Colorado Rate Review Grants Award

Cycle I Grant Application Summary

Colorado Grantee: Colorado Division of Insurance

Award Date: August 16, 2010

Award Amount: $1,000,000

• Improve the Review Process: Colorado currently prospectively reviews all health insurance premium increases. The State will update its existing review and filing requirements to enhance the quality of its review process and comply with all new federal requirements. Contracted actuaries and rate analysts will be used to develop and implement the new process.
• Increase Transparency and Accessibility: Currently, health insurance premium filings are not publicly available, but summaries are posted on the web. Colorado will make its website more consumer-friendly and will post complete premium increase filings. Additionally, the State will conduct web-based town hall meetings to educate consumers and will host public rate hearings.
• Develop and Upgrade Technology: Colorado will upgrade its systems to improve efficiency and streamline data sharing.

Cycle II Grant Application Summary

Colorado Grantee: Colorado Division of Insurance

Award Date: September 20, 2011

Total Award: $4,031,188

Baseline Award: $3,000,000

Workload Award Amount: $431,188

Performance Award Amount: $600,000

• Expand scope of rate review: Colorado will use new automated data tools to speed up the rate review processes and make the review process more efficient while also taking a more in-depth approach to the analysis and review of rates.
• Improve rate filing requirements: The Colorado Division of Insurance will amend Colorado Regulation 4-2-31 to require additional information be reported in the Health Cost Report which is used in the review of rate filings.
• Improve transparency and consumer interfaces: Colorado will expand education and outreach efforts through a combination of training, media, and outreach to consumers. Colorado intends to use these funds to plan an outreach campaign, make upgrades to consumer website resources and create publications for distribution on the rate review process.
• Hire new staff: Colorado will create 2 new positions with the Cycle II grant funds; this funding is in addition to the 6 new positions created with Cycle I resources.
• Improve IT: Colorado plans to build on State and federal plan design comparison efforts to introduce a streamlined data tool to collect uniform information on plan design. The State will develop online dashboards to enable managers to receive real-time information about the status of filings and allow for adjustment of resources to meet and exceed statutory deadlines and improve timeliness.

Cycle III Grant Application Summary

Colorado Grantee: Colorado Division of Insurance

Award Date: September 23, 2013

Total Award: $3,549,123

Baseline Award: $2,000,000

Workload Award Amount: $1,149,123

Performance Award Amount: $400,000

• Improve the Quality and Efficiency of Rate Review: The Colorado Division of Insurance (CDI) will use Cycle III funds to further automate their rate review processes. Additionally, the CDI will incorporate additional financial data and rate history into their rate review processes and initiate new rate filing quality checks.
• Improve Rate Review Transparency: The CDI will enhance the rate review website, conducting usability testing to ensure that website changes are consumer-friendly and easy to use.  The CDI will also use Cycle III funds to perform consumer outreach throughout Colorado.
• Enhance Health Pricing Transparency: In order to enhance health pricing transparency, DOI plans to contract with CIVHC, the nonprofit organization appointed as the state’s All Payer Claims Database (APCD) Administrator. CIVHC possesses the statutory authority to collect data from all commercial and public payers in Colorado. CIVHC currently publishes reports that show the variation in cost of specific procedures. In order to represent more Coloradoans, CIVHC will investigate the feasibility of adding new data sources, including self-pay, uninsured, and public payers other than Medicaid and Medicare.
• Integrate Health Pricing Data into Rata Review: The Colorado Division of Insurance will use the All Payer Claims Database to provide detailed analyses of the factors contributing to health care cost increases. CDI will use annual trend analysis for hospital services, office visits, ambulatory care, pharmacy and other services as a benchmark for rate review. The CDI’s analysis will include data on population demographics, types of health care services, health care product types, sites of care, and provider locations.

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