Rhode Island Rate Review Grants Award List

Cycle I Grant Application Summary

Rhode Island Grantee: Rhode Island Department of Business Regulation

Award Date: August 16, 2010

Award Amount: $1,000,000

• Expand the Scope of the Review Process: Rhode Island will expand to include retrospective review of small group market rates.
• Improve the Review Process: The State currently reviews all rates prospectively. Using grant funds, they will introduce compliance and quality to the affordability standards of health insurance premiums through a retrospective look back at the performance of the rate.
• Increase Transparency and Accessibility: Currently all "significant" health insurance premium increases are available on the web. Using grant funds the State will contract with a community organization to promote purchaser and consumer engagement, including public comment.
• Develop and Upgrade Technology: Rhode Island will improve efficiency and streamline data sharing.

Cycle II Grant Application Summary

Rhode Island Grantee: Rhode Island Department of Business Regulation

Award Date: September 20, 2011

Total Award: $3,724,651

Baseline Award: $3,000,000

Workload Award Amount: $124,651

Performance Award Amount: $600,000

• Expand scope of rate review: Rhode Island will use funds to create an operations manual for the rate review process. The manual will culminate in the issuance of a regulation to institutionalize Rhode Island's rate review process and procedures.
• Improve rate filing requirements: Rhode Island will collaborate on the development of revisions to its Health Insurance Supplemental Annual Statement and enhance insurer compliance with the affordability standards.
• Improve transparency and consumer interfaces: Rhode Island will work with new staff to develop a written and web based consumer guide to Rhode Island health insurance consumer services.
• Hire new staff: Rhode Island 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: Rhode Island is interested in utilizing an All Payer Claims Database to support its research into hospital payments and utilization. Rhode Island will also support efforts to develop a public portal for direct consumer access to the All Payer Claims Database once complete.

Cycle III Grant Application Summary

Rhode Island Grantee: Rhode Island Department of Business Regulation

Award Date: September 23, 2013

Total Award: $2,733,272

Baseline Award: $2,000,000

Workload Award Amount: $333,272

Performance Award Amount: $400,000

• Improve the quality and efficiency of rate review: Rhode Island plans to use rate review to encourage delivery system reform in the commercial insurance market. Specifically, Rhode Island will address hospital payment variation and patient-centered medical homes through the rate review process.
• Proposed studies: Rhode Island proposes to conduct an all-issuer, targeted examination to determine whether the premiums allocated for mental health and substance abuse services are reasonable in relation to the benefits covered.
• Improve rate review transparency: Rhode Island will hire a Health Reforms Specialist to improve compliance with consumer protection standards and expand rate review beyond document-level compliance.

Enhance health pricing transparency: Rhode Island will use Cycle III funds to support the development of a consumer-oriented website that publishes health pricing data. Rhode Island will use focus groups at multiple stages in order to get input on the design of their health pricing website.

Cycle IV Grant Application Summary

Rhode Island Grantee: Business Regulation, Rhode Island Department of
Award Date: September 19, 2014
Total Award: $1,179,000.00

• Improve the Quality/Efficiency of Rate Review: Rhode Island will further solidify its rate review process, including supporting staffing dedicated to rate review.  Rhode Island will support staff work with actuaries to collect actual rates of renewal from issuers to large groups on a quarterly basis and hold issuers accountable for annual results through post-rate review public reporting.
• Improve Rate Review Transparency: Rhode Island will use funds to make its website more accessible to consumer audiences in both form and content. With the help of the contracted vendor and consumer advocacy groups, Rhode Island will develop one-page summaries of the benefits and cost-sharing requirements associated with each specific insurance plan.  Staff will also coordinate with consumer advocacy groups to increase public awareness and understanding of the rate review process.
• Health Pricing Transparency Activities Integrated into Rate Review: Rhode Island intends to increase price transparency by using its regulatory authority through the rate review process to attach conditions to rate approval and by ensuring that consumers and providers have access to price information through a variety of channels, including approved issuer form documents and a consumer website that will allow the public to interface with price and cost data from the Data Center.  Rhode Island will use its regulatory power to standardize price transparency reporting requirements to be consistent across all issuers.

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