Section 21.3406 - Mandates for Which Data Must Be Reported(a) Data to be reported separately. For all mandated benefits and mandated offers to be reported, a reporting entity must report separately its data for individual, small group, and large group health benefit plans.(b) Mandated benefits. The following is a list of mandated benefits about which data relating to a health benefit plan must be filed under § 21.3403 of this title (relating to Collection of Data Necessary to Provide Report): (1) Certain Benefits Related to Acquired Brain Injury, Insurance Code § 1352.003 and § 1352.0035;(2) Serious Mental Illness, Insurance Code § 1355.004;(3) Autism Spectrum Disorder, Insurance Code § 1355.015;(4) Low-Dose Mammography, Insurance Code § 1356.005;(5) Reconstructive Surgery Following Mastectomy, Insurance Code § 1357.004;(6) Diabetes Equipment, Supplies, and Self-Management Training, Insurance Code § 1358.054;(7) Formulas for Phenylketonuria (PKU) or Other Heritable Diseases, Insurance Code § 1359.003;(8) Temporomandibular Joint (TMJ) Diagnosis and Treatment, Insurance Code § 1360.004;(9) Osteoporosis, Detection and Prevention, Insurance Code § 1361.003;(10) Certain Tests for Detection of Prostate Cancer, Insurance Code § 1362.003;(11) Certain Tests for Detection of Colorectal Cancer, Insurance Code § 1363.003;(12) Childhood Immunizations, Insurance Code § 1367.053;(13) Hearing Screening for Children, Insurance Code § 1367.103;(14) Chemical Dependency Coverage, Insurance Code §§ 1368.004, 1368.005, and 1368.007;(15) Prescription Contraceptive Drugs and Devices and Related Services, Insurance Code § 1369.104;(16) Certain Tests for Detection of Human Papillomavirus and Cervical Cancer, Insurance Code § 1370.003;(17) Certain Tests for Detection of Ovarian Cancer, Insurance Code § 1370.003;(18) Certain Tests for Early Detection of Cardiovascular Disease, Insurance Code § 1376.003; and(19) Certain Amino Acid-Based Elemental Formulas, Insurance Code § 1377.051.(c) Mandated offers. The following is a list of mandated offers about which data relating to a health benefit plan must be filed under § 21.3403 of this title: (1) Loss or Impairment of Speech or Hearing, Insurance Code § 1365.003;(2) In Vitro Fertilization Procedures, Insurance Code § 1366.003; and(3) Developmental Delays, Insurance Code § 1367.204.(d) Suggested procedure and diagnosis codes. TDI will provide on its website, www.tdi.texas.gov, suggested procedure and diagnosis codes that may be used in capturing the required data for the report. Regardless of whether a reporting entity uses the suggested codes or some other method of capturing the required information, each reporting entity must maintain information and documentation supporting the accuracy and completeness of its data and the report, including, but not limited to, a list of all procedural and diagnosis codes used in collecting data for the report for five years following the submission of the report on which the information was based. On receiving a request from TDI, a reporting entity must make available the supporting information described in this subsection.28 Tex. Admin. Code § 21.3406
The provisions of this §21.3406 adopted to be effective December 29, 2002, 27 TexReg 11990; Amended by Texas Register, Volume 42, Number 26, June 30, 2017, TexReg 3384, eff. 7/6/2017