Tex.
Ins. Code Section 38.252
Collection of Information; Report
(a)
The commissioner shall require a health benefit plan issuer to collect and report cost and utilization data for each mandated health benefit and mandated offer designated by the commissioner.(b)
The commissioner shall designate by rule:(1)
the issuers of health benefit plans that must collect and report data based on the annual dollar amounts of Texas premium collected by the health benefit plan issuer;(2)
the specific mandated health benefits and mandated offers of coverage for which data must be collected;(3)
a description of the data that must be collected;(4)
the beginning and ending dates of the reporting periods, which shall be no less than every two years;(5)
the date following the end of the reporting period by which the report shall be submitted to the commissioner;(6)
the detail and form in which the report shall be submitted; and(7)
any other reasonable requirements that the commissioner determines are necessary to determine the impact of mandated benefits and mandated offers of coverage for which data collection and reporting is required.(c)
The commissioner shall not require reporting of data:(1)
that could reasonably be used to identify a specific enrollee in a health benefit plan;(2)
in any way that violates confidentiality requirements of state or federal law applicable to an enrollee in a health benefit plan; or(3)
in which the health maintenance organization operating under Section 1367.053 (Coverage Required), Subchapter A (Applicability of Certain Definitions), Chapter 1452 (Physician and Provider Credentials), Subchapter B, Chapter 1507 (Consumer Choice of Benefits Plans), Chapter 222 (Life, Health, and Accident Insurance Premium Tax), 251 (General Provisions), or 258 (Health Maintenance Organizations), as applicable to a health maintenance organization, Chapter 843 (Health Maintenance Organizations), Chapter 1271 (Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges), and Chapter 1272 (Delegation of Certain Functions by Health Maintenance Organization) does not directly process the claim or does not receive complete and accurate encounter data.
Source:
Section 38.252 — Collection of Information; Report, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.38.htm#38.252 (accessed May 11, 2024).
