Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59B - Cost Management and Control
Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT
Section 59B-14.005 - Health Plan Reporting Requirements
Current through Reg. 50, No. 187; September 24, 2024
(1) Health insurers shall report health plan data to the Agency for Health Care Administration (agency) on July 1 of each year for each of the insureds included in the satisfaction survey results to be reported on July 1 of the same year as specified in Rule 59B-14.004, F.A.C. The reported health plan data must be current as of the date the sampling frame is prepared.
(2) Health plan data shall be reported for each insured sampled as described in paragraphs (a) through (f) below. All data elements (a) through (f) are required except that data elements (e) and (f) may be reported as UNKNOWN if the information is missing or unavailable. The percentage of unknown responses for any data element must not exceed 2 percent of total records, except that for measurement year 2005, the percentage of unknown responses for any data element must not exceed 5 percent of total records.
If the health plan conditions payment of covered benefits on the use of providers with whom the health insurer has entered into written agreements to provide such benefits by altering cost sharing or in any manner altering covered benefits, report subparagraph 1. network. If the health plan does not condition payment of covered benefits on the use of providers who have entered into written agreements with the health insurer to provide such benefits by altering cost sharing or in any manner altering covered benefits, report subparagraph 2. no network. Report responses as a single digit, 1 or 2.
(3) The health plan data shall be reported in a text file in the order described in subsection (2) using a tab between each data element. Report each plan type in a separate file, appending data (a) through (f) for each insured to the corresponding survey data for the insured required in Rule 59B-14.004, F.A.C., starting a new line for each respondent as described in subsection 59B-14.004(7), F.A.C.
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061(1)(c), (e) FS.
New 12-25-05.
