Utah Admin. Code R590-262-2 - Purpose and Scope
(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
26B-8-411 and 26B-85-504; 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 employee health 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 health plan.
(4)
(a) The submission of data by an insurer on
behalf of a self-funded employee health plan is considered mandatory if the
employer sponsoring the self-funded employee health plan opts-in under Section
R590-262-7.
(b) An insurer is not obligated to submit
data on behalf of a self-funded employee health plan that opts-out or fails to
respond to an opt-in request required in Section
R590-262-7.
Notes
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