TITLE 28.INSURANCE

Part 1. TEXAS DEPARTMENT OF INSURANCE

Chapter 3. LIFE, ACCIDENT, AND HEALTH INSURANCE ANNUITIES

Subchapter X. PREFERRED PROVIDER PLANS

28 TAC §3.3703

The Texas Department of Insurance proposes amendments to §3.3703, concerning required contracting provisions for preferred provider plans. The proposed amendments address the disclosure of certain information concerning fee schedules and coding procedures that affect the payment process relating to services provided by physicians and other health care providers pursuant to a preferred provider contract with an insurer that is subject to Texas Insurance Code Article 3.70-3C. The proposed amendments implement Article 3.70-3C, Sec. 3A(i), which states that insurers shall provide preferred providers with copies of all applicable claim processing policies or procedures. The amendments clarify that an insurer must disclose information concerning fees and coding that relates to or affects the claim payment process and the payment to be made to a preferred provider for services that the preferred provider has contracted to provide on behalf of an insurer. Lack of contractual access to this information may have prohibited some preferred providers from ascertaining whether they had been compensated according to the terms of their contracts with the insurer. The proposed amendments are designed to remedy this problem.

The Department has decided to publish for comment two alternative rule amendments each intended to accomplish the stated purpose. Interested persons may comment on either or both of these proposals, which are contained at §3.3703(a)(20) and (21). However, following public comment, the Department will adopt only one alternative, possibly with changes from the proposed version.

The proposed amendments to §3.3703(a)(11) require that a contract between a preferred provider and an insurer contain terms regarding compliance with all applicable prompt pay statutes and regulations. The first alternative, proposed new paragraph (20) to §3.3703(a), requires that a contract between a preferred provider and an insurer contain preferred provider-specific information in a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract. The information must explain all methodologies that will be used to process and pay claims submitted in accordance with the contract, including a fee schedule, any non-standard coding methodologies, bundling processes, downcoding policies, and any other applicable policy or procedure used by the insurer in processing or paying claims under the contract. Additionally, the insurer must provide any addendum, schedule, exhibit or policy used by the insurer that is necessary to provide a reasonable understanding of the information that is being disclosed to the preferred provider. For example, a fee schedule that indicates that the insurer will reimburse certain claims at a usual and customary rate must explain how the insurer will determine the usual and customary rate for a particular service. An insurer may provide any required information in a document or manual that is separate from the contract, provided that the terms of the contract identify the document or manual as the source of the required information and the document or manual is presented to the preferred provider no later than the execution date of the contract. If the document or manual refers to information that is held by an outside source and is not within the control of the insurer, such as state Medicaid or federal Medicare fee schedules, the contract must provide a specific means by which the preferred provider may access the source. An insurer that cannot provide the information required by proposed §3.3703(a)(20) due to copyright laws or a licensing agreement may supply a summary of the required information. However, the summary must be sufficient to allow the preferred provider to determine the payment to be made under the contract. Any information required to be provided pursuant to this paragraph may be amended, revised or substituted only upon written notice to the preferred provider at least 60 calendar days prior to the effective date of the amendment, revision or substitution. An insurer that fails to provide any required information is in violation of proposed paragraph (20) as set forth in §3.3703(b). The requirements added by proposed paragraph (20) apply to all contracts entered into or renewed on or after the effective date of the amendments. An insurer that has an existing contract with a preferred provider as of the effective date must provide the information required by this paragraph within 90 calendar days of the effective date and any amendments, revisions, or substitutions of any of this information that occur while the contract is in effect must be made pursuant to the notice requirements set forth in proposed paragraph (20). A preferred provider receiving information pursuant to proposed paragraph (20) may not use or disclose the information for any purpose other than practice management, billing activities or other business operations. A preferred provider may not use the information to misrepresent the level of services actually performed when submitting a claim under the contract. Information provided pursuant to these amendments about a particular service does not constitute a verification that the service that a preferred provider has provided or proposes to provide is a covered benefit for a particular insured. Proposed paragraph (20) is not intended to dictate the types of practices, policies or procedures that relate to or affect the claims payment process that an insurer may elect to employ. In addition, other plan requirements, such as co-payments, co-insurance or annual, lifetime or other deductibles, may also affect the actual amount of reimbursement.

The second alternative, proposed paragraph (21), requires a contract between an insurer and a preferred provider to provide that the preferred provider may request a description of the coding guidelines, including any underlying bundling, recoding, or other payment processes and fee schedules applicable to specific procedures that the preferred provider will receive under the contract. The insurer or the insurer's agent must provide the requested information no later than the 30th day after the date the insurer receives the request. In addition, the insurer must provide notice of material changes to the coding guidelines and fee schedules not later than the 60th day before the date the changes are to take effect and cannot make retroactive revisions to the coding guidelines and fee schedules. A preferred provider that receives information pursuant to proposed paragraph (21) may use or disclose the information only for the purpose of practice management, billing activities, or other business operations. The amendments provide that nothing in proposed paragraph (21) shall be interpreted to require an insurer to violate copyright or other law by disclosing proprietary software that the insurer has licensed. In addition to the above, the insurer shall, on request of a preferred provider, provide the name, edition, and model version of the software that the insurer uses to determine bundling and unbundling of claims. The requirements added by proposed paragraph (21) apply to all contracts entered into or renewed on or after the effective date of the amendments. As with proposed paragraph (20), information provided pursuant to these amendments about a particular service does not constitute a verification that the service that a preferred provider has provided or proposes to provide is a covered benefit for a particular insured. Proposed paragraph (21) is not intended to dictate the types of practices, policies or procedures that relate to or affect the claims payment process that an insurer may elect to employ. In addition, other plan requirements, such as co-payments, co-insurance or annual, lifetime or other deductibles, may also affect the actual amount of reimbursement.

The department will consider the adoption of amendments to §3.3703 in a public hearing under Docket Number 2524, scheduled for 9:30 a.m. on July 19, 2002, in Room 100 of the William P. Hobby, Jr. State Office Building, 333 Guadalupe Street, Austin, Texas.

Kimberly Stokes, Senior Associate Commissioner, Life, Health and Licensing Program, has determined that for each year of the first five years the proposed amendments will be in effect, there will be no fiscal impact to state and local governments as a result of the enforcement or administration of the amendments. There will be no measurable effect on local employment or the local economy as a result of the proposal.

Ms. Stokes has also determined that for each year of the first five years the amendments are in effect, the public benefits anticipated as a result of the proposed amendments will be the required disclosure of claim processing policies and procedures by insurers to preferred providers. The benefit of proposed paragraph (11) is that it makes the rule consistent with the statutory requirements of Article 3.70-3C. The benefits of proposed alternative paragraph (20) and proposed alternative paragraph (21) are similar. Paragraph (20) is more comprehensive in that it contains more detail and imposes a standard that the information to be disclosed will ensure that preferred providers receive information of a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract for covered services that are rendered to insureds. Paragraph (21) is more streamlined and does not specify a standard for the required disclosure of the information. It is anticipated that either alternative will increase the number of preferred providers available to provide services to insureds under preferred provider benefit plans and result in a reduction in the time and resources currently being expended on resolution of disputes between preferred providers and insurers, which, in turn, will enhance services to consumers.

The probable economic cost to persons required to comply with paragraphs (20) and (21) will depend upon the number and types of contracts that the insurer enters into with preferred providers involved in preferred provider benefit plans. Some insurers are already providing fee schedules to preferred providers and not all insurers employ bundling processes and/or downcoding policies in claim processing. It is anticipated that the cost to these insurers would be minimal.

With regard to paragraph (20), insurers that are not currently making this information available to preferred providers will need to review their claim payment processes to determine the kind of information that will have to be provided to comply with the amendments. For example, an insurer that leases software or other modalities from a vendor relating to bundling and/or downcoding will need to review the agreements and, if necessary, consult with the vendor to determine how it can comply with the requirements of these amendments. Some vendor contracts may specify a cost associated with such consultations. Insurers will also need to review current contracts, prepare the required information and identify all preferred providers that must be provided with this information. The amount of time involved will depend upon the complexity of the individual insurer's contracts and processes. The cost to the insurer will vary depending upon the types of individuals utilized to review existing contracts and prepare the information required by these amendments. The department estimates that the labor costs will range from an average of $27 per hour of labor to an average of $43 per hour of labor. The labor figures are based upon the 2001 Occupational Wage Data collected by the Texas Workforce Commission. The range of figures represents the average cost, per hour, for review of existing contracts and preparation of the required information by an administrative service manager at the low end of the range and for preparation by an attorney at the high end of the range. An insurer utilizing outside counsel may incur increased costs for labor. Both small businesses and the largest businesses affected by these amendments would incur the same cost per hour of labor. Paragraph (20) is designed to provide maximum flexibility to insurers to determine the mechanism by which information that is not physically contained in a current contract, such as any information required to be provided pursuant to §3.3703(a)(20)(A)(i)(II), (D) or (F), will be made available to preferred providers. Costs involved with providing the information to preferred providers will depend upon the mechanism selected by the insurer. For example, it is estimated that an insurer that chooses to mail required information would incur a cost of $5.00 per 50-page mailing. This figure includes the cost of paper, printing, envelopes and postage. The actual total cost to each insurer will vary depending on the number of preferred providers to whom the required information must be sent. If an insurer chooses to use a toll-free telephone system to make any required information available to a preferred provider, it is estimated that the insurer would incur costs of $27.50 per telephone line per month and an additional $5.00 per port per month for each line. It is estimated that the cost per call will be from 5 - 10 cents per minute per call. The estimates for providing toll-free telephone assistance are based on the department's costs for its toll-free telephone information assistance lines. The costs incurred by a specific insurer would vary based upon the number of lines or ports required or already in use by the insurer and the expected call volume. The call volume experienced by an insurer would vary based upon the number of preferred providers with which the insurer contracts. Based on discussions with industry, the estimated labor cost for one employee to answer the telephone calls from preferred providers on a full-time basis is $38,000 per year. The estimate is based upon the assumption that a claims examiner would be the most qualified employee for answering such inquiries. The actual costs would vary depending upon the volume of calls received and whether there are currently adequate personnel to respond to these telephone calls as part of their job activities. Insurers that opt to provide information through a searchable database would have different costs depending upon the type and sophistication of the system utilized. The department estimates that the cost of developing a Web-based search mechanism of an existing database will range from $22,000 to $45,000, depending upon the complexity of the database. This estimate is based upon the department's own experiences in developing similar tools for customers and consumers. Insurers with highly complex databases may require additional modifications that would increase the cost for these insurers. As in the case of labor costs, both small businesses and the largest businesses affected by these amendments would incur the same costs for providing information to preferred providers.

