Vermont Rate Review Grants Award List

Cycle I Grant Application Summary

Vermont Grantee: Vermont Department of Banking, Insurance, Securities and Health Care Administration
Award Date: August 16, 2010
Award Amount: $1,000,000

• Expand the Scope of the Review Process: Vermont already requires prior review and approval of health insurance premiums for some types of plans, and intends to include large group insurance plans as well as other insurance plans such as student coverage in that process.
• Improve the Review Process: Currently Vermont conducts prospective actuarial review on all filings. The filings of the largest insurers are referred to an actuarial contractor for a second level review. With grant funding the State will develop standards for expanding its review process and for improving data collection and analysis.
• Increase Transparency and Accessibility: Presently, Vermont provides hard copies of health insurance premium filings upon request, which must be picked up in person. Grant funds will be used to post plain language summaries on the State's existing web site and add comment functionality for consumers.
• Develop and Upgrade Technology: Vermont will collect and integrate historical rate filing data with current filed data and providing claims reporting by provider.
  

Cycle II Grant Application Summary

Vermont Grantee: Vermont Department of Banking, Insurance, Securities and Health Care Administration
Award Date: September 20, 2011
Total Award: $3,804,045
Baseline Award: $3,000,000
Workload Award Amount: $204,045
Performance Award Amount: $600,000

• Expand scope of rate review: Vermont will continue to review minor health insurance products of insurance and will continue to enhance the review rates in the large group market.
• Improve rate filing requirements: Vermont plans to continue the development of filing standards for individual and small group and will continue collecting relevant data and information from Third Party Administrators (TPAs).
• Improve transparency and consumer interfaces: Vermont will maintain and enhance its new rate review website, post filings within 5 days of receipt to encourage consumer comment, and use market research to support the State's review of rate increases.
• Hire new staff: Vermont will create 2 new positions with Cycle II grant funding; these positions are in addition to the 1 position created with Cycle I resources.
• Improve IT: Vermont plans to build the data and analytical structure to support a more comprehensive rate review process with enhanced transparency, including the integration of hospital budget reviews in the rate review process.

Cycle IV Grant Application Summary

Vermont Grantee: Green Mountain Care Board
Award Date:  September 19, 2014
Total Award: $1,179,000

• Health Pricing Transparency Activities Integrated into Rate Review: Vermont plans to expand its use of its All-Payer Claims Database (VHCURES) to support its efforts to integrate rate review into the larger landscape of health care reform activities and increase medical pricing transparency.
• Improve the Quality/Efficiency of Rate Review: Vermont intends to continue to simplify the rate filing cycle by moving plans toward annual filings and an annual, unified review, with midyear allowance for adjustments by carriers if needed. Annual filings will help control rate volatility and provide a more balanced view of trends (utilization and costs). Vermont will also work with its actuaries to develop additional criteria to examine rates against the market as a whole.
• IT and Other Technology Based Improvements: Vermont proposes several improvements that will strengthen the medical reimbursement data in ways that will enhance applicability to the rate review process and public price transparency reporting:
  • Improved identity management to eliminate duplicate unique member identifiers across insurers
  • A more accurate, robust master provider list for accurate attribution of claims to facilities and providers including group practices
  • Make the data more accessible to authorized users and include application of software tools to make the medical pricing information more meaningful to rate reviewers, consumers, purchasers, regulators, and policy makers
  • More granular insurance product coding to support analytics by product types

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