Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since October 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


R428. Health, Center for Health Data, Health Care Statistics.

Rule R428-12. Health Data Authority Survey of Enrollees in Health Plans.

As in effect on October 1, 2019

Table of Contents

R428-12-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a and in accordance with the Utah Health Plan Performance Measurement Plan.

R428-12-2. Purpose.

This rule establishes the process for the collection of enrollee satisfaction data from Utah carriers that are needed to promote informed consumer choice in plan selection and measure the quality of care provided to enrollees of Utah carriers.

R428-12-3. Submission of Satisfaction Data.

(1) Each carrier covered by the scope determined in subsection R428-12-5 shall compile and submit enrollee satisfaction (Consumer Assessment of Healthcare Providers and Systems survey or CAHPS) data to the Office according to this rule.

(2) By January 1 of each year, each carrier shall submit to the Office a plan for creating and providing CAHPS data for the preceding calendar year. For each required survey, the plan must clearly indicate whether the carrier will use the Office's contracted vendor or whether the carrier will contract with a survey agency on their own.

(3) By July 1 of each year, each carrier shall submit to the Office CAHPS data for the preceding calendar year, unless an alternate timeframe has been determined under subsection R428-12-5, in which case the carrier shall submit the data by the alternate due date.

R428-12-4. Sampling Frame Submission.

(1) The sources for enrollment data are Utah carriers. Each carrier shall include in the sampling frame all eligible enrollees.

(2) Each carrier shall create the sampling frame according to the criteria outlined in the NCQA Survey Specifications.

(3) The sampling frame and procedures used by the reporting carrier are subject to audit by the Office of Health Care Statistics.

(4) The carrier shall copy the sampling frame using an electronic medium acceptable to the survey agency and then send to the survey agency.

(5) The carrier shall fill out the "Sample Description" sheet to be provided by the survey agency and send it with the electronic sample file. Each carrier shall submit to the survey agency the sampling frame for each of its products no later than four weeks after the receipt of the sampling memo from the survey agency.

R428-12-5. Administration of Survey.

Each year, the Utah Department of Health, in consultation with carriers, will determine the target survey population, survey timeframes, and the scope of the survey.

KEY

health maintenance organization, performance measurement, health care quality, preferred provider organization

Date of Enactment or Last Substantive Amendment

November 21, 2016

Notice of Continuation

November 10, 2016

Authorizing, Implemented, or Interpreted Law

26-33a-104; 26-33a-108


Additional Information

Contact

For questions regarding the content or application of rules under Title R428, please contact the promulgating agency (Health, Center for Health Data, Health Care Statistics). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.