There may be somewhat different costs for proposed alternative paragraph (21). As with paragraph (20), an insurer that leases software or other modalities from a vendor relating to bundling and/or downcoding will need to review the agreements and, if necessary, consult with the vendor to determine how it can comply with the requirements of these amendments. Some vendor contracts may specify a cost associated with such consultations. Insurers will also need to review contracts and prepare the requested information. However, since paragraph (21) requires the information to be provided only upon request, an insurer will be required to review only the contracts for which a specific type of preferred provider has made a request. In addition, without the reasonable person standard imposed in paragraph (20), the review of each contract and preparation of the materials under this paragraph may not take as much time as the reviews and preparation that would take place under paragraph (20). The cost to the insurer will vary depending upon the types of individuals utilized to review existing contracts and prepare the information required by paragraph (21). The department estimates that the labor costs will range from an average of $27 per hour of labor to an average of $43 per hour of labor. The labor figures are based upon the 2001 Occupational Wage Data collected by the Texas Workforce Commission. The range of figures represents the average cost, per hour, for review of existing contracts and preparation of the required information by an administrative service manager at the low end of the range and for preparation by an attorney at the high end of the range. An insurer utilizing outside counsel may incur increased costs for labor. Both small businesses and the largest businesses affected by these amendments would incur the same cost per hour of labor. It is estimated that the cost of mailing requested information would be $5.00 per 50-page mailing. This figure includes the cost of paper, printing, envelopes and postage. If an insurer chooses to deliver requested information using some alternative method, it is anticipated that costs would be similar to those described for compliance with the alternative delivery methods set forth for paragraph (20). Again, there should be no difference in cost for large and small employers.

It is the department's position that the adoption of these proposed amendments will have no adverse economic effect on small or micro businesses. It is neither legal nor feasible to waive or modify the requirements of these amendments for small or micro businesses, because physicians and providers contracting with insurers should be able to obtain information regarding claims processing policies and procedures whether they are contracting with a small insurer or a large insurer.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on July 15, 2002 to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comment must be simultaneously submitted to Barbara Holthaus, Director of Project Development, Life, Health and Licensing Program, Mail Code 107-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.

The amendments are proposed under the Insurance Code Article 3.70-3C, Section 3A and §36.001. Article 3.70-3C, Section 3A(n) gives the Commissioner the authority to adopt rules as necessary to implement Article 3.70-3C, Section 3A. Article 3.70-3C, Section 3A(i) provides that an insurer shall make available to a preferred provider its claim processing policies and procedures. The Commissioner's authority to adopt rules relating to the disclosure of claims payment processes such as fee schedules, bundling processes, and downcoding policies was clarified by Attorney General Opinion No. JC-0502. The opinion states that the Texas Department of Insurance is authorized to promulgate rules to require preferred provider benefit plans and HMOs to disclose their fee schedules, bundling processes, and downcoding policies. Section 36.001 provides that the Commissioner of Insurance may adopt rules to execute the duties and functions of the Texas Department of Insurance as authorized by statute.

The following article is affected by this proposal: Article 3.70-3C, Preferred Provider Benefit Plans

§3.3703.Contracting Requirements.

(a) An insurer marketing a preferred provider benefit plan must contract with physicians and health care providers to assure that all medical and health care services and items contained in the package of benefits for which coverage is provided, including treatment of illnesses and injuries, will be provided under the plan in a manner that assures both availability and accessibility of adequate personnel, specialty care, and facilities. Each contract must meet the following requirements:

(1) - (10) (No change.)

(11) A contract between a preferred provider and an insurer shall require the insurer to comply with all applicable statutes and rules pertaining to prompt payment of clean claims, including, but not limited to, Insurance Code Article 3.70-3C §3A (Prompt Payment of Preferred Providers) and §§21.2801-21.2820 of this title (relating to Submission of Clean Claims) with respect to payment to the provider for covered services that are rendered to insureds . [ : ]

[ (A) within 45 calendar days after the date on which the claim for payment is received by the insurer with the documentation reasonably necessary to process the claim; or]

[ (B) within a specified number of calendar days, which number has been agreed upon by the parties and included in the contract, after the date on which the claim for payment is received by the insurer with the documentation reasonably necessary to process the claim.]

(12) - (19) (No change.)

(20) A contract between a preferred provider and an insurer must contain information of a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract for covered services that are rendered to insureds.

(A) This information must include a preferred provider-specific summary and explanation of all payment and reimbursement methodologies that will be used to process and pay claims submitted by a preferred provider which must, in turn, include:

(i) a fee schedule, including, if applicable, CPT, HCPCS, ICD-9-CM codes and modifiers:

(I) by which all claims submitted by or on behalf of the preferred provider will be calculated and paid; or

(II) that pertains to the range of health care services reasonably expected to be delivered by that type of contracting physician or health care provider on a routine basis along with a toll-free number or electronic address through which the physician or health care provider may request the fee schedules applicable to any covered services that the physician or health care provider intends to provide to an insured and any other information required by this paragraph, including non-standard coding methodologies, bundling processes, and downcoding policies, that pertain to the service for which the fee schedule is being requested if that information has not previously been provided to the preferred provider;

(ii) any non-standard coding methodologies;

(iii) any bundling processes, including if applicable, global service periods, comprehensive codes, component codes and mutually exclusive procedures;

(iv) downcoding policies, including, if applicable, evaluation and management criteria;

(v) a description of any other applicable policy or procedure the insurer may use that affects the processing or payment of specific claims submitted by or on behalf of the preferred provider, including recoupment;

(vi) any addenda, schedules, exhibits or policies used by the insurer in carrying out the processing or payment of claims submitted by or on behalf of the preferred provider that are necessary to provide a reasonable understanding of the information provided pursuant to this paragraph; and

(vii) any information required to be provided by the insurer to the preferred provider through the contract under any applicable statutes and rules pertaining to prompt payment of clean claims, including, but not limited to, Insurance Code Article 3.70-3C §3A (Prompt Payment of Preferred Providers) and §§21.2801 - 21.2820 of this title.

(B) An insurer may comply with this paragraph by providing the required information in a document or manual that is separate from the contract only if:

(i) the additional document or manual is clearly identified as the source of the specific information required by this paragraph;

(ii) the additional document or manual is provided to the preferred provider no later than the time at which the contract is presented for execution; or

(iii) in the case of a reference to an outside source of information as the basis for fee computation that is not within the control of the insurer, such as state Medicaid or federal Medicare fee schedules, the contract clearly identifies the source and provides within the contract the means by which the provider may readily access the source electronically, telephonically, or as otherwise agreed to by the parties; and

(iv) the additional document or manual document is clearly identified by and incorporated into the contract by reference.

(C) Nothing in this paragraph shall be construed to require an insurer to provide specific information that would violate any applicable copyright law or licensing agreement. However, the insurer must supply, in lieu of any information withheld on the basis of copyright law or licensing agreement, a summary of the information that will allow a reasonable person with sufficient training, experience and competence in claims processing to determine the payment to be made according to the terms of the contract for covered services that are rendered to insureds as required by subparagraph (A) of this paragraph.

(D) No amendment, revision, or substitution of any of the information, including addenda, schedules, exhibits, or documents or manuals incorporated by reference required by this paragraph shall be effective as to the preferred provider, unless the insurer provides at least 60 calendar days written notice to the preferred provider identifying with specificity the amendment, revision or substitution. In the case of a contractual provision between the insurer and the preferred provider that provides for mutual agreement of the parties as the sole mechanism for requiring amendment, revision or substitution of the information required by this paragraph, then the written notice specified in this section does not supersede the requirement for mutual agreement.

(E) Failure to comply with this paragraph constitutes a violation as set forth in subsection (b) of this section.

(F) This paragraph applies to all contracts entered into or renewed after the effective date of this paragraph. Notwithstanding this subparagraph, if a preferred provider contract does not contain the terms set forth in subparagraphs (A) and (B) of this paragraph, the insurer must provide the information required by subparagraphs (A) and (B) of this paragraph to the preferred provider within 90 calendar days of the effective date of these amendments. If the preferred provider has previously agreed to communicate with the insurer electronically, the insurer may provide the required information via e-mail, or by the use of an electronic database through which the preferred provider can access this information. Any amendments, revisions or substitutions of any information provided pursuant to this subparagraph must be made in accordance with subparagraph (D) of this paragraph.

(G) A preferred provider that receives information under this paragraph:

(i) may not use or disclose the information for any purpose other than the preferred provider's practice management, billing activities, or other business operations;

(ii) may not use this information to knowingly submit a claim that does not accurately represent the level, type or amount of services that were actually provided to an insured or to misrepresent any aspect of the services for purposes of payment; and

(iii) may not rely upon information provided pursuant to this paragraph about a service as a verification that an insured is covered for that service under the terms of the insured's policy or certificate.

(21) A preferred provider contract between an insurer and a physician or provider must provide that the physician or provider may request a description of the coding guidelines, including any underlying bundling, recoding, or other payment process and fee schedules applicable to specific procedures that the physician or provider will receive under the contract.

(A) The insurer or the insurer's agent will provide the coding guidelines and fee schedules not later than the 30th day after the date the insurer receives the request.

(B) The insurer will provide notice of material changes to the coding guidelines and fee schedules not later than the 60th day before the date the changes take effect and will not make retroactive revisions to the coding guidelines and fee schedules.

(C) A physician or provider who receives information under subparagraph (A) of this paragraph may use or disclose the information only for the purpose of practice management, billing activities, or other business operations.

(D) Nothing in this paragraph shall be interpreted to require an insurer to violate copyright or other law by disclosing proprietary software that the insurer has licensed. In addition to the above, the insurer shall, on request of a physician or provider, provide the name, edition, and model version of the software that the insurer uses to determine bundling and unbundling of claims.

(E) This paragraph applies to all contracts entered into or renewed after the effective date of this paragraph.

(b) - (c) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 3, 2002.

