28 Tex. Admin. Code § 21.5501 - Applicability and Effective Date
(a) Except
as provided in subsections (b) and (c) of this section, this subchapter applies
to issuers of health benefit plans as specified in Insurance Code §
1662.003, concerning
Applicability of Chapter, that provide major medical coverage for which federal
reporting requirements under 26 C.F.R. Part 54, concerning Pension Excise
Taxes; 29 C.F.R. Part 2590, concerning Rules and Regulations for Group Health
Plans; 45 C.F.R. Part 147, concerning Health Insurance Reform Requirements for
the Group and Individual Health Insurance Markets; and 45 C.F.R. Part 158,
concerning Issuer Use of Premium Revenue: Reporting and Rebate Requirements, do
not apply, including:
(1) issuers providing
short-term limited-duration insurance, as defined in Insurance Code Chapter
1509, concerning Short-Term Limited-Duration Insurance;
(2) issuers providing grandfathered health
plan coverage, as defined in
45 C.F.R. §
147.140, concerning Preservation of Right to
Maintain Existing Coverage; and
(3)
a regional or local health care program operated under Health and Safety Code §
75.104,
concerning Health Care Services.
(b) This subchapter does not apply to the
following types of plans:
(1) a plan that is
not considered creditable coverage as specified under Insurance Code §
1205.004(b),
concerning Creditable Coverage;
(2)
the child health plan program operated under Health and Safety Code Chapter 62,
concerning Child Health Plan for Certain Low-Income Children;
(3) the health benefits plan for children
operated under Health and Safety Code Chapter 63, concerning Health Benefits
Plan for Certain Children; and
(4)
the state Medicaid program operated under Human Resources Code Chapter 32,
concerning Medical Assistance Program, including the Medicaid managed care
program operated under Government Code Chapter 533, concerning Medicaid Managed
Care Program.
(c) Except
as provided by subsections (d) and (e) of this section, with respect to an
applicable health benefit plan, an issuer must begin publishing
machine-readable files as required under this subchapter in the month in which
the plan year or policy year begins.
(d) A health benefit plan issuer with fewer
than 1,000 total enrollees in all health benefit plans subject to reporting as
of December 31, 2021, must begin publishing machine-readable files as required
under this subchapter no later than January 1, 2024.
(e) Except as provided by subsection (d) of
this section, an issuer is required to begin publishing machine-readable files
no sooner than 180 days after the effective date of this section and no later
than the earliest date specified in paragraphs (1) and (2) of this subsection:
(1) the date that the federal Departments of
Labor, Health and Human Services, and Treasury begin enforcing the federal
Transparency in Coverage rules specific to the publication of machine-readable
files for prescription drug pricing, in-network rates, and out-of-network
allowed amounts and billed charges, if the date of enforcement occurs after the
180th day following the effective date of this section; or
(2) January 1, 2024.
Notes
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