1. (1) The purpose of this rule is to:

   1. (a) establish the requirements for entities that pay for health care to submit data to the Utah Department of Health and Human Services;

   2. (b) coordinate with:

      1. (i) Sections 26B-8-411 and 26B-85-504; and
      2. (ii) Rules R428-1 and R428-15;

   3. (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:

      1. (i) in compliance with data security standards established by:

         1. (A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936: and
         2. (B) the electronic commerce agreements established in a business associate agreement;
      2. (ii) for coordination of health insurance benefits; and
      3. (iii) for the enrollment data elements identified in Rule R428-15.
2. (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. (3) This rule does not apply to:

   1. (a) an insurer that, as of the first day of the reporting period, covers fewer than 2,500 individual Utah residents;
   2. (b) a long-term care insurance policy;
   3. (c) an income replacement policy; or
   4. (d) except as provided in Subsection (2)(c), a self-funded employee health plan.

4. (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.

   1. (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.

KEY: health insurance claims reporting

Date of Last Change: October 22, 2024

Notice of Continuation: March 3, 2022

Authorizing, and Implemented or Interpreted Law: 31A-22-614.5(3)(a)