§ 97449. Total Health Care Expenditures Data Submission.
22 CA ADC § 97449Barclays Official California Code of RegulationsEffective: March 4, 2024
Effective: March 4, 2024
22 CCR § 97449
§ 97449. Total Health Care Expenditures Data Submission.
In order for the Office to measure total health care expenditures and per capita total health care expenditures, the reporting requirements for payers and fully integrated delivery systems to submit data and other information are as follows:
(1) The payer or fully integrated delivery system is a Medi-Cal managed care plan contracted with the State Department of Health Care Services to provide full scope benefits to 40,000 or more Medi-Cal beneficiaries pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code. The number of Medi-Cal beneficiaries shall be calculated as of December 31 of each calendar year prior to the submission year. This subsection (a)(1) is effective beginning with the first annual data file submission as described in subsections (e)(2) and (h)(2).
(2) The payer or fully integrated delivery system enrolls or insures 40,000 or more covered lives in Medicare Advantage products under Medicare Part C. The number of covered lives in Medicare Advantage products shall be calculated by adding together all the covered lives in the entity's Medicare Advantage products in California as of December 31 of each calendar year prior to the submission year.
(3) The payer or fully integrated delivery system enrolls or insures 40,000 or more covered lives in commercial products. The number of covered lives in commercial products shall be calculated by adding together all the covered lives in the entity's commercial health insurance products and commercial health plan products in California as of December 31 of each calendar year prior to the submission year. For purposes of this paragraph, “commercial” refers to products that are not Medi-Cal or Medicare Advantage products.
(c) Voluntary Data Submission. To request to become a voluntary submitter, a payer or fully integrated delivery system or their authorized agent shall submit to the Office a written request to participate. Each request shall provide the voluntary submitter's contact information, number of covered lives, and types of coverage offered. The Office shall notify requestors if they are approved to register to submit data.
(j) Test File Submission. Registered submitters may use the Data Portal to submit test files to confirm and test their ability to create data files meeting the file intake specifications detailed in the Guide. Test files will be identified as specified in the Guide. Test files will not be considered to have been submitted to the Office for reporting purposes.
(2) If the Office determines that a previously accepted file contains initially unidentified errors, the submitter shall be notified through the Data Portal. The submitter shall respond through the Data Portal within three business days of notification by the Office. The Office may make multiple requests for corrections or resubmissions.
Credits
Note: Authority cited: Sections 127501, 127501.2 and 127501.4, Health and Safety Code. Reference: Sections 127500.2, 127500.5 and 127501.4, Health and Safety Code.
History
1. New section filed 3-4-2024 as an emergency; operative 3-4-2024 (Register 2024, No. 10). Pursuant to Health and Safety Code section 127501.2, subdivision (b), this regulation shall be repealed by operation of law on 3-2-2029 unless the adoption, amendment, or repeal of the regulation is promulgated by the office pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of title 2, of the Government Code before that date.
This database is current through 6/7/24 Register 2024, No. 23.
Cal. Admin. Code tit. 22, § 97449, 22 CA ADC § 97449
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