| (a) Required machine-readable files. Issuers must publish
the following machine-readable files consistent with Insurance Code
Chapter 1662, Subchapter C, concerning Required Public Disclosures,
and the rules under this subchapter:
(1) an in-network negotiated rates file, containing
in-network provider negotiated rates for all covered health care services
and supplies, consistent with Insurance Code §1662.103(a)(1),
concerning Required Information, and §1662.104, concerning Network
Rate Disclosures;
(2) an out-of-network allowed amounts file, containing
billed charges and allowed amounts for covered health care services
or supplies provided by out-of-network providers, consistent with
Insurance Code §1662.103(a)(2) and §1662.105, concerning
Out-of-Network Allowed Amounts; and
(3) an in-network prescription drugs file, containing
in-network historical net prices and negotiated rates for prescription
drugs, consistent with Insurance Code §1662.103(a)(3) and §1662.106,
concerning Historical Net Price.
(b) Transport mechanism. An issuer must make all machine-readable
files available via HTTPS.
(c) Content type. An issuer must use a nonproprietary
and open format for publishing machine-readable files. Examples of
acceptable formats include JSON, XML, and YAML. Examples of proprietary
formats that are not acceptable include PDF, XLS, and XLSX.
(d) Public discoverability. An issuer must make machine-readable
files available to the public consistent with Insurance Code §1662.107,
concerning Required Method and Format for Disclosure, and without
restrictions that would impede the reuse of that information. The
issuer must provide the location of the URLs for the machine-readable
files over HTTPS to ensure the integrity of the data.
(e) Indexing. To allow for search engine discoverability,
an issuer may not use a mechanism, such as a robots.txt file or a
meta tag on the page where the files are hosted, or other mechanism
that gives instructions to web crawlers to not index the page.
(f) Special data types. Dates must be strings in ISO
8601 format (e.g., YYYY-MM-DD).
(g) Different flat files. Issuers must publish three
machine-readable files using the following file type names:
(1) "in-network-rates" for the file containing in-network
provider negotiated rates for all covered health care services and
supplies, consistent with Insurance Code §1662.103(a)(1) and §1662.104;
(2) "allowed-amounts" for the file containing billed
charges and allowed amounts for covered health care services or supplies
provided by out-of-network providers, consistent with Insurance Code §1662.103(a)(2)
and §1662.105; and
(3) "prescription-drugs" for the file containing historical
net prices and negotiated rates for prescription drugs, consistent
with Insurance Code §1662.103(a)(3) and §1662.106.
(h) Multiple plans per file. An issuer that has multiple
plans with the same negotiated rates with the same group of providers
for the same covered health care services and supplies may group multiple
plans together within a single file. An issuer that groups multiple
plans into a single file must create a file with the file type name
"table-of-contents" that uses the naming convention and standards
required under subsection (i)(2) of this section. The filing convention
for single plan files under subsection (i)(1) of this section will
not apply to files published as permitted under this subsection.
(i) File-naming convention. An issuer must name each
file using the naming convention and standards required under this
subsection.
(1) The file naming convention for single plan files
includes the elements identified in subparagraphs (A) - (D) of this
paragraph, each separated by an underscore, followed by a period and
the file extension:
(A) the four-digit year, two-digit month, and two-digit
day, each separated by dashes (e.g., "2022-12-01" would be used for
a file published December 1, 2022);
(B) the issuer name, with any spaces replaced with
dashes (e.g., "issuer-abc" would be used for an issuer called "issuer
abc");
(C) the plan name, with any spaces replaced with dashes
(e.g., "healthplan-100" would be used for a plan called "healthplan
100"); and
(D) the file type name (e.g., "in-network-rates").
(2) The file naming convention for the table-of-contents
file published by an issuer that includes multiple plans per file,
as permitted by subsection (h) of this section, includes the elements
identified in subparagraphs (A) - (C) of this paragraph, each separated
by an underscore, followed by a period and the file extension:
(A) the four-digit year, two-digit month, and two-digit
day, each separated by dashes (e.g., "2022-12-01" would be used for
a file published December 1, 2022);
(B) the issuer name, with any spaces replaced with
dashes (e.g., "issuer-abc" would be used for an issuer called "issuer
abc"); and
(C) the word "index."
(3) An issuer may include only alphanumeric characters
in the file name. An issuer may not include special characters or
punctuation other than the dashes, underscores, and periods specified
in the naming convention. An issuer must either remove special characters
completely or replace the special characters with a dash ("-").
(4) Examples of the file naming conventions are provided
in Figure: 28 TAC §21.5502(i)(4).
Attached Graphic
(j) Safe harbor. An issuer that publishes machine-readable
files in the form and method specified by the federal guidance published
on the following website: github.com/CMSgov/price-transparency-guide,
and its associated schemas, will be deemed compliant for the purposes
of this subchapter.
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