No. 38905 (5-year Review): Rule R428-15. Health Data Authority Health Insurance Claims Reporting

DAR File No.: 38905
Filed: 10/10/2014 01:46:34 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

This rule is authorized by Subsection 26-33a-104(1) to "direct a statewide effort to collect, analyze, and distribute health care data to facilitate the promotion and accessibility of quality and cost-effective health care and also to facilitate interaction among those with concern for health care issues."

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

Regence BCBSU (October 2013): Can you extend the 30-day period for extensions to reduce paperwork and staff time, when longer extension periods are needed? In summary, OHCS provided the following response: Our reason for requiring a separate request every 30 days is so that we can best track movement by the submitter toward compliance. United Healthcare (October 2013): Please confirm whether or not the current registration process through the following Utah Office of Health Care Statistics site: http://health.utah.gov/hda/apd/payer_registration.php will remain the same. In summary, OHCS provided the following response: Yes, this requirement will remain the same. At its meeting on 05/13/2014, the Utah Health Data Committee (HDC) unanimously approved the most recent edits to Rule R428-15. HDC members represent various interests in Utah including payers, physicians, hospitals, public health, business, and consumers. Per the Utah Department of Health (UDOH) legal office, Center for Health Data, Health Care Statistics can appropriately use the aforementioned approval for current, five-year review purposes (October 2014).

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule establishes requirements for certain entities that pay for health care to submit data to UDOH. The data are needed to develop and maintain an All Payer Claims Database (APCD). The APCD assists in the comparison of health care cost efficiencies and effectiveness statewide from both a cross sectional as well as from more longitudinally-based, disease progression perspective. Current requests for secure and approved use of APCD data are received from a variety of sources including qualified researchers, institutions, and inter-agency staff. Many analytic reports are expected over the next year that will help monitor trends in claims, costs, and quality of care for the people in Utah. The uses of the data and reports are justifications for continuation of the rule.

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

Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at [e-mail]
• Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at [e-mail]
• Stephanie Saperstein at the above address, by phone at 801-538-6430, by FAX at , or by Internet E-mail at [e-mail]

Effective:

10/10/2014

Authorized by:

David Patton, Executive Director

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