760 Ind. Admin. Code 1-83-32

Current through December 12, 2024

Section 760 IAC 1-83-32 - Violations; penalties

Authority: IC 27-1-44.5-11

Affected: IC 27-1-3-28; IC 27-1-44.5

Sec. 32.

(a) If a health payer fails to:

(1) submit required data to the APCD;

(2) submit required data passing the data quality validations or variances under the:

(A) submission guide and APCD-CDLT; or

(B) periods outlined in this rule;

(3) register for the APCD; or

(4) correct submissions rejected because of errors;

the administrator shall give written notice of the nature of the violation and required steps to cure the violation to the health payer by registered or certified mail, return receipt requested, and copy the executive director on the written notice.

(b) If a health payer fails to provide the required information set forth in the written notice described in subsection (a) within thirty (30) calendar days after receiving the notice, the administrator shall give written notice of the failure to report to the health payer by registered or certified mail, return receipt requested and notify the executive director of the health payer's failure to report.

(c) The executive director may assess a penalty for uncured violations of up to:

(1) one hundred dollars ($100) a day, for each issue, for the first thirty (30) days a health payer fails to provide the required data to the APCD, beginning on the date the health payer receives written notice of the failure to report described in subsection (b); and

(2) one thousand dollars ($1,000) for each day thereafter.

In determining whether to impose a penalty, the executive director may consider mitigating factors, including the reasons for the failure to report and the detrimental impact on the public purpose served by the APCD.

(d) If the failure to perform any of the actions set forth in subsection (a) is a result of the action or inaction of a contracted entity identified as a designated submitter or a designated submitter representative, the penalty is assessed to the health payer.

(e) The penalties specified in this section do not apply to voluntarily participating entities.

(f) Penalties will be deposited into the department of insurance fund created by IC 27-1-3-28.

760 IAC 1-83-32

Department of Insurance; 760 IAC 1-83-32; Filed 10/30/2024, 9:32 a.m.: 20241127-IR-760240151FRA