No. 39768 (Amendment): Rule R428-12. Health Data Authority Survey of Enrollees in Health Plans

(Amendment)

DAR File No.: 39768
Filed: 09/25/2015 12:44:38 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to clarify submission requirements for satisfaction data and the creation of appropriate sampling frames reflecting current business practice. Also perform nonsubstantive format editing where needed.

Summary of the rule or change:

Update language in Rule R428-12 to clarify existing processes for data submissions and sampling frames including mandatory deadlines for carrier submissions as specified by January 1st and July 1st of each calendar year.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 33a

Anticipated cost or savings to:

the state budget:

This rule amendment updates language in Rule R428-12 which outlines specific processes for collecting 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. The Utah Department of Health determines enactment of the amended version will not create any cost or savings impact to the state budget or UDOH's budget, since the change will not increase workload and can be carried out with existing budget.

local governments:

This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule; nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.

small businesses:

None--Small businesses are not impacted by this rule change, with all potentially impacted having more than 50 employees. As a result, the rule will have no effect on small business budgets for costs or savings.

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

Technical changes will not create any cost or savings to businesses, individuals, local governments or persons that are not small businesses.

Compliance costs for affected persons:

As stated earlier, these changes are being made to align with existing business practice; therefore, no compliance costs are expected.

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

There is no fiscal impact on business because the amendment aligns the procedures set out in the rule with existing business practices.

Joseph Miner, 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:

• 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]

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:

11/16/2015

This rule may become effective on:

11/23/2015

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

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

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

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. [Creating the Sampling Fram]Submission of Satisfaction Data.

[(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.

] (1) Each carrier 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.

 

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.

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

[(2)](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 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: [August 5, 2014]2015

Notice of Continuation: November 30, 2011

Authorizing, and Implemented or Interpreted Law: 26-33a-104; 26-33a-108

 

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