TRD-200203434

Lynda Nesenholtz

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: July 14, 2002

For further information, please call: (512) 463-6327


Chapter 5. PROPERTY AND CASUALTY INSURANCE

Subchapter A. AUTOMOBILE INSURANCE

1. CERTIFICATES OF ASSUMPTION

28 TAC §5.11

The Texas Department of Insurance proposes an amendment to §5.11, concerning assumption certificates related to automobile insurance policies. The section provides for the issuance of assumption certificates covering automobile policies only after the Texas Department of Insurance has approved a reinsurance assumption agreement that is in the best interests of the policyholders. This proposed amendment deletes the requirement of the ceding carrier being in conservatorship or receivership as the department recognizes the need for approving assumption reinsurance agreements in other limited situations. In general, these limited situations are tied to the best interests of the affected policyholders when a transaction such as a related dissolution, sale or hazardous financial condition, or other financial condition of the ceding insurer indicates an assumption of the policies would be in the best interest of the policyholders. Each situation will be determined on a case-by-case review.

Betty Patterson, Senior Associate Commissioner, Financial Program, has determined that for each year of the first five years the proposed amendment is in effect, there will be no fiscal implications for state or local government as a result of enforcing and administering the section as proposed. There is no anticipated effect on local employment or local economy.

Ms. Patterson also has determined that for each year of the first five years the proposed amendment is in effect, the public benefit anticipated as a result of the adoption of the amendment will be the more efficient servicing and handling of policyholders where the ceding insurer is dissolving, being sold, or in hazardous financial condition. In addition, the security of the policyholder is a primary factor in the consideration of any request to approve an assumption reinsurance transaction. Ms. Patterson has also determined that, for each year of the first five years that this proposed section is in effect, there will be no anticipated economic cost to persons required to comply with the proposed section and thus will have no adverse impact to small or micro business.

To be considered, written comments on the proposal must be submitted no later than 5:00 P.M. on July 15, 2002, to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comments should be submitted simultaneously to Jimmy Atkins, Staff Attorney, Mail Code 110-1A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. A request for a public hearing on the proposal should be submitted separately to the Office of the Chief Clerk.

The amendment is proposed under the Insurance Code Articles 5.06 and 5.10 and §36.001. Articles 5.06 and 5.10 authorize the commissioner to adopt rules as necessary to carry out the provisions of the Insurance Code, Chapter 5, regarding automobile insurance. Section 36.001 provides the commissioner of insurance with the authority to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

Insurance Code Article 5.06 is affected by this section.

§5.11.Certificates of Assumption.

A certificate of assumption may be attached only to an automobile insurance [ a ] policy issued for an insurer [ a company in receivership or conservatorship ] for which a reinsurance assumption agreement has been approved by a [ court order, ] commissioner's order pursuant to 28 Texas Administrative Code §7.604 [ , or board order applies ]. For utilization under this section, the Texas Department of Insurance [ State Board of Insurance ] adopts by reference a certificate of assumption form which is published by the Texas Department of Insurance [ State Board of Insurance ] and available from the Automobile [ and Miscellaneous Lines ] Division , P.O. Box 149104, Mail Code 104-1A, Austin, Texas 78714-9104. [ of the State Board of Insurance, 1110 San Jacinto Boulevard, Austin, Texas 78701-1998. ]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on May 30, 2002.

TRD-200203355

Lynda Nesenholtz

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: July 14, 2002

For further information, please call: (512) 463-6327


Chapter 7. CORPORATE AND FINANCIAL REGULATION

Subchapter A. EXAMINATION AND FINANCIAL ANALYSIS

28 TAC §7.65

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Insurance or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Department of Insurance proposes the repeal of §7.65 concerning the 1995 annual statement and 1996 quarterly statements, other reporting forms, and diskettes necessary to report information concerning the financial condition and business operations and activities of insurers and other entities regulated by the department. The section is proposed for repeal to facilitate the proposal of a new §7.65 concerning 2002 annual and quarterly statement blanks, other reporting forms, electronic data filings with the National Association of Insurance Commissioners via the Internet and instructions to be used by insurers and certain other entities regulated by the Texas Department of Insurance when reporting their financial condition and business operations and activities of the 2002 calendar year. The department is proposing the new §7.65 which appears elsewhere in this issue of the Texas Register .

Betty Patterson, CPA, AFE, Senior Associate Commissioner, Financial Program has determined that, for the first five-year period the repeal of the section will be in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the repeal, and there will be no effect on local employment or local economy.

Ms. Patterson also has determined that, for each year of the first five years the repeal of the section will be in effect, the public benefit anticipated as a result of the repeal of the section will be the elimination of obsolete regulations. There will be no economic cost to persons who are required to comply with the repeal as proposed.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on July 15, 2002 to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comments should be submitted to Betty Patterson, CPA, AFE, Senior Associate Commissioner, Financial Program, Mail Code 305-2A, Texas Department of Insurance, P.O. Box 149099, Austin, Texas 78714-9099. A request for a public hearing should be submitted separately to the Office of the Chief Clerk.

The repeal of the section is proposed under the Insurance Code Article 1.11 and §36.001. Article 1.11 authorizes the commissioner to make changes in the forms of the annual statements required of insurance companies of any kind, as shall seem best adapted to elicit a true exhibit of their condition and methods of transacting business. Section 36.001 provides that the commissioner may adopt rules for the conduct and execution of the duties and functions of the department as authorized by statute for general and uniform application.

The following articles and section of the Insurance Code will be affected by this proposed repeal: Articles 1.11, 3.07, 3.20-1, 3.27-2, 3.77, 6.11, 6.12, 8.07, 8.08, 8.21, 8.24, 9.22, 9.47, 10.30, 11.06, 11.19, 14.15, 14.39, 15.15, 15.16, 16.18, 16.24, 17.22, 17.25, 18.12, 19.08, 20.02, 20A.10, 20A.22, 21.39, 21.43, 21.49, 21.52F, 21.54, 22.06, 23.02 and 23.26, and §32.041.

§7.65.Requirements for Filing the 1995 Annual and 1996 Quarterly Statements, Other Reporting Forms, and Diskettes.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on May 30, 2002.

TRD-200203344

Lynda Nesenholtz

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: July 14, 2002

For further information, please call: (512) 463-6327


28 TAC §7.65

The Texas Department of Insurance proposes new §7.65 concerning 2002 annual and quarterly statement blanks, other reporting forms, electronic data filings with the National Association of Insurance Commissioners (NAIC) via the Internet and instructions to be used by insurers and certain other entities regulated by the Texas Department of Insurance when reporting their financial condition and business operations and activities of the 2002 calendar year. The information provided by the completion of the forms is necessary to allow the department to monitor the solvency, business activities and statutory compliance of the insurers and other entities regulated by the department. The new section defines terms relevant to the statement blanks and reporting forms; provides the dates by which certain reports are to be filed; and proposes to adopt by reference the NAIC 2002 annual and 2002 quarterly statement blanks, other reporting forms and instructions for reporting the financial condition and business operations and activities; and requires insurance companies and certain other regulated entities to file such annual and quarterly statements and other reporting forms with the department and/or the NAIC as directed. Subsection (a) explains the purpose of the section and adopts by reference the forms described in the section. Subsection (b) defines terms used in the section. Subsection (c) describes the hierarchy of laws in the event of a conflict between the Insurance Code, this section and other regulations. Subsections (d)-(l) describe the forms, instructions and filing requirements for the various types of insurers and other regulated entities. Subsection (m) provides the department may request financial reports other than those specified in this section. Copies of the forms and instructions are available for inspection in the office of the Financial Analysis and Examinations Activity of the Texas Department of Insurance, William P. Hobby Jr. State Office Building, 333 Guadalupe, Building 3, Third Floor, Austin, Texas. The new section will replace existing §7.65 which concerned the adoption of the 1995 annual and 1996 quarterly statement filings and is proposed for repeal elsewhere in this issue of the Texas Register .

Betty Patterson, CPA, AFE, Senior Associate Commissioner, Financial Program, has determined that for the first year the section will be in effect, there will not be fiscal implications for state government as a result of enforcing or administering the section. There will be fiscal implications in connection with the filing of annual statements in 2003 as a result of Insurance Code Article 1.11. Under Article 1.11, insurers are required to file a copy of their annual statement with the NAIC. However, Article 1.11 also provides that insurers cannot be required to pay any costs or expenses (other than the expense of preparing and furnishing the annual statement to the NAIC) for the filing of the annual statement with the NAIC; therefore such costs are paid by the department to the NAIC. There will be no effect on local government or local employment for the first year of the five-year period the section will be in effect. There will not be fiscal implications for the remaining four years the section is in effect since the section is applicable to financial reporting for 2002 with the final report being due in 2003.

Ms. Patterson has also determined that, for each year of the first five years this section, as proposed, is in effect, the public benefits anticipated as a result of enforcing this section are the ability of the department to provide financial information to the public and other regulatory bodies as requested, and to monitor the financial condition of insurers and other regulated entities licensed in Texas to better assure financial solvency. Such insurers and other regulated entities are generally required by statute to provide the department with annual reports on their operations. These reports generally summarize information already captured or created by the insurer or other regulated entity in its normal course of business. The probable economic cost to insurers and other regulated entities required to comply with this proposed section is estimated to be no more than $3,500. Such estimated cost may be lower based upon factors such as the type of company (e.g. life, accident and health, or property and casualty); the size of the company (e.g. large or small); the type of business written within a company; and the cost of annual statement software. The department assumes that micro, small and large businesses will utilize employees who are familiar with the records of the insurer or health maintenance organization and accounting practices in general. Such individuals are compensated from $17 to $30 per hour based on the department's experience. On the basis of cost per hour of labor, there is no expected difference in cost of compliance between micro, small and larger businesses affected by this section. The department finds it neither legal nor feasible to reduce the effect of the proposed section on micro or small insurers subject to the section since the information required by the forms is necessary to effectively regulate and monitor the activities of insurers and other regulated entities licensed in Texas regardless of their size.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on July 15, 2002, to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comments should be submitted to Betty Patterson, CPA, AFE, Senior Associate Commissioner, Financial Program, Mail Code 305-2A, Texas Department of Insurance, P. O. Box 149099, Austin, Texas 78714-9099. A request for a public hearing on the proposal should be submitted separately to the Office of the Chief Clerk.

