DAR File No. 39103

Insurance, Administration

Rule R590-271

Data Reporting for Consumer Quality Comparison

Notice of Proposed Rule

(New Rule)

DAR File No.: 39103
Filed: 01/30/2015 05:01:27 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this new rule to adopt a methodology for determining and comparing insurer transparency information as required by Subsection 31A-22-613.5(4)(b).

Summary of the rule or change:

The rule adopts the Utah Health Information Network data interchange standards, the Transparency Administration Performance Standards, and the Transparency Denial Standards. The rule requires insurers to report the required data elements on an annual basis, with the first report due on 04/01/2016.

State statutory or constitutional authorization for this rule:

• Section 31A-22-613.5
• Section 31A-2-216

This rule or change incorporates by reference the following material:

• Adds Transparency Administration Performance Standard, published by Utah Health Information Network, 06/18/2011
• Adds Transparency Denial Standards, published by Utah Health Information Network, 06/30/2012

Anticipated cost or savings to:

the state budget:

The rule will create no fiscal impact or increased workload for the department or state budget. The rule sets forth reporting requirements for health insurers to follow on an annual basis.

local governments:

This rule will have no effect on local governments since it deals with the relationship between the department and health insurers licensed through the department to do business in Utah.

small businesses:

This rule will have no effect on small businesses since it deals with the relationship between the department and health insurers licensed through the department to do business in Utah.

persons other than small businesses, businesses, or local governmental entities:

Health insurers will be required to collect and report the required data elements. The associated costs are anticipated to be insignificant.

Compliance costs for affected persons:

Health insurers will be required to collect and report the required data elements. The associated costs are anticipated to be insignificant.

Comments by the department head on the fiscal impact the rule may have on businesses:

The fiscal impact on health insurers will be minimal if any. The rule merely requires aggregation of data that insurers gather for other reasons.

Todd E. Kiser, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY, UT 84114-1201

Direct questions regarding this rule to:

• Steve Gooch at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at sgooch@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/17/2015

This rule may become effective on:

03/24/2015

Authorized by:

Todd Kiser, Commissioner

R590. Insurance, Administration.

R590-271. Data Reporting for Consumer Quality Comparison.

R590-271-1. Authority.

This rule is promulgated pursuant to Subsections 31A-2-216 and 31A-22-613.5 wherein the commissioner is directed to educate consumers and to adopt a rule for purposes of reporting transparency information.

 

R590-271-2. Purpose and Scope.

(1) The purpose of this rule is to:

(a) define terms;

(b) define the methodology for determining and comparing insurer transparency information;

(c) provide the data and format for submission to the commissioner; and

(d) provide the date the information is due.

(2)(a) This rule applies to all health benefit plans issued or renewed on or after January 1, 2015.

(b) This rule does not apply to an insurer whose health benefit plans cover fewer than 3,000 individual Utah residents.

 

R590-271-3. Definitions.

In addition to the definitions in Sections 31A-1-301, the following definitions shall apply for the purpose of this rule:

(1) "Electronic Data Interchange Standard" means the:

(a) the standards developed by the UHIN Standards Committee at the request of the commissioner; and

(b) others as adopted by the commissioner by rule.

(2) "SFTP" means the Secure File Transfer Protocol.

(3) "UHIN" means the Utah Health Information Network.

(4) "UHIN Standards Committee" means the Standards Committee of the UHIN.

 

R590-271-4. Reporting Requirements.

(1) The commissioner has convened a group, as identified in 31A-22-613.5(4)(a), to develop information for consumers to compare health insurers and health benefit plans. As a result of the group's work, the commissioner adopts the following UHIN electronic data interchange standards developed and adopted by the UHIN Standards Committee, which are hereby incorporated by reference with this rule and are available for public inspection at the department during normal business hours, at www.insurance.utah.gov, or at www.uhin.org:

(a) the Transparency Administration Performance Standard; and

(b) the Transparency Denial Standards, version 1.1.

(2)(a) Beginning on April 1, 2016, and each year thereafter, an insurer shall submit the reports referenced in R590-271-4(1)(a) to UHIN in an electronic data interchange standard which includes data for the previous calendar year.

(b) Each report shall include data for both paper and electronic claims combined.

(3) Submission format, procedures and guidelines are described in detail in the adopted transparency standards published by UHIN.

 

R590-271-5. Records.

The commissioner finds the data submitted to the commissioner in the Transparency Administration Performance Standard and the Transparency Denial Standards to be considered a public record as defined in Section 63G-2-103 for the purpose of display on:

(1) the Health Insurance Exchange as described in Section 63M-1-2505, avenueh.com;

(2) the department's website, insurance.utah.gov; and

(3) the department's transparency website, healthrates.utah.gov.

 

R590-271-6. Penalties.

A person found to be in violation of this rule shall be subject to penalties as provided under Section 31A-2-308.

 

R590-271-7. Enforcement Date.

The commissioner will begin enforcing this rule 45 days from the rule's effective date.

 

R590-271-8. Severability.

If any provision of this rule or its application to any person or circumstances is for any reason held to be invalid, the remainder of the rule and the application of the provision to other persons or circumstances shall not be affected thereby.

 

KEY: data, data reporting, insurance

Date of Enactment or Last Substantive Amendment: 2015

Authorizing, and Implemented or Interpreted Law: 31A-2-216; 31A-22-613.5