The Center for Consumer Information & Insurance Oversight
Rhode Island Health Insurance Marketplace Grants Awards List
Rhode Island has received multiple grant awards to build its Health Insurance Marketplace. This includes a Planning Grant, an Early Innovator Grant, seven Level One Establishment Grants and a Level Two Establishment Grant.
Summaries of Rhode Island's applications for each grant are provided below:
Establishment Grant Level Two Application Summary
Administrator: Rhode Island Department of Business Regulation
Award Amount: $58,515,871
Award Date: November 29, 2011
Application Due Date: September 30, 2011
Supplement Amount: $7,950,989 (January 17, 2013)
Supplement Amount: $6,197,165 (December 17, 2013)
Level of Funding: Level Two
Summary: Rhode Island will use Level Two funding to continue work already underway through its Level One grant, which includes: operations, information technology (IT) infrastructure design and development; establishment of an integrated consumer support structure; reporting and evaluation; establishment of governance structures and staffing. Under the Level Two grant, Rhode Island will begin building its capacity in the following critical areas: health plan certification and qualification; financial sustainability; and oversight and financial integrity.
The State plans to implement these project areas as a single, integrated initiative, led jointly by Medicaid and Exchange leadership. The State will continue to work closely with the New England States Collaborative Insurance Exchange Systems collaborative and leverage IT systems knowledge and design where appropriate and feasible. Its total federal request is intended to fund the seven major projects listed below, plus implementation of technology components, which will be reviewed and refined through IT reviews conducted by CCIIO. Funding will be provided through December 31, 2014.
Administrative Supplement Award Amount: $7,950,989 (January 17, 2013)
Summary: Rhode Island's supplement to the state's Level Two grant awarded in November 2011 will support: mature estimates of expenses for Exchange Customer Service (call center) costs for training and testing; expanded stakeholder outreach to brokers and small businesses; the creation of a robust in person assister program for small businesses and their employees; funding for governance and staffing; funding for health plan certification and qualification; and managing the implementation of the Commercial Claims Database to support risk adjustment and reinsurance.
Administrative Supplement Award Amount: $6,197,165 (December 17, 2013)
Summary: Rhode Island will use these additional funds for activities categorized under System Integration for eligibility and non-eligibility functions. More specifically, these funds will be used to support the creation of an overall financial management IT system that can be broken into two primary components: a premium billing system, and a general ledger based accounting system. This request also includes a financial management call center, which will receive and address calls related to billing and payment issue resolution. The request will also be used to support financial oversight and monitoring of programs to prevent fraud, waste and abuse.
Establishment Grant Level One Application Summary
State: Executive Office of the State of Rhode Island
Award Amount: $2,920,467
Award Date: December 15, 2014
Application Due Date: October 15, 2014
Grant Level: Level One
Rhode Island received funding to support 2015 active renewals for all enrollees, and Health Source Rhode Island plans for four projects i.e., IPA/CAC Planning, Training, and Information Hub; Contact Center Laptop Procurement; technology developments to address current system issues around APTC eligibility, SHOP/Individual & Family enrollment, and account functionalities; and a Health Insurance Survey Follow- up activity.
Administrator: Executive Office of State of Rhode Island
Amount Awarded: $5,874,736
Award Date: October 14, 2014
Application Due Date: August 15, 2014
Level of Funding: Level One
Rhode Island received funding to continue to establish its Exchange by improving and enhancing its processes and IT system. Eight projects are planned to support 2015 reenrollment of Rhode Islanders currently enrolled in a qualified health plan : create the Partnership Builders Initiative to foster and support partnerships among agencies to achieve renewal goals; create Contact Center pop ups to reduce wait time on the phone and in person during peak periods of enrollment; deploy mobile assistors to reach and renew over 25,000 individuals for 2015 coverage; improve consumer health insurance literacy through a Rhode Island education campaign; provide immediate technical assistance to all customer service representatives for complex policy and technology issues by providing access to an onsite Deloitte-staffed Contact Center technology team; build an automated consumer premium refund functionality; procure, configure and install additional technology equipment; and build new functionality for financial data.
Administrator: Rhode Island Department of Business Regulation
Award Amount: $5,240,668, $9,822,646; $15,298,487; $6,176,368; $29,230,326
Award Date: May 23, 2011; April 8, 2013; October 23, 2013; January 22, 2014; May 2, 2014
Application Due Date: March 30, 2011; February 15, 2013; August 15, 2013; November 15, 2013; February 14, 2014
Supplement Amount: $1,300,000 (January 17, 2013)
Supplement Amount: $3,046,771 (December 22, 2014)
Level of Funding: Level One
Summary: Rhode Island will use resources from the Affordable Care Act to strengthen health information technology systems, develop an integrated consumer support program to provide support to individuals and small businesses, and strengthen its business operations.