The new section is proposed under the Insurance Code Articles 1.11, 3.07, 3.20-1, 3.27-2, 3.77, 6.11, 6.12, 8.07, 8.08, 8.21, 8.24, 9.22, 9.47, 10.30, 11.06, 11.19, 14.15, 14.39, 15.15, 15.16, 16.18, 16.24, 17.22, 17.25, 18.12, 19.08, 20.02, 20A.10, 20A.22, 21.39, 21.43, 21.49, 21.52F, 21.54, 22.06, 23.02, 23.26, and §§32.041 and 36.001. Article 1.11 authorizes the commissioner to make changes in the forms of the annual statements required of insurance companies of any kind, as shall seem best adapted to elicit a true exhibit of their condition and methods of transacting business, and requires certain insurers to make filings with the National Association of Insurance Commissioners. Articles 3.07, 3.20-1, 3.27-2, 3.77, 6.11, 6.12, 8.07, 8.08, 8.21, 8.24, 9.22, 9.47, 10.30, 11.06, 11.19, 14.15, 14.39, 15.15, 15.16, 16.18, 16.24, 17.22, 17.25, 18.12, 19.08, 20.02, 20A.10, 20A.22, 21.49, 21.54, 22.06, 23.02, and 23.26 require the filing of financial reports and other information by insurers and other regulated entities, and specify particular rulemaking authority of the commissioner relating to those insurers and other regulated entities. Article 21.39 requires insurers to establish adequate reserves and provides for the adoption of each current formula for establishing reserves applicable to each line of insurance. Article 21.43 provides the conditions under which foreign insurers are permitted to do business in this state and requires foreign insurers to comply with the provisions of the Insurance Code. Article 21.52F authorizes the commissioner to adopt rules to implement the regulation of nonprofit health corporations holding a certificate of authority under that article. Section 32.041 requires the department to furnish the statement blanks and other reporting forms necessary for companies to comply with the filing requirements. Section 36.001 provides that the commissioner may adopt rules for the conduct and execution of the duties and functions of the department as authorized by statute for general and uniform application.

The following articles and section of the Insurance Code will be affected by this proposed section: Articles 1.11, 3.07, 3.20-1, 3.27-2, 3.77, 6.11, 6.12, 8.07, 8.08, 8.21, 8.24, 9.22, 9.47, 10.30, 11.06, 11.19, 14.15, 14.39, 15.15, 15.16, 16.18, 16.24, 17.22, 17.25, 18.12, 19.08, 20.02, 20A.10, 20A.22, 21.39, 21.43, 21.49, 21.52F, 21.54, 22.06, 23.02 and 23.26, and §32.041.

§7.65.Requirements for Filing the 2002 Quarterly and 2002 Annual Statements, Other Reporting Forms, and Electronic Data Filings with the NAIC.

(a) Scope. This section provides insurers and other regulated entities with the requirements for the 2002 quarterly statements, 2002 annual statement, other reporting forms, and electronic data filings via the Internet with the National Association of Insurance Commissioners (NAIC) necessary to report information concerning the financial condition and business operations and activities of insurers. This section applies to all insurers and other regulated entities authorized to do the business of insurance in this state and includes, but is not limited to, life insurers; accident insurers; life and accident insurers; life and health insurers; accident and health insurers; life, accident and health insurers; mutual life insurers; stipulated premium insurers; group hospital service corporations; fire insurers; fire and marine insurers; U.S. Branch of an alien insurer; Mexican casualty insurers; general casualty insurers; fire and casualty insurers; mutual insurers other than life; exempt associations; county mutual insurers; Lloyd's plans; reciprocal and inter-insurance exchanges; domestic risk retention groups; domestic joint underwriting associations; title insurers; fraternal benefit societies; farm mutual insurers; health maintenance organizations; nonprofit health corporations; nonprofit legal services corporations; the Texas Health Insurance Risk Pool; the Texas Mutual Insurance Company (successor to the Texas Workers' Compensation Insurance Fund); and the Texas Windstorm Insurance Association. The commissioner adopts by reference, the 2002 NAIC quarterly statement blanks, the 2002 NAIC annual statement blanks and the related instruction manuals, and other reporting forms specified in this section. The annual and quarterly statement blanks and other reporting forms are available from the department, Financial Analysis and Examinations Activity, Mail Code 303-1A, P. O. Box 149099, Austin, Texas 78714-9099. Insurers and other regulated entities shall properly report to the department and the NAIC by completing the appropriate annual and quarterly statement blanks, prepared with laser quality print (hand written copies must be prepared legibly using black ink), other reporting forms, and electronic data filings with the NAIC via the Internet following the applicable instructions as outlined in subsections (d) - (m) of this section.

(b) Definitions. The following words and terms, when used in this section, shall have the following meanings:

(1) Association edition--Blanks and forms promulgated by the NAIC.

(2) Commissioner--The commissioner of insurance appointed under the Texas Insurance Code.

(3) Department--The Texas Department of Insurance.

(4) Texas edition--Blanks and forms promulgated by the commissioner.

(c) Conflicts with other laws. In the event of a conflict between the Insurance Code, any currently existing departmental rule, form, instructions, or any specific requirement of this section and the NAIC instructions listed in this section, then and in that event, the Insurance Code, the department's promulgated rule, form, instruction, or the specific requirement of subsections (d) - (m) of this section shall take precedence and in all respects control.

(d) Filing requirements for life, accident and health insurers. Each life, life and accident, life and health, accident, accident and health, mutual life, or life, accident and health insurance company, stipulated premium insurance company, group hospital services corporation and the Texas Health Insurance Risk Pool shall complete and file the blanks, forms, or electronic data filings as directed in this subsection. (This subsection does not apply to health maintenance organizations. Filing requirements for health maintenance organizations are described in subsection (h) of this section.) The forms and reports identified in paragraphs (1)(A)-(C); (1)(F) and (G); (2)(A)-(C); and (3)(A)-(J) of this subsection shall be completed in accordance with the 2002 NAIC Annual Statement Instructions, Life, Accident and Health. The forms and reports identified in paragraphs (1)(D)-(G); (2)(A) and (B); (3)(B), (D) and (E) of this subsection shall be completed in accordance with the 2002 NAIC Health Annual Statement Instructions. The electronic data filings with the NAIC via the Internet identified in paragraph (3)(K) and (L) of this subsection shall be in accordance with the NAIC data specifications and instructions for internet filing and shall include PDF format filing. Insurers described under this subsection that reported 100% of their total direct premiums as health premiums for the calendar year ending December 31, 2001 may elect to file on the NAIC Health statement blank for the three quarters of 2002 and the calendar year 2002 if the insurer wrote "health premiums" as defined in the 2002 NAIC Health Annual Statement Instructions. Those instructions describe health premiums to include hospital, surgical and major medical; Medicare supplement business reportable in the Medicare Supplement Insurance Experience Exhibit of the annual statement; dental and vision only coverage issued as stand alone or as a rider to a medical policy that is not related to the medical policy through deductibles or out of pocket limits; federal employees health benefits plan premiums (FEHBP); Title XVIII - Medicare premiums; Title XIX - Medicaid premiums that result from an arrangement between the company and a Medicaid state agency for services to a Medicaid beneficiary; and other health premiums such as stop loss, disability income, long term care, and other. If a reporting entity qualifying under this subsection, elects to use the health annual statement, it must continue to use that annual statement for a minimum of three years or obtain written approval from its domestic state to change to another type of annual statement. Foreign companies that wrote less than 100% of health premiums in 2001 may file on the health annual statement blank if permitted or required by their domicilary state.

(1) Reports to be filed both with the department and the NAIC include the following:

(A) 2002 Life, Accident and Health Annual Statement (association edition) for the 2002 calendar year to be filed on or before March 1, 2003 (stipulated premium insurance companies, April 1, 2003);

(B) 2002 Life, Accident and Health Annual Statement of the Separate Accounts (association edition) for the 2002 calendar year (required of companies maintaining separate accounts), to be filed on or before March 1, 2003 ;

(C) 2002 Life, Accident and Health Quarterly Statements (association edition), to be filed on or before May 15, August 15, and November 15, 2002. However, a Texas stipulated premium insurance company, unless specifically requested to do so by the department, is not required to file quarterly statements with the department or the NAIC if it meets all three of the following conditions:

(i) it is authorized to write only life insurance on its certificate of authority;

(ii) it collected premiums in the prior calendar year of less than $1 million; and

(iii) it had a profit from operations in the prior two calendar years.

(D) 2002 Health Quarterly Statements (association edition), to be filed on or before May 15, August 15, and November 15, 2002 if the company qualifies as described in this subsection;

(E) 2002 Health Annual Statement (association edition) for the 2002 calendar year, to be filed on or before March 1, 2003 if the company qualifies as described in this subsection;

(F) Management's Discussion and Analysis, to be filed as part of the 2002 Life, Accident and Health Annual Statement on or before April 1, 2003, or if the 2002 Health Annual Statement is required, then filed as part of the 2002 Health Annual Statement on or before April 1, 2003;

(G) Actuarial Opinion, to be attached to the Life, Accident and Health Annual Statement or Health Annual Statement, as applicable, and in accordance with paragraph (4) of this subsection;

(2) Reports to be filed only with the department:

(A) Schedule SIS, Stockholder Information Supplement (association edition) (required of domestic stock companies which have 100 or more stockholders), to be filed on or before March 1, 2003. This filing is also required if filing a Health Annual Statement, as applicable;

(B) Supplemental Compensation Exhibit (association edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003 (stipulated premium companies, April 1, 2003). This filing is also required if filing a Health Annual Statement, as applicable;

(C) The Texas Health Insurance Risk Pool shall file the 2002 Life, Accident and Health Annual and Quarterly Statements as follows:

(i) 2002 Life, Accident and Health Annual Statement (association edition), with only pages 1 - 5, the Notes to Financial Statements on page 19 and Schedule E Part 1 on page E24 to be completed and filed on or before March 1, 2003.; and

(ii) 2002 Life, Accident and Health Quarterly Statement (association edition), with only pages 1-5, the notes on page 7 and Schedule E on page E08 to be completed and filed on or before May 15, August 15, and November 15, 2002.

(iii) The Texas Health Insurance Risk Pool is not required to file any reports, diskettes, or electronic data filings with the NAIC.

