| (a) Data to be reported separately. For all mandated
benefits and mandated offers to be reported, a reporting entity must
report separately its data for individual, small group, and large
group health benefit plans.
(b) Mandated benefits. The following is a list of mandated
benefits about which data relating to a health benefit plan must be
filed under §21.3403 of this title (relating to Collection of
Data Necessary to Provide Report):
(1) Certain Benefits Related to Acquired Brain Injury,
Insurance Code §1352.003 and §1352.0035;
(2) Serious Mental Illness, Insurance Code §1355.004;
(3) Autism Spectrum Disorder, Insurance Code §1355.015;
(4) Low-Dose Mammography, Insurance Code §1356.005;
(5) Reconstructive Surgery Following Mastectomy, Insurance
Code §1357.004;
(6) Diabetes Equipment, Supplies, and Self-Management
Training, Insurance Code §1358.054;
(7) Formulas for Phenylketonuria (PKU) or Other Heritable
Diseases, Insurance Code §1359.003;
(8) Temporomandibular Joint (TMJ) Diagnosis and Treatment,
Insurance Code §1360.004;
(9) Osteoporosis, Detection and Prevention, Insurance
Code §1361.003;
(10) Certain Tests for Detection of Prostate Cancer,
Insurance Code §1362.003;
(11) Certain Tests for Detection of Colorectal Cancer,
Insurance Code §1363.003;
(12) Childhood Immunizations, Insurance Code §1367.053;
(13) Hearing Screening for Children, Insurance Code §1367.103;
(14) Chemical Dependency Coverage, Insurance Code §§1368.004,
1368.005, and 1368.007;
(15) Prescription Contraceptive Drugs and Devices and
Related Services, Insurance Code §1369.104;
(16) Certain Tests for Detection of Human Papillomavirus
and Cervical Cancer, Insurance Code §1370.003;
(17) Certain Tests for Detection of Ovarian Cancer,
Insurance Code §1370.003;
(18) Certain Tests for Early Detection of Cardiovascular
Disease, Insurance Code §1376.003; and
(19) Certain Amino Acid-Based Elemental Formulas, Insurance
Code §1377.051.
(c) Mandated offers. The following is a list of mandated
offers about which data relating to a health benefit plan must be
filed under §21.3403 of this title:
(1) Loss or Impairment of Speech or Hearing, Insurance
Code §1365.003;
(2) In Vitro Fertilization Procedures, Insurance Code §1366.003;
and
(3) Developmental Delays, Insurance Code §1367.204.
(d) Suggested procedure and diagnosis codes. TDI will
provide on its website, www.tdi.texas.gov, suggested procedure and
diagnosis codes that may be used in capturing the required data for
the report. Regardless of whether a reporting entity uses the suggested
codes or some other method of capturing the required information,
each reporting entity must maintain information and documentation
supporting the accuracy and completeness of its data and the report,
including, but not limited to, a list of all procedural and diagnosis
codes used in collecting data for the report for five years following
the submission of the report on which the information was based. On
receiving a request from TDI, a reporting entity must make available
the supporting information described in this subsection.
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