Under the Affordable Care Act (health care reform), any proposed rate increase at or above 10 percent by an individual or small group market insurer must be scrutinized by independent experts to ensure justifiability. The Department of Health & Human Services has issued final regulations that describe the process of how independent experts will scrutinize any proposed increase. In most situations, the individual states will have the primary responsibility for reviewing the rate increases. The Centers for Medicare & Medicaid Services (CMS) will provide this review for states that do not have the resources or authority to review rates. CMS has found that 40 states, the District of Columbia, and the U.S. Virgin Islands have effective review processes for all insurance markets. In three states, CMS will partner with the states to conduct reviews. In seven states and four U.S. territories, CMS will independently conduct the reviews. (76 Fed. Reg. 29964; CMS Fact Sheet, http://cciio.cms.gov/resources/factsheets/rate_review_fact_sheet.html)