(D) Texas Overhead Assessment Form (Texas edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003 (stipulated premium insurance companies, April 1, 2003);

(E) Analysis of Surplus (Texas edition) for life, accident and health insurers, to be filed on or before March 1, 2003 (stipulated premium insurance companies, April 1, 2003);

(F) Supplemental Investment Income Exhibit (Texas edition) (shows percent of net investment income by type of investment), to be filed with the annual statement on or before March 1, 2003 (stipulated premium companies, April 1, 2003); and

(G) Texas Supplemental Form - Number of Persons Covered Under Texas Health Policies, as an attachment to the Texas state page of the annual statement. This filing is also required if filing a Health Annual Statement, as applicable.

(3) Reports or electronic data filings via the Internet filed only with the NAIC:

(A) Trusteed Surplus Statement (association edition), Life, Accident and Health Supplement (required of the U. S. branch of an alien insurer), to be filed on or before May 15, August 15, November 15, 2002 and March 1, 2003 with the annual statement;

(B) Medicare Supplement Insurance Experience Exhibit (association edition) (for insurers writing Medicare supplement business), to be filed on or before March 1, 2003. This filing is also required if filing a Health Annual Statement, as applicable;

(C) Credit Insurance Experience Exhibit (association edition) (required of companies writing credit business), to be filed on or before April 1, 2003;

(D) Long-Term Care Insurance Exhibit (association edition) (required of companies writing long-term care business), to be filed on or before March 1, 2003 (stipulated premium insurance companies, April 1, 2003). This filing is also required if filing a Health Annual Statement, as applicable;

(E) Long-Term Care Experience Reporting Forms (association edition) (required of companies writing long-term care business), to be filed on or before April 1, 2003. This filing is also required if filing a Health Annual Statement, as applicable;

(F) Interest Sensitive Life Insurance Products Report (association edition) (required of companies writing interest sensitive products), to be filed on or before April 1, 2003;

(G) Life, Health and Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit (association edition), to be filed on or before April 1, 2003;

(H) Adjustments to the Life, Health and Annuity Guaranty Association Model Act Assessment Base Reconciliation Exhibit (association edition), to be filed on or before April 1, 2003;

(I) Workers' Compensation Carve-Out Supplement, to be filed on or before March 1, 2003;

(J) Supplemental Investment Risks Interrogatories, to be filed on or before April 1, 2003;

(K) Electronic data filings via the Internet containing annual statement data, to be filed on or before March 1, 2003 (stipulated premium insurance companies, April 1, 2003); and

(L) Electronic data filings via the Internet containing quarterly statement data, to be filed on or before May 15, August 15, and November 15, 2002. A Texas stipulated premium insurance company, unless specifically requested to do so by the department, is not required to file quarterly electronic data filings via the Internet with the NAIC if it meets all three of the following conditions:

(i) it is authorized to write only life insurance on its certificate of authority;

(ii) it collected premiums in the prior calendar year of less than $1 million; and

(iii) it had a profit from operations in the prior two calendar years.

(4) Actuarial opinions required by paragraph (1)(G) of this subsection shall be in accordance with the following:

(A) Unless exempted, the statement of actuarial opinion, attached to either the Life, Accident and Health Annual Statement or the Health Annual Statement, should follow the applicable provisions of §§3.1601-3.1611 of this title (relating to Actuarial Opinion and Memorandum Regulation).

(B) For those companies exempted from §§3.1601-3.1611 of this title, instructions 1-12, established by the NAIC, must be followed.

(C) Any stipulated premium company subject to §§3.1601-3.1611 of this title which does not insure or assume risk on contracts with death benefits, cash value, or accumulation values on any one life in excess of $15,000, except as permitted by Insurance Code Article 22.13, §1(b), is exempt from submission of a statement of actuarial opinion in accordance with §3.1608 of this title (relating to Statement of Actuarial Opinion Based on an Asset Adequacy Analysis), but must submit an actuarial opinion pursuant to §3.1607 of this title (relating to Statement of Actuarial Opinion Not Including an Asset Adequacy Analysis).

(D) Any company required by §3.4505(b)(3)(I) of this title (relating to General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves) to opine on the application of X factors, shall attach this opinion to the Life, Accident and Health Annual Statement or the Health Annual Statement, as applicable.

(e) Requirements for property and casualty insurers. Each fire, fire and marine, general casualty, fire and casualty, or U.S. Branch of an alien insurer, county mutual insurance company, mutual insurance company other than life, Lloyd's plan, reciprocal or inter-insurance exchange, domestic risk retention group, life insurance company that is licensed to write workers' compensation, any farm mutual insurance company that filed an NAIC property and casualty annual statement for the 2001 calendar year or had gross written premiums in 2002 in excess of $5,000,000, any Mexican non-life insurer licensed under any article of the Insurance Code other than, or in addition to, Insurance Code Article 8.24, domestic joint underwriting association, the Texas Mutual Insurance Company (successor to the Texas Workers' Compensation Insurance Fund) and the Texas Windstorm Insurance Association shall complete and file the following blanks, forms, and diskettes or electronic data filings as directed by this subsection. The forms and reports identified in paragraphs (1)(A)-(E); (2)(A)-(C); and (3)(A)-(H) of this subsection shall be completed in accordance with the 2002 NAIC Annual Statement Instructions, Property and Casualty. The diskettes or electronic version of the filings with the NAIC via the Internet identified in paragraph (3)(I)-(K) of this subsection shall be in accordance with the NAIC data specifications and instructions and shall include PDF format filing.

(1) Reports to be filed both with the department and the NAIC:

(A) 2002 Property and Casualty Annual Statement (association edition), to be filed on or before March 1, 2003;

(B) 2002 Property and Casualty Quarterly Statements (association edition), to be filed on or before May 15, August 15, and November 15, 2002;

(C) 2002 Combined Property/Casualty Annual Statement (association edition), to be filed on or before May 1, 2003. This statement is required only for those affiliated insurers that wrote more than $35 million in direct premiums as a group in calendar year 2002, as disclosed in Schedule T of the Annual Statement(s);

(D) Management's Discussion and Analysis, to be filed on or before April 1, 2003;

(E) Actuarial Opinion to be filed with the annual statement; and

(2) Reports to be filed only with the department:

(A) Schedule SIS, Stockholder Information Supplement (association edition) (required of domestic stock companies which have 100 or more stockholders), to be filed on or before March 1, 2003;

(B) Supplemental Compensation Exhibit (association edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(C) The Texas Windstorm Insurance Association (Insurance Code Article 21.49) shall complete and file only the following:

(i) Property and Casualty Annual Statement (association edition), to be filed on or before March 1, 2003;

(ii) Property and Casualty Quarterly Statement (association edition), to be filed on or before May 15, August 15, and November 15, 2002; and

(iii) Management's Discussion and Analysis, to be filed on or before April 1, 2003.

(iv) The Texas Windstorm Insurance Association is not required to file any reports with the NAIC.

(D) Supplemental Investment Income Exhibit (Texas edition) (shows percent of net investment income by type of investment), to be filed with the annual statement on or before March 1, 2003;

(E) Texas Overhead Assessment Form (Texas edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(F) Analysis of Surplus (Texas edition) for property and casualty insurers except Texas county mutual companies, to be filed on or before March 1, 2003;

(G) Supplement for County Mutuals (Texas edition) (required of Texas county mutual companies), to be filed with the annual statement on or before March 1, 2003;

(H) Texas Supplemental A for County Mutuals (Texas edition) (required of Texas county mutual companies), to be filed with the annual statement on or before March 1, 2003; and

(I) Texas Supplemental Form-Number of Persons Covered Under Texas Health Policies), as an attachment to the Texas state page of the annual statement.

(3) Reports or electronic data filings via the Internet filed only with the NAIC:

(A) Medicare Supplement Insurance Experience Exhibit (association edition) (for insurers writing Medicare supplement business), to be filed on or before March 1, 2003;

(B) Trusteed Surplus Statement (association edition) (required of the U. S. branch of an alien insurer), to be filed on or before May 15, August 15, November 15, 2002, and March 1, 2003 with the annual statement;

(C) Supplement "A" to Schedule T, Exhibit of Medical Malpractice Premiums Written (association edition) (required of companies writing medical malpractice business), to be filed on or before March 1, 2003;

(D) Insurance Expense Exhibit (association edition), to be filed on or before April 1, 2003;

(E) Credit Insurance Experience Exhibit (association edition) (required of companies writing credit accident and/or health business), to be filed on or before April 1, 2003;

(F) Long-Term Care Experience Reporting Forms (association edition) (required of companies writing long-term care business), to be filed on or before April 1, 2003;

(G) Financial Guaranty Insurance Exhibit (association edition) (required of companies writing financial guaranty business), to be filed on or before March 1, 2003;

(H) Supplemental Investment Risks Interrogatories, to be filed on or before April 1, 2003;

(I) Electronic data filings via the Internet containing annual statement data, to be filed on or before March 1, 2003;

(J) Electronic data filings via the Internet containing combined annual statement data, to be filed on or before May 1, 2003; and

(K) Electronic data filings via the Internet containing quarterly statement data, to be filed on or before May 15, August 15, and November 15, 2002.

(f) Requirements for fraternal benefit societies. Each fraternal benefit society shall complete and file the following blanks, forms, and electronic data filings for the 2002 calendar year and the three quarters for the 2002 calendar year. The forms and reports identified in paragraphs (1)(A)-(D), (2)(A)-(C), and (3)(A)-(D), (F) and (G) of this subsection shall be completed in accordance with the 2002 NAIC Annual Statement Instructions, Fraternal. The electronic data filings with the NAIC via the Internet identified in paragraph (3)(E) of this subsection shall be in accordance with the NAIC data specifications and instructions and shall include PDF format filing.

(1) Reports to be filed both with the department and the NAIC:

(A) Annual Statement, Fraternal (association edition), to be filed on or before March 1, 2003;

(B) Annual Statement of the Separate Accounts, Fraternal, (association edition) (required of companies maintaining separate accounts), to be filed on or before March 1, 2003;

(C) Management's Discussion and Analysis, to be filed on or before April 1, 2003; and

(D) Actuarial Opinion to be filed with the annual statement.

