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Commissioner’s Bulletin # B-0017-14

July 08, 2014

TO: ISSUERS OF PREFERRED PROVIDER BENEFIT PLANS, HEALTH MAINTENANCE ORGANIZATION PLANS, AND SPECIFIED GOVERNMENTAL EMPLOYEE PLANS IN THE STATE OF TEXAS

RE: HEALTH CARE REIMBURSEMENT RATE INFORMATION DATA CALL AND ALTERNATIVE 2014 SURVEY

SURVEY DUE: July 25, 2014, or

DATA SUBMISSION DUE: September 1, 2014, for reporting period January 1, 2014, to June 30, 2014

In past years, the Texas Department of Insurance has issued an annual data call for health care reimbursement rate information under Insurance Code Chapter 38, subchapter H. This subchapter requires the department to collect health benefit plan reimbursement rate information in a uniform format, and to disseminate the combined rates derived from this data by geographical regions in the state. This data call applies to issuers of preferred provider benefit plans, health maintenance organization plans, and specified governmental employee plans under Insurance Code Chapters 1551, 1575, 1579, and 1601. The rules that implement this statute are in 28 Texas Administrative Code Chapter 21, subchapter KK. Issuers submit this data by completing form LHL616.

However, to improve the quality of the data collected under the rule, TDI invites carriers to respond to a more limited survey about the reimbursement rate data reporting in lieu of the full reporting of 2014 reimbursement rate information. The alternative survey is shorter and simpler than the data call. As a result, TDI anticipates that most carriers will elect to submit the survey. The survey will assist TDI's efforts to improve the quality of future health reimbursement rate data collections.

Companies that choose to respond to the survey do not need to submit form LHL616.
 
Survey:

The response to the limited survey is due July 25, 2014. The survey may be completed online at: Survey download link: http://www.tdi.texas.gov/health/reimbursement.html. As previously noted, companies that choose to respond to the limited survey do not need to submit form LHL616.

Companies that are exempt by rule from the data collection should not respond to the survey, but should follow the instructions below for submitting an exemption statement.

Data Call:

Companies choosing to submit the LHL616 report instead of participating in the limited survey must do so by September 1, 2014. The 2014 report covers data for claim payments from January 1, 2014, to June 30, 2014. The instructions below apply only to companies choosing not to respond to the limited survey alternative. Failure to comply with the requirements of the data call by September 1, 2014, is a violation of the Insurance Code and may subject the issuer to penalty.

Issuers choosing to respond to the data call with reimbursement rate data must use the Microsoft Excel form LHL616, which may be found at the following Internet link: LHL616 Data Entry Form and Instructions. Form LHL616 must be submitted electronically to ReimbursementRates@tdi.texas.gov. To access the reporting form, you must accept the "End User Agreement" concerning use of current procedural terminology by clicking the button labeled, "Accept." The content of the End User Agreement is provided in 28 TAC §21.4506(f).

TDI requests that responding issuers voluntarily comply with reporting data for updated Zip codes. Newly added Zip codes that are not in 28 Texas Administrative Code Chapter 21, subchapter KK are 73960 (Panhandle), 75033 (Metroplex), 77407 (Gulf Coast), 77498 (Gulf Coast), 77523 (Gulf Coast), and 78542 (Gulf Coast). Data about these Zip codes should be included in data reported for the corresponding regions.

Certain group health benefit plan issuers may submit to TDI an exemption statement, and the data required in Section B of form LHL616, to support an exemption in place of the full report. As required by 28 TAC §21.4506(e), a group health benefit plan issuer asserting an exemption must certify that the group health benefit plan issuer is exempt from the reporting requirement applicable to its health benefit plans for one of the following reasons:

(1) The total number of all covered lives in private market preferred provider benefit plans operating under Insurance Code Chapter 1301 and offered by the health benefit plan issuer in Texas does not exceed 10,000 persons as of December 31 of the year preceding the report; or

(2) The total number of all covered lives in the private market health maintenance organization plans operating under Insurance Code Chapter 843 and offered by the health benefit plan issuer does not exceed 10,000 persons as of December 31 of the year preceding the report.

If you are unable to download the form, or have any questions concerning this data call, you may contact TDI by email at ReimbursementRates@tdi.texas.gov.


Julia Rathgeber
Commissioner of Insurance





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Last updated: 01/06/2025


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