DAR File No. 39103

This rule was published in the May 15, 2015, issue (Vol. 2015, No. 10) of the Utah State Bulletin.

Insurance, Administration

Rule R590-271

Data Reporting for Consumer Quality Comparison

Change in Proposed Rule

DAR File No.: 39103
Filed: 04/24/2015 11:03:48 AM


Purpose of the rule or reason for the change:

The purpose of this filing is to update the Utah Health Information Network (UHIN) standards version and incorporate the Department of Health's Healthcare Effectiveness Data and Information Set (HEDIS) reporting requirements for insurers.

Summary of the rule or change:

The change updates the version number of two UHIN standards that are incorporated by reference, and incorporates the Department of Health's HEDIS reporting requirements for insurers. (DAR NOTE: This change in proposed rule has been filed to make additional changes to a proposed new rule that was published in the February 15, 2015, issue of the Utah State Bulletin, on page 19. Underlining in the rule below indicates text that has been added since the publication of the proposed rule mentioned above; strike-out indicates text that has been deleted. You must view the change in proposed rule and the proposed new rule together to understand all of the changes that will be enforceable should the agency make this rule effective.)

State statutory or constitutional authorization for this rule:

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

This rule or change incorporates by reference the following material:

  • Updates Transparency Denial Standards, published by Utah Health Information Network, 06/06/2015
  • Updates Transparency Administration Performance Standard, published by Utah Health Information Network, 06/06/2015

Anticipated cost or savings to:

the state budget:

Budget neutral--No new information is required by the change. Cost information can be found in the original rule filing.

local governments:

Budget neutral--No new information is required by the change. Cost information can be found in the original rule filing.

small businesses:

Budget neutral--No new information is required by the change. Cost information can be found in the original rule filing.

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

Budget neutral--No new information is required by the change. Cost information can be found in the original rule filing.

Compliance costs for affected persons:

There will be no additional costs as a result of this rule change. Cost information can be found in the original rule filing.

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

This rule change will have no fiscal impact on any entity. The change is merely clerical in nature.

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:

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:


This rule may become effective on:


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) (a) 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)](i) the Transparency Administration Performance Standard, version 1.2; and

[(b)](ii) the Transparency Denial Standards, version 1.[1]2.

[(2)(a)](b)(i) Beginning on April 1, 2016, and each year thereafter, an insurer shall submit the reports referenced in R590-271-4(1)(a)

(ii) to UHIN in an electronic data interchange standard which includes data for the previous calendar year.

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

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

(2) Beginning on July 1, 2016, and each year thereafter, an insurer shall comply with the reporting guidelines, procedures and format of R428-13 and submit to the Utah Department of Health Office of Health Care Statistics, the Healthcare Effectiveness Data and Information Set, HEDIS, data for the preceding calendar year.


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


Additional Information

More information about a Notice of Change in Proposed Rule is available online.

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2015/b20150515.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

Text to be deleted is struck through and surrounded by brackets ([example]). Text to be added is underlined (example).  Older browsers may not depict some or any of these attributes on the screen or when the document is printed.

For questions regarding the content or application of this rule, please contact 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.  For questions about the rulemaking process, please contact the Division of Administrative Rules.