(2) Reports to be filed only with the department:

(A) Fraternal Quarterly statement (association edition), to be filed on or before May 15, August 15, and November 15, 2002;

(B) Supplemental Compensation Exhibit (association edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(C) Fraternal Benefit Societies Supplement to Valuation Report (association edition) to be filed on or before June 30, 2003; and

(D) Texas Overhead Assessment Form (Texas edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(E) Analysis of Surplus (Texas Edition) for fraternal benefit societies to be filed on or before March 1, 2003; and

(F) Supplemental Investment Income Exhibit (Texas edition) (shows percent of net investment income by type of investment), to be filed with the annual statement on or before March 1, 2003.

(3) Reports and diskettes or electronic data filings via the Internet to be filed only with the NAIC:

(A) Trusteed Surplus Statement (association edition, Fraternal Supplement) (required of the U. S. branch of an alien insurer), to be filed on or before March 1, 2003 with the annual statement;

(B) Medicare Supplement Insurance Exhibit (association edition) (for insurers writing Medicare supplement business) to be filed on or before March 1, 2003;

(C) Long-Term Care Insurance Exhibit (association edition) (required of companies writing long-term care business), to be filed on or before March 1, 2003;

(D) Long-Term Care Experience Reporting Forms (association edition) (required of companies writing long-term care business), to be filed on or before April 1, 2003;

(E) Electronic data filings via the Internet containing annual statement data, to be filed on or before March 1, 2003; and

(F) Fraternal Interest Sensitive Life Insurance Products Report (association edition) (required of companies writing interest sensitive products), to be filed on or before April 1, 2003.

(G) Supplemental Investment Risks Interrogatories, due on or before April 1, 2003.

(g) Requirements for title insurers. Each title insurance company shall complete and file the following blanks and forms for the 2002 calendar year and the three quarters of the 2002 calendar year. The reports and forms identified in paragraphs (1)(A)-(C), (2)(A)-(C), and (3)(A) of this subsection shall be completed in accordance with the 2002 NAIC Annual Statement Instructions, Title. The electronic version of the filings with the NAIC via the Internet identified in paragraph (3)(B) of this subsection shall be in accordance with the NAIC data specifications and instructions and shall include PDF format filing.

(1) Reports to be filed with the department and the NAIC:

(A) Title Annual Statement (association edition), to be filed on or before March 1, 2003;

(B) Management's Discussion and Analysis, to be filed on or before April 1, 2003; and

(C) Actuarial Opinion to be filed on or before March 1, 2003;.

(2) Reports to be filed only with the department:

(A) Title Quarterly Statement (association edition), to be filed on or before May 15, August 15, and November 15, 2002;

(B) Supplemental Compensation Exhibit (association edition), (required of Texas domestic companies only), to be filed on or before March 1, 2003; and

(C) Schedule SIS, Stockholder Information Supplement (association edition) (required of domestic stock companies which have 100 or more stockholders), to be filed on or before March 1, 2003.

(D) Texas Overhead Assessment Form (Texas edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(E) Analysis of Surplus (Texas Edition) for title companies to be filed on or before March 1, 2003; and

(F) Supplemental Investment Income Exhibit (Texas edition) (shows percent of net investment income by type of investment), to be filed with the annual statement on or before March 1, 2003;

(3) Reports to be filed only with the NAIC:

(A) Supplemental Investment Risk Interrogatories, to be filed on or before April 1, 2003; and

(B) Electronic data filings via the Internet containing annual statement data, to be filed on or before March 1, 2003.

(h) Requirements for health maintenance organizations. Each health maintenance organization shall use the NAIC Health blank to file the 2002 annual and 2002 quarterly information. The forms and reports, identified in paragraphs (1)(A)-(D); (2)(A); and (3)(C)-(E) of this subsection shall be completed in accordance with the 2002 NAIC Annual and Quarterly Statement Instructions, Health. The actuarial opinion shall include the additional requirements of the department set forth in paragraph (1)(D) of this subsection. The forms, reports, and diskettes identified in paragraphs (1)(A) and (B), and (2)(B), (C), and (D) of this subsection shall be completed in accordance with instructions provided by the department. The electronic data filings with the NAIC via the Internet identified in paragraph (3)(A) and (B) of this subsection shall be in accordance with NAIC data specifications and instructions and shall include PDF format filing.

(1) Reports to be filed both with the department and the NAIC:

(A) 2002 Health Annual Statement (association edition), to be filed on or before March 1, 2003;

(B) NAIC Health Quarterly Statements (association edition), on or before May 15, August 15, and November 15, 2002. As part of each quarterly filing, include a completed copy of Schedule E - part 2 - Special Deposits, from the 2002 NAIC Health Annual Statement;

(C) Management's Discussion and Analysis, to be filed on or before April 1, 2003;

(D) Actuarial Opinion to be filed with the annual statement. In addition to the requirements set forth in the 2002 NAIC Annual Statement Instructions, Health, the department requires that the actuarial opinion include the following:

(i) The statement of actuarial opinion must include assurance that an actuarial report and underlying actuarial workpapers supporting the actuarial opinion will be maintained at the company and available for examination for seven years. The foregoing must be available by May 1 of the year following the year-end for which the opinion was rendered or within two weeks after a request from the commissioner. The suggested wording used will depend on whether the actuary is employed by the company or is a consulting actuary. The wording for an actuary employed by the company should be similar to the following: "An actuarial report and any underlying actuarial workpapers supporting the findings expressed in this Statement of Actuarial Opinion will be retained for a period of seven years in the administrative offices of the company and available for regulatory examination." The wording for a consulting actuary retained by the company should be similar to the following: "An actuarial report and any underlying actuarial workpapers supporting the findings expressed in this Statement of Actuarial Opinion have been provided to the company to be retained for a period of seven years in the administrative offices of the company and available for regulatory examination."

(ii) Under the scope paragraph requirements of section 5 of the instructions relating to the Actuarial Certification in the 2002 NAIC Annual Statement Instructions, Health, the department requires that the actuarial opinion specifically list the premium deficiency reserve as an item and disclose the amount of such reserve.

(2) Reports to be filed only with the department:

(A) Supplemental Compensation Exhibit (association edition), (required of Texas domestic companies only), to be filed on or before March 1, 2003;

(B) HMO Supplement (Texas edition), to be filed quarterly on or before May 15, August 15, November 15, 2002;

(C) Department formatted diskettes containing annual statement data (diskettes provided by the department for entering of health maintenance organization financial statement data), to be completed according to the instructions provided by the department and filed with the department on or before March 1, 2003; and

(D) Department formatted diskettes containing quarterly statement data (diskettes provided by the department for entering of health maintenance organization financial statement data), to be completed according to the instructions provided by the department and filed with the department on or before May 15, August 15, and November 15, 2002.

(E) Texas Overhead Assessment Form (Texas edition) (required of Texas domestic companies only), to be filed on or before March 1, 2003; and

(F) HMO Supplement 2002 Annual Data (Texas edition), to be filed on or before March 1, 2003.

(3) Reports and electronic data filings via the Internet to be filed only with the NAIC.

(A) Diskettes or electronic data filings via the Internet containing annual statement data, to be filed on or before March 1, 2003;

(B) Diskettes or electronic data filings via the Internet containing quarterly statement data, to be filed on or before May 15, August 15, and November 15, 2002;.

(C) Medicare Supplement Insurance Experience Exhibit (association edition) (for insurers writing Medicare supplement business) to be filed on or before March 1, 2003;

(D) Long-Term Care Experience Reporting Form (association edition) (for those insurers writing long-term care), to be filed on or before April 1, 2003;

(E) Supplemental Investment Risk Interrogatories, to be filed on or before April 1, 2003.

(i) Requirements for farm mutual insurers not subject to the provisions of subsection (e) of this section relating to filing requirements for property and casualty insurers. Each farm mutual insurance company shall file the following completed blanks and forms for the 2002 calendar year with the department only, on or before March 1, 2003:

(1) Annual statement (Texas edition);

(2) Texas Overhead Assessment Form (Texas edition);

(3) Actuarial Opinion, unless otherwise exempted.

(j) Requirements for statewide mutual assessment companies, local mutual aid and mutual burial associations, and exempt companies. Each statewide mutual assessment company, local mutual aid association, local mutual burial association, and exempt company shall complete and file the following blanks and forms for the 2002 calendar year with the department only, on or before April 1, 2003:

(1) Annual Statement (Texas Edition) (exempt companies are required to complete all pages except lines 22, 23, 24, 25, and 26 on page 3, the special instructions at the bottom of page 3, and pages 4 - 7);

(2) Texas Overhead Assessment Form (Texas edition);

(3) Release of Contributions Form (Texas edition);

(4) 3 1/2 % Chamberlain Reserve Table (Reserve Valuation) (Texas edition);

(5) Reserve Summary (1956 Chamberlain Table 3 1/2 %) (Texas edition);

(6) Inventory of Insurance in Force by Age of Issue or Reserving Year (Texas edition); and

(7) Summary of Inventory of Insurance in Force by Age and Calculation of Net Premiums (Texas edition).

(k) Requirements for Non-profit Legal Service Corporations. Each non-profit legal service corporation doing business as authorized by a certificate of authority issued under the Insurance Code Chapter 23 shall complete and file the following blanks and forms for the 2002 calendar year with the department only. An actuarial opinion is not required. The following forms are required to be filed on or before March 1, 2003:

(1) Annual Statement (Texas edition);

(2) Texas Overhead Assessment Form (Texas edition);

(l) Requirements for Mexican casualty companies. Each Mexican casualty company doing business as authorized by a certificate of authority issued under the Insurance Code Article 8.24, shall complete and file the following blanks and forms for the 2002 calendar year with the department only. All submissions shall be printed or typed in English and all monetary values shall be clearly designated in United States dollars. The form identified in paragraph (1) of this subsection shall be completed in accordance with the 2002 NAIC Annual Statement Instructions, Property and Casualty, except as provided by this subsection. An actuarial opinion is not required. It is the express intent of this subsection that it shall not repeal or otherwise modify or amend any department rule or the Insurance Code. The following blanks or forms are to be filed on or before March 1, 2003:

(1) Annual Statement (association edition); provided, however, only pages 1 - 4, 24, and 108 are required to be completed;

(2) A copy of the balance sheet and the statement of profit and loss from the Mexican financial statement (printed or typed in English);

(3) A copy of the official documents issued by the COMISION NACIONAL DE SEGUROS Y FIANZAS approving the 2002 annual statement; and

(4) A copy of the current license to operate in the Republic of Mexico.

