| (a) Payors must submit monthly data files according
to the following schedule:
(1) January data must be submitted no later than May
7 of that year;
(2) February data must be submitted no later than June
7 of that year;
(3) March data must be submitted no later than July
7 of that year;
(4) April data must be submitted no later than August
7 of that year;
(5) May data must be submitted no later than September
7 of that year;
(6) June data must be submitted no later than October
7 of that year;
(7) July data must be submitted no later than November
7 of that year;
(8) August data must be submitted no later than December
7 of that year;
(9) September data must be submitted no later than
January 7 of the following year;
(10) October data must be submitted no later than February
7 of the following year;
(11) November data must be submitted no later than
March 7 of the following year; and
(12) December data must be submitted no later than
April 7 of the following year;
(b) Except as provided in subsections (c) and (d) of
this section, payors must submit test data files, historical data
files, and monthly data files according to the dates specified by
the Center, subject to the following requirements:
(1) the Center will provide notice of the timeline
for payors to submit registration and test data no later than 90 days
before the data is due, and test data will be due no sooner than October
1, 2022;
(2) the Center will provide notice of the timeline
for submitting historical data, which must include data for reporting
periods spanning from January 1, 2019, to the most recent monthly
reporting period, no later than 120 days before the data is due, and
historical data will be due no sooner than January 1, 2023; and
(3) the Center will provide notice of the timeline
for submitting monthly data no later than 180 days before the commencement
of the monthly data submission, and the first monthly data submission
date will be no sooner than March 1, 2023.
(c) A payor with fewer than 10,000 covered lives in
plans that are subject to reporting under this subchapter as of December
31 of the previous year must begin reporting no later than 12 months
after the dates otherwise required, as specified by the Center, consistent
with subsection (a) of this section. The payor must register with
the Center to document the payor's eligibility for this extension.
(d) A payor may request a temporary exception from
one or more requirements of this subchapter or the Texas APCD CDL
by submitting a request to the Center no less than 30 calendar days
before the date the payor is otherwise required to comply with the
requirement. Except as provided in paragraph (2) of this subsection,
the Center may grant an exception if the payor demonstrates that compliance
would impose an unreasonable cost or burden relative to the public
value that would be gained from full compliance.
(1) An exception may not last more than 12 consecutive
months.
(2) An exception may not be granted from any requirement
contained in Insurance Code Chapter 38, Subchapter I.
(3) The Center may request additional information from
a payor in order to make a determination on an exception request.
A request for additional information must be in writing and must be
submitted to the payor within 14 calendar days from the date the payor's
request is received.
(4) A request for an exception that is neither accepted
nor rejected by the Center within 14 calendar days from the date the
payor's request is received will be deemed accepted. If the Center
has requested additional information from a payor under paragraph
(3) of this subsection, the 14-day timeline begins the day after the
payor submits such information. If a payor does not respond to or
fails to provide the Center with additional information as requested,
the payor's request for an exception may be deemed withdrawn by the
Center at the end of the 14-day period.
(e) A payor that is unable to meet the reporting schedule
provided by this section may submit a request for an extension to
the Center before the reporting due date. The Center may grant a request
for good cause at its discretion.
(1) The Center may request additional information from
a payor in order to make a determination on an extension request.
A request for additional information must be in writing and must be
submitted to the payor within 14 calendar days from the date the payor's
request is received.
(2) A request for an extension that is neither accepted
nor rejected by the Center within 14 calendar days from the date the
payor's request is received will be deemed accepted. If the Center
has requested additional information from a payor under paragraph
(1) of this subsection, the 14-day timeline begins the day after the
payor submits such information. If a payor does not respond to or
fails to provide the Center with additional information as requested,
the payor's request for an extension may be deemed withdrawn by the
Center at the end of the 14-day period.
(f) The Center will assess each data submission to
ensure the data files are complete, accurate, and correctly formatted.
(g) The Center will communicate receipt of data within
14 calendar days, inform the payor of the data quality assessments,
and specify any required data corrections and resubmissions.
(h) Upon receipt of a resubmission request, the payor
must respond within 14 calendar days with either a revised and corrected
data file or an extension request.
(i) If a payor fails to submit required data or fails
to correct submissions rejected due to errors or omissions, the Center
will provide written notice to the payor. If the payor fails to provide
the required information within 30 calendar days following receipt
of said written notice, the Center will notify the department of the
failure to report. The department may pursue compliance with this
subchapter via any appropriate corrective action, sanction, or penalty
that is within the authority of the department.
|
