28 CA ADC § 1300.75.4.3
28 CCR s 1300.75.4.3
Cal. Admin. Code tit. 28, s 1300.75.4.3
CALIFORNIA CODE OF REGULATIONS
TITLE 28. MANAGED HEALTH CARE
DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
CHAPTER 2. HEALTH CARE SERVICE PLANS
ARTICLE 9. FINANCIAL RESPONSIBILITY
RISK-BEARING ORGANIZATIONS
This database is current through 06/09/06, Register 2006, No. 23.
s 1300.75.4.3. Plan Reporting.
(a) Plan Quarterly Survey. Every plan that contracts with an organization
shall, by May 15, 2001, and not more than forty-five (45) days after the
close of each subsequent calendar quarter, submit a quarterly survey
report in an electronic format to the Director listing all its contracting
organizations, including their names, addresses, contact persons,
telephone numbers, and number of enrollees assigned to the organization as
of thelast day of the quarter being reported.
(b) Plan Annual Survey. Along with the quarterly report due May 15,2001,
and for the report due by May 15 of each subsequent year (i.e., anannual
reporting period), every plan shall submit an annual survey report in an
electronic format to the Director, containing the following information,
as of December 31 of the prior calendar year, for each organization with
which the plan has a risk arrangement:
(1) For the plan's commercial, Medicare+hoice, and Medi-Cal product lines,
the report shall disclose, in a separate matrix for each product line, the
allocation of risk between the plan, the organization, and the facility by
major expense category. For each of the plan's commercial,
Medicare+Choice, and Medi-Cal product lines, the report shall disclose the
number of covered lives and the counties primarily served by the
organization.
(2) The report shall disclose whether the plan provides stop-loss
insurance to the organization, and if so, the nature of any and all
stop-loss arrangements.
(c) Each quarterly and annual survey report and matrix submitted to the
Department shall include a written verification stating that the plan has
complied with all the risk arrangement disclosure requirements of section
1300.75.4.1 and that the survey report or matrix is true and correct to
the best knowledge and belief of a principal officer of the plan,
andsigned by a principal officer, as defined by regulation 1300.45(o) of
Title 28 of the California Code of Regulations.
(d) Upon request, the plan shall provide any additional information that
the Director may from time to time require to understand the type, amount,
or appropriateness, of the financial risk assumed by the plan's
contracting organizations.
(e) Every plan that contracts with an organization shall have adequate
procedures in place to ensure that the plan notifies the Department of
Managed Health Care or its designated agent no later than five (5)
business days from discovering that any of its contracting organizations
experienced any event which materially alters the organization's financial
situation, or threatens its solvency.
Note: Authority cited: Sections 1344 and 1375.4, Health and Safety Code.
Reference: Section 1375.4, Health and Safety Code.
HISTORY
1. New section filed 3-22-2001 as an emergency; operative 3-22-2001
(Register
2001, No. 12). A Certificate of Compliance must be transmitted to OAL by
7-
20-2001 or emergency language will be repealed by operation of law on the
following day.
2. Certificate of Compliance as to 3-22-2001 order, including amendment
section, transmitted to OAL 7-20-2001 and filed 8-31-2001 (Register 2001,
No.35).
28 CA ADC s 1300.75.4.3
END OF DOCUMENT
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