Section 21.5405 - Timing and Frequency of Data Submissions(a) Payors must submit monthly data files according to the following schedule: (1) January data must be submitted no later than May 7 of that year;(2) February data must be submitted no later than June 7 of that year;(3) March data must be submitted no later than July 7 of that year;(4) April data must be submitted no later than August 7 of that year;(5) May data must be submitted no later than September 7 of that year;(6) June data must be submitted no later than October 7 of that year;(7) July data must be submitted no later than November 7 of that year;(8) August data must be submitted no later than December 7 of that year;(9) September data must be submitted no later than January 7 of the following year;(10) October data must be submitted no later than February 7 of the following year;(11) November data must be submitted no later than March 7 of the following year; and(12) December data must be submitted no later than April 7 of the following year;(b) Except as provided in subsections (c) and (d) of this section, payors must submit test data files, historical data files, and monthly data files according to the dates specified by the Center, subject to the following requirements:(1) the Center will provide notice of the timeline for payors to submit registration and test data no later than 90 days before the data is due, and test data will be due no sooner than October 1, 2022;(2) the Center will provide notice of the timeline for submitting historical data, which must include data for reporting periods spanning from January 1, 2019, to the most recent monthly reporting period, no later than 120 days before the data is due, and historical data will be due no sooner than January 1, 2023; and(3) the Center will provide notice of the timeline for submitting monthly data no later than 180 days before the commencement of the monthly data submission, and the first monthly data submission date will be no sooner than March 1, 2023.(c) A payor with fewer than 10,000 covered lives in plans that are subject to reporting under this subchapter as of December 31 of the previous year must begin reporting no later than 12 months after the dates otherwise required, as specified by the Center, consistent with subsection (a) of this section. The payor must register with the Center to document the payor's eligibility for this extension.(d) A payor may request a temporary exception from one or more requirements of this subchapter or the Texas APCD CDL by submitting a request to the Center no less than 30 calendar days before the date the payor is otherwise required to comply with the requirement. Except as provided in paragraph (2) of this subsection, the Center may grant an exception if the payor demonstrates that compliance would impose an unreasonable cost or burden relative to the public value that would be gained from full compliance. (1) An exception may not last more than 12 consecutive months.(2) An exception may not be granted from any requirement contained in Insurance Code Chapter 38, Subchapter I.(3) The Center may request additional information from a payor in order to make a determination on an exception request. A request for additional information must be in writing and must be submitted to the payor within 14 calendar days from the date the payor's request is received.(4) A request for an exception that is neither accepted nor rejected by the Center within 14 calendar days from the date the payor's request is received will be deemed accepted. If the Center has requested additional information from a payor under paragraph (3) of this subsection, the 14-day timeline begins the day after the payor submits such information. If a payor does not respond to or fails to provide the Center with additional information as requested, the payor's request for an exception may be deemed withdrawn by the Center at the end of the 14-day period.(e) A payor that is unable to meet the reporting schedule provided by this section may submit a request for an extension to the Center before the reporting due date. The Center may grant a request for good cause at its discretion.(1) The Center may request additional information from a payor in order to make a determination on an extension request. A request for additional information must be in writing and must be submitted to the payor within 14 calendar days from the date the payor's request is received.(2) A request for an extension that is neither accepted nor rejected by the Center within 14 calendar days from the date the payor's request is received will be deemed accepted. If the Center has requested additional information from a payor under paragraph (1) of this subsection, the 14-day timeline begins the day after the payor submits such information. If a payor does not respond to or fails to provide the Center with additional information as requested, the payor's request for an extension may be deemed withdrawn by the Center at the end of the 14-day period.(f) The Center will assess each data submission to ensure the data files are complete, accurate, and correctly formatted.(g) The Center will communicate receipt of data within 14 calendar days, inform the payor of the data quality assessments, and specify any required data corrections and resubmissions.(h) Upon receipt of a resubmission request, the payor must respond within 14 calendar days with either a revised and corrected data file or an extension request.(i) If a payor fails to submit required data or fails to correct submissions rejected due to errors or omissions, the Center will provide written notice to the payor. If the payor fails to provide the required information within 30 calendar days following receipt of said written notice, the Center will notify the department of the failure to report. The department may pursue compliance with this subchapter via any appropriate corrective action, sanction, or penalty that is within the authority of the department.28 Tex. Admin. Code § 21.5405
Adopted by Texas Register, Volume 47, Number 23, June 10, 2022, TexReg 3475, eff. 6/16/2022