The Agency is proposing to amend Rule 59B-13.001, F.A.C. to change the title, update submission requirements, correct citations for Laws Implemented and align submission requirements with existing national standards.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Cost Management and Control

RULE NO.:RULE TITLE:

59B-13.001Reporting Instructions

PURPOSE AND EFFECT: The Agency is proposing to amend Rule 59B-13.001, F.A.C. to change the title, update submission requirements, correct citations for Laws Implemented and align submission requirements with existing national standards.

SUMMARY: 59B-13.001, F.A.C., Reporting Instructions, details the quality indicator reporting requirements for health plans licensed under Chapter 641, F.S.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A SERC has not been prepared by the agency. For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 408.15(8); 641.51, FS.

LAW IMPLEMENTED: 408.061, 408.063(2), 408.08(5), 408.15(11), 641.51(9) FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: April 10, 2019, 9:00 a.m. – 10:00 a.m.

PLACE: Agency for Health Care Administration, Conference Room D, 2727 Mahan Drive, Building #3, Tallahassee, FL 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Dana Watson, Bureau of the Florida Center Health Information Exchange and Transparency, 2727 Mahan Drive, Tallahassee, Florida, [phone].. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Dana Watson, Bureau of the Florida Center Health Information Exchange and Transparency, 2727 Mahan Drive, Tallahassee, Florida, [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59B-13.001 Health Plan Quality Indicators Reporting Instructions

(1) Reporting Instructions

(a) Any health maintenance organization authorized to transact business in the state under Chapter 641, F.S, as of January 1 of the report year shall report access and quality indicator data for Florida members to the Aagency as identified described in this rule and specified in the Healthcare Effectiveness Data and Information Set developed by the National Committee for Quality Assurance (NCQA), 1100 13th St. NW, Third Floor, Washington , DC  20005 Rules 59B-13.001, 59B-13.002, 59B-13.003 and 59B-13.004, F.A.C.

(b)(2) Beginning with calendar year 2018 1999 data, each health maintenance organization shall submit indicator data for each calendar year period no later than October 1 of the following year.  The amendments appearing herein are effective beginning with calendar year 2002 data due October 1, 2003.

(c)(3) Extensions to the indicator data due date will be granted by the Agency Administrator of Research and Analysis for a maximum of 30 days from the due date in response to a written request signed by the chief executive officer of the health maintenance organization or his/her designee. The request must be received prior to the due date and the delay must be due to unforeseen and unforeseeable factors beyond the control of the reporting health maintenance organization. Extensions shall not be granted verbally.

(d)(4) Each health maintenance organization must shall submit the HEDIS measures from the NCQA Interactive Data Submission System (IDSS) file as an Excel file indicator data in a text (ASCII) file. The file name shall be in the format: HMOyyyy.txt where yyyy is the year of the indicator data.

(e)(5) Each health maintenance organization shall send indicator data by electronic mail to [e-mail] and shall include in the electronic mailing the following information:  [e-mail] or to the agency’s mailing address using a 3.5'' diskette or CD-ROM. The mailing address of the agency is: Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308 with the statement, “Attention: Florida Center for Health Information and Policy Analysis.”

(6) The diskette or CD-ROM must have an external label affixed with the following information:

1.(a) “HMO Indicator Data”;

2.(b) Health maintenance organization identification number assigned by the Aagency;

3.(c) Health maintenance organization name; and

4.(d) File name in the format HMOyyyy.xls HMOyyyy.txt where yyyy is the year of the indicator data.; and,

(e) Number of records in the file.

(7) Health maintenance organizations submitting indicator data using electronic mail shall include in the electronic mailing the following information:

(a) “HMO Indicator Data”;

(b) Health maintenance organization identification number assigned by the agency;

(c) Health maintenance organization name;

(d) File name in the format HMOyyyy.txt where yyyy is the year of the indicator data; and,

(e) Number of records in the file.

(2)Definitions.

(a) “HEDIS” means the Healthcare Effectiveness Data and Information Set developed and published by the National Committee for Quality Assurance, 1100 13th St. NW, Third Floor, Washington, DC  20005. HEDIS Volume 2: Technical Specifications for Health Plans includes technical specifications for the calculation of indicators of access and quality of care.

(3) Measures Required to be Reported.

Each health maintenance organization shall submit Florida member data for each HEDIS measure listed in (a) through (k) for each line of business included for that measure. For each measure, the applicable guideline is HEDIS 2019 Volume 2: Technical Specifications for Health Plans which is hereby incorporated by reference and effective at adoption. The copyrighted material can be viewed at the Agency 2727 Mahan Drive, Tallahassee, FL 32308 and the Department of State, R.A. Gray building 500 South Bronough Street, Tallahassee, FL, 32399. A copy may also be obtained from the National Committee for Quality Assurance (NCQA), 1100 13th St. NW, Third Floor, Washington, DC 20005.

(a) Adult BMI Assessment (ABA) Medicaid

(b) Childhood Immunization Status (CIS) Medicaid

(c) Immunizations for Adolescents (IMA) Medicaid

(d) Breast Cancer Screening (BCS) Medicaid, Commercial, Medicare

(e) Cervical Cancer Screening (CCS) Medicaid, Commercial

(f) Chlamydia Screening in Women (CHL) Medicaid, Commercial

(g) Controlling High Blood Pressure (CBP) Medicaid, Commercial, Medicare

(h) Comprehensive Diabetes Care (CDC) Medicaid, Commercial, Medicare

(i) Prenatal and Postpartum Care (PPC) Medicaid, Commercial

(j) Well-Child Visits in the First 15 Months of Life (W15) Medicaid, Commercial

(k) Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) Medicaid, Commercial

(4) Certification.

A copy of the statement of certification from the HEDIS auditor that includes report designations for each performance measure must accompany the plan’s report submission.

(5) Penalties for Report Deficiencies.

(a) For purposes of this rule, a report, certification, or other information is incomplete when it does not contain all data required by the Agency in this rule or when it contains inaccurate data. A report or certification is “false” if done or made with the knowledge of the preparer or a superior of the preparer that it contains information or data which is not true or accurate.

(b) A health maintenance organization that refuses to file, fails to timely file, or files a false or incomplete report, certification or other information required to be filed under the provisions of Section 408.061, F.S., other Florida law, or rules adopted thereunder, shall be subject to administrative penalties pursuant to Section 408.08(5), F.S.

(c) The penalty period will begin on the first work day following the due date for purposes of penalty assessments.

(6) Uniform Publication Format.

(a) The Agency shall publish the following indicator data for each indicator no less frequently than every two years:

1. Health maintenance organization name;

2. Calendar year of data;

3. Type of product line;

4. Rate; and,

5. Notation that the health plan is new or small (not measurable) if applicable.

(b) In each publication of indicator data, the Agency shall include a title and a summary description of the indicator.

Rulemaking Authority 408.15(8), 641.51(9) FS. Law Implemented 408.061, 408.063(2), 408.08(5), 408.15(11), 641.51(9) FS. History–New 6-27-2000, Amended 10-22-2002, __________ .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Dana Watson, Bureau of the Florida Center Health Information Exchange and Transparency

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Mary C. Mayhew, Secretary, Agency for Health Care Administration

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 14, 2019

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 8, 2018