(m) Other financial reports. Nothing in this section prohibits the department from requiring any insurer or other regulated entity from filing other financial reports with the department.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on May 30, 2002.

TRD-200203343

Lynda Nesenholtz

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: July 14, 2002

For further information, please call: (512) 463-6327


Chapter 11. HEALTH MAINTENANCE ORGANIZATIONS

Subchapter J. PHYSICIAN AND PROVIDER CONTRACTS AND ARRANGEMENTS

28 TAC §11.901

The Texas Department of Insurance proposes amendments to §11.901, concerning required contracting provisions for health maintenance organizations (HMOs). The proposed amendments address the disclosure of certain information concerning fee schedules and coding procedures that affect the payment process relating to services provided by physicians and providers pursuant to a physician or provider contract with an HMO that is subject to Texas Insurance Code Article 20A.18B. The proposed amendments implement Article 20A.18B(i), which states that HMOs shall provide contracting physicians and providers with copies of all applicable claim processing policies or procedures. The amendments clarify that an HMO must disclose information concerning fees and coding that relates to or affects the claim payment process and the payment to be made to a physician or provider for services that the physician or provider has contracted to provide on behalf of an HMO. Lack of contractual access to this information may have prohibited some physicians or providers from ascertaining whether they had been compensated according to the terms of their contracts with the HMO. The proposed amendments are designed to remedy this problem.

The Department has decided to publish for comment two alternative rule amendments each intended to accomplish the stated purpose. Interested persons may comment on either or both of these proposals, which are contained at §11.901(10) and (11). However, following public comment, the Department will adopt only one alternative, possibly with changes from the proposed version.

The proposed amendments to §11.901(7) require that a contract between a physician or provider and an HMO contain terms regarding compliance with all applicable prompt pay statutes and regulations. The first alternative, proposed new paragraph (10) to §11.901, requires that a contract between a physician or provider and an HMO contain physician-specific or provider-specific information in a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract. The information must explain all methodologies that will be used to process and pay claims submitted in accordance with the contract, including a fee schedule, any non-standard coding methodologies, bundling processes, downcoding policies, and any other applicable policy or procedure used by the HMO in processing or paying claims under the contract. Additionally, the HMO must provide any addendum, schedule, exhibit or policy used by the HMO that is necessary to provide a reasonable understanding of the information that is being disclosed to the physician or provider. For example, a fee schedule that indicates that the HMO will reimburse certain claims at a usual and customary rate must explain how the HMO will determine the usual and customary rate for a particular service. An HMO may provide any required information in a document or manual that is separate from the contract, provided that the terms of the contract identify the document or manual as the source of the required information and the document or manual is presented to the physician or provider no later than the execution date of the contract. If the document or manual refers to information that is held by an outside source and is not within the control of the HMO, such as state Medicaid or federal Medicare fee schedules, the contract must provide a specific means by which the physician or provider may access the source. An HMO that cannot provide the information required by proposed §11.901(10) due to copyright laws or a licensing agreement may supply a summary of the required information. However, the summary must be sufficient to allow the physician or provider to determine the payment to be made under the contract. Any information required to be provided pursuant to this paragraph may be amended, revised or substituted only upon written notice to the physician or provider at least 60 calendar days prior to the effective date of the amendment, revision or substitution. An HMO that fails to provide any required information is in violation of Texas Insurance Code Chapter 20A (Texas Health Maintenance Organization Act). The requirements added by proposed paragraph (10) apply to all contracts entered into or renewed on or after the effective date of the amendments. An HMO that has an existing contract with a physician or provider as of the effective date must provide the information required by this paragraph within 90 calendar days of the effective date and any amendments, revisions, or substitutions of any of this information that occur while the contract is in effect must be made pursuant to the notice requirements set forth in proposed paragraph (10). A physician or provider receiving information pursuant to proposed paragraph (10) may not use or disclose the information for any purpose other than practice management, billing activities or other business operations. A physician or provider may not use the information to misrepresent the level of services actually performed when submitting a claim under the contract. Information provided pursuant to these amendments about a particular service does not constitute a verification that the service that a physician or provider has provided or proposes to provide is a covered benefit for a particular enrollee. Proposed paragraph (10) is not intended to dictate the types of practices, policies or procedures that relate to or affect the claims payment process that an HMO may elect to employ. In addition, other plan requirements, such as co-payments, co-insurance or annual, lifetime or other deductibles, may also affect the actual amount of reimbursement.

The second alternative, proposed paragraph (11), requires a contract between an HMO and a physician or provider to provide that the physician or provider may request a description of the coding guidelines, including any underlying bundling, recoding, or other payment processes and fee schedules applicable to specific procedures that the physician or provider will receive under the contract. The HMO or the HMO's agent must provide the requested information no later than the 30th day after the date the HMO receives the request. In addition, the HMO must provide notice of material changes to the coding guidelines and fee schedules not later than the 60th day before the date the changes are to take effect and cannot make retroactive revisions to the coding guidelines and fee schedules. A physician or provider that receives information pursuant to proposed paragraph (11) may use or disclose the information only for the purpose of practice management, billing activities, or other business operations. The proposed amendments provide that nothing in proposed paragraph (11) shall be interpreted to require an HMO to violate copyright or other law by disclosing proprietary software that the HMO has licensed. In addition to the above, the HMO shall, on request of a physician or provider, provide the name, edition, and model version of the software that the HMO uses to determine bundling and unbundling of claims. The requirements added by proposed paragraph (11) apply to all contracts entered into or renewed on or after the effective date of the amendments. As with proposed paragraph (10), information provided pursuant to proposed paragraph (11) about a particular service does not constitute a verification that the service that a physician or provider has provided or proposes to provide is a covered benefit for a particular enrollee. Proposed paragraph (11) is not intended to dictate the types of practices, policies or procedures that relate to or affect the claims payment process that an HMO may elect to employ. In addition, other plan requirements, such as co-payments, co-insurance or annual, lifetime or other deductibles, may also affect the actual amount of reimbursement.

The department will consider the adoption of amendments to §11.901 in a public hearing under Docket Number 2525, scheduled for 9:30 a.m. on July 19, 2002, in Room 100 of the William P. Hobby, Jr. State Office Building, 333 Guadalupe Street, Austin, Texas.

Kimberly Stokes, Senior Associate Commissioner, Life, Health and Licensing Program, has determined that for each year of the first five years the proposed amendments will be in effect, there will be no fiscal impact to state and local governments as a result of the enforcement or administration of the amendments. There will be no measurable effect on local employment or the local economy as a result of the proposal.

Ms. Stokes has also determined that for each year of the first five years the amendments are in effect, the public benefits anticipated as a result of the proposed amendments will be the required disclosure of claim processing policies and procedures by HMOs to physicians and providers. The benefit of proposed paragraph (7) is that it makes the rule consistent with the statutory requirements of Article 20A.18B. The benefits of proposed alternative paragraph (10) and proposed alternative paragraph (11) are similar. Paragraph (10) is more comprehensive in that it contains more detail and imposes a standard that the information to be disclosed will ensure that contracting physicians and providers receive information of a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract for covered services that are rendered to enrollees. Paragraph (11) is more streamlined and does not specify a standard for the required disclosure of the information. It is anticipated that either alternative will increase the number of contracting physicians and providers available to provide services to enrollees under HMO plans and result in a reduction in the time and resources currently being expended on resolution of disputes between contracting physicians, providers and HMOs, which, in turn, will enhance services to consumers.

The probable economic cost to persons required to comply with paragraphs (10) and (11) will depend upon the number and types of contracts that the HMO enters into with physicians and providers involved in HMO plans. Some HMOs are already providing fee schedules to contracting physicians and providers and not all HMOs employ bundling processes and/or downcoding policies in claim processing. It is anticipated that the cost to these HMOs would be minimal.

With regard to paragraph (10), HMOs that are not currently making this information available to contracting physicians and providers will need to review their claim payment processes to determine the kind of information that will have to be provided to comply with the amendments. For example, an HMO that leases software or other modalities from a vendor relating to bundling and/or downcoding will need to review the agreements and, if necessary, consult with the vendor to determine how it can comply with the requirements of these amendments. Some vendor contracts may specify a cost associated with such consultations. HMOs will also need to review current contracts, prepare the required information and identify all physicians and providers that must be provided with this information. The amount of time involved will depend upon the complexity of the individual HMO's contracts and processes. The cost to the HMO will vary depending upon the types of individuals utilized to review existing contracts and prepare the information required by these amendments. The department estimates that the labor costs will range from an average of $27 per hour of labor to an average of $43 per hour of labor. The labor figures are based upon the 2001 Occupational Wage Data collected by the Texas Workforce Commission. The range of figures represents the average cost, per hour, for review of existing contracts and preparation of the required information by an administrative service manager at the low end of the range and for preparation by an attorney at the high end of the range. An HMO utilizing outside counsel may incur increased costs for labor. Both small businesses and the largest businesses affected by paragraph (10) would incur the same cost per hour of labor. Paragraph (10) is designed to provide maximum flexibility to HMOs to determine the mechanism by which information that is not physically contained in a current contract, such as any information required to be provided pursuant to §11.901(10)(A)(i)(II), (D) or (F), will be made available to contracting physicians and providers. Costs involved with providing the information to contracting physicians and providers will depend upon the mechanism selected by the HMO. For example, it is estimated that an HMO that chooses to mail required information would incur a cost of $5.00 per 50-page mailing. This figure includes the cost of paper, printing, envelopes and postage. The actual total cost to each HMO will vary depending on the number of contracting physicians and providers to whom the required information must be sent. If an HMO chooses to use a toll-free telephone system to make any required information available to a contracting physicians or provider, it is estimated that the HMO would incur costs of $27.50 per telephone line per month and an additional $5.00 per port per month for each line. It is estimated that the cost per call will be from 5 - 10 cents per minute per call. The estimates for providing toll-free telephone assistance are based on the department's costs for its toll-free telephone information assistance lines. The costs incurred by a specific HMO would vary based upon the number of lines or ports required or already in use by the HMO and the expected call volume. The call volume experienced by an HMO would vary based upon the number of physicians and providers with which the HMO contracts. Based on discussions with industry, the estimated labor cost for one employee to answer the telephone calls from contracting physicians and providers on a full-time basis is $38,000 per year. The estimate is based upon the assumption that a claims examiner would be the most qualified employee for answering such inquiries. The actual costs would vary depending upon the volume of calls received and whether there are currently adequate personnel to respond to these telephone calls as part of their job activities. HMOs that opt to provide information through a searchable database would have different costs depending upon the type and sophistication of the system utilized. The department estimates that the cost of developing a Web-based search mechanism of an existing database will range from $22,000 to $45,000, depending upon the complexity of the database. This estimate is based upon the department's own experiences in developing similar tools for customers and consumers. HMOs with highly complex databases may require additional modifications that would increase the cost for these HMOs. As in the case of labor costs, both small businesses and the largest businesses affected by these amendments would incur the same costs for providing information to contracting physicians or providers.

