No. 41172 (Amendment): Rule R590-262. Health Data Authority Health Insurance Claims Reporting

(Amendment)

DAR File No.: 41172
Filed: 01/13/2017 11:04:27 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The rule has two separate areas for providing two different exemptions. The change makes it so the exemptions are in the same section and have the same standard.

Summary of the rule or change:

The original proposed rule has two separate areas that provided for two different standards of exemption. The rule change moves both exemptions to the same section and makes the exemption standards the same.

Statutory or constitutional authorization for this rule:

• Subsection 31A-22-614.5(3)(a)
• Subsection 26-1-37(2)(b)

Anticipated cost or savings to:

the state budget:

There is no anticipated cost or savings to the state budget. The change is merely for clarification purposes and will have no effect on budgeting.

local governments:

There is no anticipated cost or savings to local governments. The change is merely for clarification purposes and will have no effect on budgeting.

small businesses:

There is no anticipated cost or savings to small businesses. The change is merely for clarification purposes and will have no effect on budgeting.

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

There is no anticipated cost or savings to any other persons. The change is merely for clarification purposes and will have no effect on budgeting.

Compliance costs for affected persons:

There are no compliance costs for affected persons. The change is merely for clarification purposes and has no costs associated with it.

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

There will be no fiscal impact on businesses due to this rule change. The change is merely being done to create a more logical flow and to align the standards laid out in the rule, which will make the rule clearer.

Todd E. Kiser, Commissioner

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

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
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 [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:

03/03/2017

This rule may become effective on:

03/10/2017

Authorized by:

Steve Gooch, Information Specialist

RULE TEXT

R590. Insurance, Administration.

R590-262. Health Data Authority Health Insurance Claims Reporting.

R590-262-1. Authority.

This rule is promulgated pursuant to Subsection 31A-22-614.5(3)(a) to coordinate with the provision of Subsection 26-1-37(2)(b) and Utah Department of Health rules R428-1 and R428-15.

 

R590-262-2. Purpose and Scope.

(1) This rule establishes requirements for certain entities that pay for health care to submit data to the Utah Department of Health.

(2) This rule allows the data to be shared with the state's designated secure health information master index person index, Clinical Health Information Exchange (cHIE), to be used:

(a) in compliance with data security standards established by:

(i) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936: and

(ii) the electronic commerce agreements established in a business associate agreement;

(b) for the purpose of coordination of health benefit plans; and

(c) for the enrollment data elements identified in Utah Administrative Rule R428-15, Health Data Authority Health Insurance Claims Reporting.

(3)(a) This rule applies to an insurer offering:

(i) a health benefit plan; or

(ii) a dental plan.

(b) This rule does not apply to:

(i) an insurer that as of the first day of the reporting period:

(A) covers fewer than 2 ,500 individual Utah residents[:]; or

(B) provides administrative services for fewer than 2,500 individual Utah residents covered under self-funded employee plans; and

(ii) a fully insured employer group or self-funded employee plan whose primary place of business is outside the state of Utah and no more than 25% of the employees are residents of Utah;

(ii i) a long-term care insurance policy; or

([ii]i v) an income replacement policy.

(c) Except as provided in Subsection (4), this rule does not require a person to provide information concerning a self-funded employee plan.

(4)(a) The submission of health care claims data by an insurer on behalf of a self-funded employee plan is considered mandatory if and only if the self-funded employee plan opts-in under R590-262-7.

(b) An insurer is not obligated to submit data on behalf of a self-funded employee plan that fails to respond to opt-in requests required in R590-262-7.

 

R590-262-15. Exemptions and Extensions.

(1) The Office may grant exemptions or extensions from reporting requirements in this rule under certain circumstances.

(2) The Office may grant an exemption to an insurer when the insurer demonstrates that compliance imposes an unreasonable cost.

(a) An insurer may request an exemption from any particular requirement or set of requirements of this rule. The insurer must submit a request for exemption no less than 30 calendar days before the date the insurer would have to comply with the requirement.

(b) The Office may grant an exemption for a maximum of one calendar year. An insurer wishing an additional exemption must submit an additional, separate request.

(3) The Office may grant an extension to an insurer when the insurer demonstrates that technical or unforeseen difficulties prevent compliance.

(a) An insurer may request an extension for any deadline required in this rule. For each deadline for which the insurer requests an extension, the insurer must submit its request no less than seven calendar days before the deadline in question.

(b) The Office may grant an extension for a maximum of 30 calendar days. An insurer wishing an additional extension must submit an additional, separate request.

(4) The insurer requesting an extension or exemption shall include:

(a) The insurer's name, mailing address, telephone number, and contact person;

(b) the dates the exemption or extension is to start and end;

(c) a description of the relief sought, including reference to specific sections or language of the requirement;

(d) a statement of facts, reasons, or legal authority in support of the request; and

(e) a proposed alternative to the requirement or deadline.

[(5) An insurer may exclude from the requirements of this rule an employer who maintains a self-funded employee plan:

(a) with less than 100 individual Utah residents as of the first day of the reporting period that services are provided; or

(b) whose primary place of business is outside the state of Utah and no more than 25% of the employees are residents.]

 

KEY: health insurance claims reporting

Date of Enactment or Last Substantive Amendment: [December 12, 2016]2017

Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)

 

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