La. Admin. Code tit. 37 § XIII-3117

Current through Register Vol. 50, No. 11, November 20, 2024

Section XIII-3117 - Evaluation and Reporting Requirements

A. Each plan shall be evaluated by the commissioner on its ability to enhance the delivery and improve the cost effectiveness of medical services for the insured. This evaluation shall compare the results of the plan's coverage. The criteria and methodology for this evaluation shall be determined by the commissioner, with prior advice of the authorized carrier. An authorized carrier shall agree to participate in the evaluation process as a condition of operating under the LA Health Plan.

B. An authorized carrier shall provide the following reports to the commissioner:

1. a written overview of plan results for each six months of plan operations. The report shall outline the operating results of the plan, including significant issues which arose and the responding actions taken by the plan and shall specify the number of insured and a demographic breakdown of those enrolled, the premiums collected, and utilization reports. The report shall be compiled after each six-month period of plan operation and shall be mailed to the commissioner by the twentieth day of the subsequent month;

2. all reports required in accordance with §3117. A

C. Nothing in this rule shall be construed to limit the commissioner's authority to require information from an authorized carrier as necessary to monitor the carrier's compliance with the requirements of the LA Health Plan.

La. Admin. Code tit. 37, § XIII-3117

Promulgated by the Department of Insurance, Office of the Commissioner, LR 20:1012 (September 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:244-247 of the Insurance Code.