Rhode Island's second Level One Establishment Grant will support 1) the development of a robust In-Person Assister Program, 2) product and delivery system development, 3) a strategy for premium invoice consolidation, 4) independent verification and validation services for system development, and 5) post-Marketplace-implementation quality improvements.
Rhode Island will use the Level One grant supplement to increase the scale of their Exchange's planned data and evaluation components, to ensure that the Exchange is able to measure and report on the full range of its work, especially in the areas of improvements for small businesses, health outcomes, and payment and delivery system reforms.
The Rhode Island Health Benefits Exchange, recently named “HealthSource RI,” will use its third Level One grant to build and expand upon existing work underway through previous Establishment agreements. Specifically, the Level One award will fund Rhode Island’s:
- Contact Center through the end of calendar year 2014
- Technology for non-Navigator assisters (also known as In Person Assistors) to assist in onsite enrollment of Rhode Islanders
- Technical enhancements to Integrated Eligibility System to ensure that the user experience is easy and seamless
- Mail center equipment for HealthSource RI. Website and mobile platform development that include new features for the website to facilitate easy access and enhanced decision support for all Rhode Islanders
- Predictive Modeling to allow HealthSource RI to continue to develop its strategic policy and planning, refine its organizational priorities, and further develop strategic partnerships and relationships
- Tools development to track progress on enrollment, quality, access, cost, and effectiveness.
The Rhode Island Marketplace will use its fourth Level One funds to build critical new Small Business Health Options Program (SHOP) capacities. These include a SHOP application Information Technology (IT) interface that will: allow brokers assess the effects of different employer insurance offerings on employees; and enable small business owners and employees to review, compare and select insurance plans. Funding will also support outreach and engagement activities to ensure employer awareness of the tax credit value and availability as well as other potential tax savings.
Rhode Island’s fifth Level One grant will support four major components of their Marketplace:
- The first is for costs of modifications to Rhode Island’s eligibility and enrollment system (UHIP), as well as costs for customer service, technical assistance, and technology support due to changes in federal guidance.
- The second component of this funding will support new enhancements to the eligibility and enrollment system. This includes fully linking the HealthSource RI (HSRI) website to the application portal to provide easy-to-access, up-to-date information for applicants making decisions, resulting in a customer-friendly process that fully supports applicant and enrollee decision-making.
- The third component of this award will support the transition from a start-up staffing model to a sustainable long term operational staffing model.
- The fourth and final component of this award will support implementation of an overall security and financial compliance program for Rhode Island’s Exchange in accordance with CMS Regulation 9957, HIPAA, HITECH and Omnibus security requirements.
Administrative Supplement Award Amount: $1,300,000 (January 17, 2013)
Summary: Rhode Island will use these supplemental funds are necessary to increase the scale of Rhode Island Exchange’s planned data and evaluation components, to ensure that the Exchange is able to measure and report on the full range of its work, especially in the areas of improvements for small businesses, health outcomes, and payment and delivery system reforms.
Administrative Supplement Award Amount: $3,046,771 (December 22, 2014)
Summary: Rhode Island will use the level one grant supplement to enhance the marketplace’s IT systems. Rhode Island will provide resources for plan enrollment functionality, carrier communication (834’s and 999’s), communication and coordinated operations with billing and collection subcontractor’s systems, and federal reporting of APTC and CSR.
Early Innovator Grant
Grantee: University of Massachusetts Medical School
Award Amount: $35,591,333
Summary: This is a multi-State consortia proposal led by the University of Massachusetts Medical School and will benefit individuals and small businesses in Connecticut, Maine, Massachusetts, Rhode Island, and Vermont. These consumers will be able to shop for, select, and purchase affordable and high-quality health plans. The proposed project approach will be to create and build a flexible Exchange information technology framework in Massachusetts and share those products with other New England states. The proposal hopes to learn from the Massachusetts Exchange implementation and gain efficiencies so it can accelerate Exchange development for participating New England states.
State Planning Grant
Awarded September 30, 2010
Administrator: Office of the Health Insurance Commissioner
Amount Awarded: $1,000,000
- Create an Interagency Task Force to assure activities supported by grant are appropriately coordinated.
- Compare cost and benefit of State run Exchange versus federally run Exchange
- Create an operations plan which provides staffing plan.
- Coordinate eligibility and enrollment with Medicaid.
- Develop a product design and contracting plan.
- Create a data and evaluation plan.
- Put in place information system requirements support.
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19.
- April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)