Section 3 AAC 31.530 - Accounting, reporting, and auditing(a) A health care insurer that cedes a risk to the program shall submit to the program all data and information when required by the association and in the manner and format required by the association. The data and information must include (1) eligibility information; (2) claims information; and (b) The association shall maintain its books, records, accounts, and operations on a calendar-year basis.(c) The association shall conduct a final accounting and anual claims true-up with respect to each calendar year after April 30 of the following calendar year.(d) Claims with respect to ceded risk that are incurred during a calendar year and are submitted for reimbursement not later than April 30 of the following calendar year will be allocated to the calendar year in which they are incurred. The association may not reimburse claims submitted after April 30 following the calendar year in which they are incurred.(e) If the total receipts of the fund with respect to a calendar year are expected to be insufficient to pay all program expenses, claims for reimbursement, and other disbursements allocable to that calendar year, all claims for reimbursement allocable to that calendar year will be reduced proportionately to the extent necessary to prevent a deficit in the fund for that calendar year. Any reduction in claims for reimbursement with respect to a calendar year will apply to all claims allocable to that calendar year without regard to when those claims are submitted for reimbursement, and any reduction will be applied to each claim in the same proportion.(f) The association shall establish a process for auditing each health care insurer ceding risk to the program. Audits may include both a baseline audit conducted in connection with commencement of an insurer's participation in the program and periodic audits up to four times a year throughout the insurer's participation in the program.(g) The association shall engage an independent qualified auditing entity to perform a financial and programmatic audit for each benefit year in accordance with generally accepted auditing standards. The association shall provide a copy of the audit to the director at the time the association receives the audit. The association shall make a public summary of the results of the audit. The public summary must be made available within a time period and in a manner that a prudent person would consider to be timely and informative.(h) The director or the director's designee may conduct financial and programmatic audits of the reinsurance program and the association to assess compliance with(1)3 AAC 31.500 - 3 AAC 31.549; (2) the contract between the director and the association; and(3) the plan of operation established for the administration and operation of the program.Eff. 2/2/2013, Register 205; am 12/22/2016, Register 220, January 2017; am 11/1/2018,Register 228, January 2019Authority:AS 21.06.090
AS 21.55.040
AS 21.55.220
AS 21.55.400
AS 21.55.430