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Utah Administrative Code (Current through November 1, 2019) |
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R428. Health, Center for Health Data, Health Care Statistics |
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R428-13. Health Data Authority. Audit and Reporting of Health Plan Performance Measures |
| R428-13-1. Legal Authority |
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This rule is promulgated under authority granted by Title 26, Chapter 33a, Utah Code, and in accordance with the Utah Health Care Performance Measurement Plan. |
| R428-13-2. Purpose |
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This rule establishes the process for the collection of HEDIS 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. |
| R428-13-3. Submission of Performance Measures |
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(1) Each carrier shall compile and submit HEDIS data for the preceding calendar year to the Office by July 1 of each year. (2) By January 1 of each year, each carrier shall submit to the Office a plan for creating and providing HEDIS data for the preceding calendar year. (3) Each carrier shall contract with an independent audit agency certified by the NCQA to verify the HEDIS data using NCQA HEDIS specifications prior to submitting data to the Office. (4) Each carrier may employ the rotation strategy for HEDIS measures developed and updated by NCQA. (5) If a carrier presents "Not Reported (NR)" for required measures, it must document why it did not report the required measure. (6) Each carrier 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 carrier's comments. |
| R428-13-4. Exemptions |
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(1) Notwithstanding the requirements in Subsection R428-2-11(2), a carrier that cannot comply with the requirements of this rule must request an exemption by January 1 of the relevant submission year. (2) A carrier may request an exemption from this rule if the carrier did not operate in Utah for the reporting year, if the number of covered lives is too low for HEDIS standards, or for other similarly prohibitive circumstances beyond the carrier's control. |