utah Rate Review Grants Award List
Cycle I Grant Application Summary
Utah Grantee: Utah Insurance Department
Award Date: August 16, 2010
Award Amount: $1,000,000
- Pursue Additional Legislative Authority: Currently Utah has no explicit authority to review or pre-approve premium increases. The State intends to develop legislative language to allow for expanded rate review in the individual and small group markets, and to add large group market review. In addition, language to allow public access to rate filing and creation of a web based portal for consumers will be developed. Legislation will be presented in the 2011 session.
- Expand the Scope of the Review Process: Utah will increase the number of reviews conducted, and expand the scope of review, with the goal of reviewing 50 percent of small and individual market filings and to add the large group market.
- Improve the Review Process: Currently insurers are required to file rating manuals with the department before use. Grant funds will be used to create a comprehensive health insurance premium review process. This will include development of review manuals as well as staff training.
- Increase Transparency and Accessibility: Currently all health insurance premium filings are deemed protected records under State law. Utah will attempt to gain legislative authority to create a consumer web based environment, and will implement a public hearing process.
- Develop and Upgrade Technology: Utah will collect, analyze, and report critical information about health insurance premium filings.
Cycle II Grant Application Summary
Utah Grantee: Utah Insurance Department
Award Date: September 20, 2011
Total Award: $3,315,679
Baseline Award: $3,000,000
Workload Award Amount: $315,679
- Introduce legislation: Utah will use funds to support the drafting of rules and laws for expanding authority into the large group market.
- Expand scope of rate review: Utah will conduct a study and work to draft legislation for the expansion of rate review authority over the large group market.
- Improve rate filing requirements: Utah will revise Rule R590-220 to include a written description justifying any proposed rate increase, as well as requiring other relevant data elements.
- Improve transparency and consumer interfaces: Utah will implement a web-based transparency database for consumer comments on the rate review process and increasing advanced notice to consumers before rate changes become effective. Utah's database will be accessible to consumers from all types of mobile devices and will allow consumers to compare health insurance rates between insurers, view requested rate changes, and provide meaningful data related to the cost of health insurance.
- Hire new staff: Utah will create 4 new positions with Cycle II grant funding; these positions are in addition to the 1 position created with Cycle I resources.
- Improve IT: Utah will continue to develop a consumer-friendly database and support data exchange capabilities between the State and federal government.
Cycle III Grant Application Summary
Utah Grantee: Utah Department of Health
Award Date: September 23, 2013
Total Award Amount: $3,255,398
Baseline Award Amount: $2,000,000
Workload Award Amount: $855,398
Performance Award Amount: $400,000
- Enhance Data Center: The Utah Department of Health (UDOH) will use Cycle III grant funds to partner with the Utah Insurance Department, the University of Utah, and two non-profit organizations, HealthInsight and Utah Health Information Network, to enhance the existing capacity and functionality of the Utah All Payer Claims Database. The Utah Department of Health will use this data to produce online pricing transparency reports for consumers, employers, researchers, and the public.
- Enhance Data Quality: The Department of Health plans to improve the All Payer Claims Database's data quality by working with participating stakeholders to increase the accuracy and completeness of submissions.
- Improve Health Pricing Transparency: The Utah Department of Health will use Cycle III funds to develop web applications to broadly disseminate price information for selected health services by patient population, geographic area, healthcare setting, and provider.
Cycle IV Grant Application Summary
Utah Grantee: Office of Health Care Statistics, Utah Department of Health
Award Date: September 19, 2014
Total Award: $1,179,000
- Establish or Improve Data Collection: The Utah Department of Health plans to have all healthcare facilities supply encounter data via a single secure upload system. This system will include a series of edit checks for data quality assurance, and provide a system for providing data quality feedback to submitters.
- Expand and Improve Data Analysis: Utah plans to explore the possibility of linking patients across datasets, including claims data, discharge encounters, vital records, and clinical information. Utah will use identity resolution software to link patients and providers in the claims data.
- Establish or Improve Data Collection: Utah would like to augment its data collection to include Medicare claims (including Parts A, B, C & D and Medicare Supplemental), collect data on a broader range of encounters that are not reimbursed (including non-pay and self-pay clients), and expand its claims data definition to include vision and dental payers. Utah will also ask stakeholders to identify other possible sources to be included in its existing data collection efforts.
- 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