No. 30956 (Amendment): R428-13-4. Submission of Performance Measures

DAR File No.: 30956
Filed: 02/07/2008, 12:47
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

An updated reference to the current (2008) HEDIS (Health Plan Employer Data and Information Set) Compliance Audit: Standards, Policies and Procedures, published by the National Committee for Quality Assurance, is needed to reflect revised guidelines and requirements. Certified auditors use the information in this manual when verifying HEDIS data submitted by health maintenance organizations and health plans for subsequent reporting by the Office of Health Care Statistics.

Summary of the rule or change:

The amendment updates the incorporated reference, HEDIS Compliance Audit: Standards, Policies, and Procedures from "2002" to "2008" in Subsection R428-13-4(7), and corrects a minor punctuation error.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 33a

This rule or change incorporates by reference the following material:

2008: Volume 5: HEDIS Compliance Audit: Standards, Policies, and Procedures

Anticipated cost or savings to:

the state budget:

This amendment will have no fiscal impact on the department or the state budget since the changes do not modify any current requirement with a financial impact.

local governments:

The proposed changes would not have any impact on any local government budget since the changes do not modify any current requirement with a financial impact.

small businesses and persons other than businesses:

The proposed changes would not have any financial impact on other persons since the changes do not create additional work for those affected by the amendment.

Compliance costs for affected persons:

There are no compliance costs for affected persons associated with the proposed rule changes since the changes do not create additional work for those affected by the amendment.

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

No unacceptable fiscal impact is expected on businesses impacted by this rule change. This will be evaluated after the public has an opportunity to comment. David N. Sundwall, MD, Executive Director

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:

Sam Vanous at the above address, by phone at 801-538-7074, by FAX at 801-538-9916, or by Internet E-mail at [e-mail]

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:

04/14/2008

This rule may become effective on:

04/21/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R428-13. Health Data Authority. Audit and Reporting of HMO Performance Measures.

R428-13-4. Submission of Performance Measures.

(1) Each HMO and health plan shall compile and submit HEDIS data to the Office according to this rule.

(2) By July 1 of each year, all HMOs and health plans shall submit to the Office audited HEDIS data for the prec[e]eding calendar year.

(3) Each HMO and health plan shall contract with an independent audit agency certified by the NCQA to verify the HEDIS data prior to the HMO's or health plan's submitting it to the Office.

(4)

(5) Each HMO and health plan may employ the rotation strategy for HEDIS measures developed and updated by NCQA.

(6) If an HMO or health plan presents "Not Reported (NR)" for required measures, it must document why it did not report the required measure.

(7) The auditor shall follow the guidelines and procedures contained in 200[2]8: Volume 5: HEDIS Compliance Audit: Standards, Policies, and Procedures["] published by NCQA, which is incorporated by reference.

(8) Each HMO and health plan shall cause its contracted audit agency to submit a copy of the audit agency's report by July 1 of the submission year to the Office.

(9) Each HMO and health plan shall cause its contracted audit agency to submit a copy of the audit agency's final report by August 15 of the submission year to the Office. The final report shall incorporate the HMO's or health plan's comments.

 

KEY: health, health planning, health policy

Date of Enactment or Last Substantive Amendment: [August 14, 2002]2008

Notice of Continuation: March 10, 2003

Authorizing, and Implemented or Interpreted Law: 26-33a