There may be somewhat different costs for proposed alternative paragraph (11). As with paragraph (10), an HMO that leases software or other modalities from a vendor relating to bundling and/or downcoding will need to review the agreements and, if necessary, consult with the vendor to determine how it can comply with the requirements of these amendments. Some vendor contracts may specify a cost associated with such consultations. HMOs will also need to review contracts and prepare the requested information. However, since paragraph (11) requires the information to be provided only upon request, an HMO will be required to review only the contracts for which a specific type of physician or provider has made a request. In addition, without the reasonable person standard imposed in paragraph (10), the review of each contract and preparation of the materials under this paragraph may not take as much time as the reviews and preparation that would take place under paragraph (10). The cost to the HMO will vary depending upon the types of individuals utilized to review existing contracts and prepare the information required by paragraph (11). The department estimates that the labor costs will range from an average of $27 per hour of labor to an average of $43 per hour of labor. The labor figures are based upon the 2001 Occupational Wage Data collected by the Texas Workforce Commission. The range of figures represents the average cost, per hour, for review of existing contracts and preparation of the required information by an administrative service manager at the low end of the range and for preparation by an attorney at the high end of the range. An HMO utilizing outside counsel may incur increased costs for labor. Both small businesses and the largest businesses affected by these amendments would incur the same cost per hour of labor. It is estimated that the cost of mailing requested information would be $5.00 per 50-page mailing. This figure includes the cost of paper, printing, envelopes and postage. If an HMO chooses to deliver requested information using some alternative method, it is anticipated that costs would be similar to those described for compliance with the alternative delivery methods set forth for paragraph (10). Again, there should be no difference in cost for large and small employers.

It is the department's position that the adoption of these proposed amendments will have no adverse economic effect on small or micro businesses. It is neither legal nor feasible to waive or modify the requirements of these amendments for small or micro businesses, because physicians and providers contracting with HMOs should be able to obtain information regarding claim processing policies and procedures whether they are contracting with a small HMO or a large HMO.

To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on July 15, 2002 to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comment must be simultaneously submitted to Barbara Holthaus, Director of Project Development, Life, Health and Licensing Program, Mail Code 107-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.

The amendments are proposed under the Insurance Code Article 20A.18B and §36.001. Article 20A.18B(o) gives the Commissioner the authority to adopt rules as necessary to implement Article 20A.18B. Article 20A.18B(i) provides that an HMO shall make available to a contracting physician or provider its claim processing policies and procedures. The Commissioner's authority to adopt rules relating to the disclosure of claims payment processes such as fee schedules, bundling processes, and downcoding policies was clarified by Attorney General Opinion No. JC-0502. The opinion states that the Texas Department of Insurance is authorized to promulgate rules to require preferred provider benefit plans and HMOs to disclose their fee schedules, bundling processes, and downcoding policies. Section 36.001 provides that the Commissioner of Insurance may adopt rules to execute the duties and functions of the Texas Department of Insurance as authorized by statute.

The following article is affected by this proposal: Article 20A.18B

§11.901.Required Provisions.

Physician and provider contracts and arrangements shall include the following provisions:

(1) - (6) (No change.)

(7) regarding prompt payment of claims as described in the Insurance Code Article 20A.09(j) and all applicable statutes and rules pertaining to prompt payment of clean claims, including, but not limited to, Insurance Code Article 20A.18B (Prompt Payment of Physician and Providers) and §§21.2801-21.2820 of this title (relating to Submission of Clean Claims) with respect to the payment to the physician or provider for covered services that are rendered to enrollees;

(8) - (9) (No change.)

(10) A contract between a physician or provider and an HMO must contain information of a sufficient level of detail that a reasonable person with sufficient training, experience and competence in claims processing can determine the payment to be made according to the terms of the contract for covered services that are rendered to enrollees.

(A) This information must include a physician-specific or provider-specific summary and explanation of all payment and reimbursement methodologies that will be used to process and pay claims submitted by a physician or provider which must, in turn, include:

(i) a fee schedule, including, if applicable, CPT, HCPCS, ICD-9-CM codes and modifiers:

(I) by which all claims submitted by or on behalf of the contracting physician or provider will be calculated and paid; or

(II) that pertains to the range of health care services reasonably expected to be delivered by that type of contracting physician or provider on a routine basis along with a toll-free number or electronic address through which the contracting physician or provider may request the fee schedules applicable to any covered services that the physician or provider is authorized and plans to provide to an enrollee and any other information required by this paragraph, including non-standard coding methodologies, bundling processes and downcoding policies, that pertain to the service for which the fee schedule is being requested if that information has not previously been provided to the physician or provider;

(ii) any non-standard coding methodologies;

(iii) any bundling processes, including if applicable, global service periods, comprehensive codes, component codes and mutually exclusive procedures;

(iv) downcoding policies, including, if applicable, evaluation and management criteria;

(v) a description of any other applicable policy or procedure the HMO may use that affects the processing or payment of specific claims submitted by or on behalf of the contracting physician or provider, including recoupment;

(vi) any addenda, schedules, exhibits or policies used by the HMO in carrying out the processing or payment of claims submitted by or on behalf of the contracting physician or provider that are necessary to provide a reasonable understanding of the information provided pursuant to this paragraph; and

(vii) any information required to be provided by the HMO to the physician or provider through the contract under any applicable statutes and rules pertaining to prompt payment of clean claims, including, but not limited to, Insurance Code Article 20A.18B (Prompt Payment of Physicians Providers) and §§21.2801 - 21.2820 of this title.

(B) An HMO may comply with this paragraph by providing the required information in a document or manual that is separate from the contract only if:

(i) the additional document or manual is clearly identified as the source of the specific information required by this paragraph;

(ii) the additional document or manual is provided to the contracting physician or provider no later than the time at which the contract is presented for execution; or

(iii) in the case of a reference to an outside source of information as the basis for fee computation that is not within the control of the HMO, such as state Medicaid or federal Medicare fee schedules, the contract clearly identifies the source and provides within the contract the means by which the physician or provider may readily access the source electronically, telephonically, or as otherwise agreed to by the parties; and

(iv) the additional document or manual document is clearly identified by and incorporated into the contract by reference.

(C) Nothing in this paragraph shall be construed to require an HMO to provide specific information that would violate any applicable copyright law or licensing agreement. However, the HMO must supply, in lieu of any information withheld on the basis of copyright law or licensing agreement, a summary of the information that will allow a reasonable person with sufficient training, experience and competence in claims processing to determine the payment to be made according to the terms of the contract for covered services that are rendered to enrollees as required by subparagraph (A) of this paragraph.

(D) No amendment, revision, or substitution of any of the information, including addenda, schedules, exhibits, or documents or manuals incorporated by reference required by this paragraph shall be effective as to the contracting physician or provider, unless the HMO provides at least 60 calendar days written notice to the contracting physician or provider identifying with specificity the amendment, revision or substitution. In the case of a contractual provision between the HMO and the physician or provider that provides for mutual agreement of the parties as the sole mechanism for requiring amendment, revision or substitution of the information required by this paragraph, then the written notice specified in this section does not supersede the requirement for mutual agreement.

(E) Failure to comply with this paragraph constitutes a violation of Insurance Code Chapter 20A (Texas Health Maintenance Organization Act).

(F) This paragraph applies to all contracts entered into or renewed after the effective date of this paragraph. Notwithstanding this subparagraph, if a physician or provider contract does not contain the terms set forth in subparagraphs (A) and (B) of this paragraph, the HMO must provide the information required by subparagraphs (A) and (B) of this paragraph to the contracting physician or provider within 90 calendar days of the effective date of these amendments. If the contracting physician or provider has previously agreed to communicate with the HMO electronically, the HMO may provide the required information via e-mail, or by the use of an electronic database through which the contracting physician or provider can access this information. Any amendments, revisions or substitutions of any information provided pursuant to this subparagraph must be made in accordance with subparagraph (D) of this paragraph.

(G) A contracting physician or provider that receives information under this paragraph:

(i) may not use or disclose the information for any purpose other than the contracting physician or provider's practice management, billing activities, or other business operations;

(ii) may not use this information to knowingly submit a claim that does not accurately represent the level, type or amount of services that were actually provided to an enrollee or to misrepresent any aspect of the services for purposes of payment; and

(iii) may not rely upon information provided pursuant to this paragraph about a service as a verification that an enrollee is covered for that service under the terms of the enrollee's evidence of coverage.

(11) A contract between an HMO and a physician or provider must provide that the physician or provider may request a description of the coding guidelines, including any underlying bundling, recoding, or other payment process and fee schedules applicable to specific procedures that the physician or provider will receive under the contract.

(A) The HMO or the HMO's agent will provide the coding guidelines and fee schedules not later than the 30th day after the date the HMO receives the request.

(B) The HMO will provide notice of material changes to the coding guidelines and fee schedules not later than the 60th day before the date the changes take effect and will not make retroactive revisions to the coding guidelines and fee schedules.

(C) A physician or provider who receives information under subparagraph (A) of this paragraph may use or disclose the information only for the purpose of practice management, billing activities, or other business operations.

(D) Nothing in this paragraph shall be interpreted to require an HMO to violate copyright or other law by disclosing proprietary software that the HMO has licensed. In addition to the above, the HMO shall, on request of a contracting physician or provider, provide the name, edition, and model version of the software that the HMO uses to determine bundling and unbundling of claims.

(E) This paragraph applies to all contracts entered into or renewed after the effective date of this paragraph.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 3, 2002.

TRD-200203435

Lynda Nesenholtz

General Counsel and Chief Clerk

Texas Department of Insurance

Earliest possible date of adoption: July 14, 2002

For further information, please call: (512) 463-6327