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 March 7 of that year;(2) February data must be submitted no later than April 7 of that year;(3) March data must be submitted no later than May 7 of that year;(4) April data must be submitted no later than June 7 of that year;(5) May data must be submitted no later than July 7 of that year;(6) June data must be submitted no later than August 7 of that year;(7) July data must be submitted no later than September 7 of that year;(8) August data must be submitted no later than October 7 of that year;(9) September data must be submitted no later than November 7 of that year;(10) October data must be submitted no later than December 7 of that year;(11) November data must be submitted no later than January 7 of the following year; and(12) December data must be submitted no later than February 7 of the following year.(b) Payors must submit test data files as provided in the submission guide:(1) after registering for the first time with the Center as a payor that is subject to reporting under this subchapter;(2) after a merger, acquisition, divestiture, or other change of ownership that requires an update to a payor's registration; and(3) before the effective date of a new version of the Texas APCD CDL, consistent with § 21.5403 of this title (relating to Texas APCD Common Data Layout and Submission Guide) that contains additional data elements.(c) A payor may request a temporary exception or extension of time from complying with one or more requirements of this subchapter or the Texas APCD CDL by submitting a request to the Center, as provided in the submission guide posted on https://go.uth.edu/DSG, no less than 15 calendar days before the date the payor is otherwise required to comply with the requirement. (1) The Center may grant an exception or extension for good cause for not more than 12 consecutive months, 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. An exception may not be granted from any requirement contained in Insurance Code Chapter 38, Subchapter I, concerning Texas All Payor Claims Database.(2) A payor that registers with the Center and demonstrates that it has fewer than 10,000 covered lives in plans subject to this subchapter qualifies for an extension under this subsection for the payor's first required reporting. The Center may grant an extension for new payors for not more than 12 consecutive months.(3) The Center may request additional information from a payor in order to make a determination on an exception or 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. The deadline for data submission is tolled while the Center makes a determination on an exception or extension request.(4) A request for an exception or 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 (3) of this subsection, the 14-day timeline begins the day after the payor submits the 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 or extension may be deemed withdrawn by the Center at the end of the 14-day period.(5) In order to assist TDI's oversight and enforcement required by Insurance Code §38.409, the Center will provide TDI on or before July 1st of each year for the prior year: (A) the names of payors that timely reported data;(B) information about payors that did not report data and either requested an exception or extension that the Center did not grant or otherwise failed to demonstrate an exemption from reporting under this subchapter;(C) information about payors that obtained exceptions and extensions, including the nature of the exceptions and amount of extensions granted;(D) information about payors that failed to report timely without obtaining an exception or extension, including the filing due dates and the dates of actual filing; and(E) information about payors that otherwise failed to materially comply with the requirements of Insurance Code Chapter 38, Subchapter I, or this subchapter.(d) The Center will assess each data submission to ensure the data files are complete, accurate, and correctly formatted.(e) 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.(f) Payors must provide reasonable follow-up information requested by the Center, limited to ensuring that the payor submitted complete and correct information.(g) 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.(h) 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 the 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.(i) The reporting schedule under subsection (a) of this section applies to monthly data submissions due on or after March 7, 2025, containing data for months beginning January 1, 2025. Payors must submit data for November and December 2024 at the same time as January 2025 data.28 Tex. Admin. Code § 21.5405
Adopted by Texas Register, Volume 47, Number 23, June 10, 2022, TexReg 3475, eff. 6/16/2022; Amended by Texas Register, Volume 49, Number 47, November 22, 2024, TexReg 9556, eff. 11/28/2024