Utah Administrative Code
Topic - Insurance
Title R590 - Administration
Rule R590-262 - Health Data Authority Health Insurance Claims Reporting
Section R590-262-2 - Purpose and Scope
Universal Citation: UT Admin Code R 590-262-2
Current through Bulletin 2024-06, March 15, 2024
(1) The purpose of this rule is to:
(a) establish the
requirements for entities that pay for health care to submit data to the Utah
Department of Health and Human Services;
(b) coordinate with:
(i) Sections
26-1-37 and
26-33a-106.1; and
(ii) Rules R428-1 and
R428-15;
(c) allow the
data to be shared with the state's designated secure health information master
patient index, Clinical Health Information Exchange (cHIE), to be used:
(i) in compliance with data security
standards established by:
(A) the federal
Health Insurance Portability and Accountability Act of 1996,
Pub. L.
104-191, 110 Stat. 1936: and
(B) the electronic commerce agreements
established in a business associate agreement;
(ii) for coordination of health insurance
benefits; and
(iii) for the
enrollment data elements identified in Rule
R428-15.
(2) This rule applies to an insurer offering or administering health insurance, including a self-funded plan that opts-in under Section R590-262-7.
(3) This rule does not apply to:
(a) an insurer that, as of the first day of
the reporting period, covers fewer than 2,500 individual Utah
residents;
(b) a long-term care
insurance policy;
(c) an income
replacement policy; or
(d) except
as provided in Subsection (2)(c), a self-funded employee welfare
plan.
(4)
(a) The submission of data by an insurer on
behalf of a self-funded plan is considered mandatory if the self-funded
employer opts-in under Section
R590-262-7.
(b) An insurer is not obligated to submit
data on behalf of a self-funded plan that opts-out or fails to respond to an
opt-in request required in Section
R590-262-7.
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