California Code of Regulations › Title 10 - Investment › Chapter 5.5 - Major Risk Medical Insurance Board › Article 6 - Pilot Program Payments › Section 2698.600 - Semiannual Interim Payment and Reporting Procedures for Pilot Program Health Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				semiannual interim payment process for Pilot Program payment shall occur
				starting at the end of the first reporting period, September 1, 2003 through
				December 31, 2003, and on June 30 and December 31 of each year thereafter, as
				long as there are Program Graduates or Program Graduate dependents enrolled. In
				order to qualify for a semiannual interim payment a Pilot Program health plan
				shall submit a semiannual interim enrollment report no later than 90 days after
				the semiannual reporting period as established above in this section. If a
				Pilot Program health plan does not submit a semiannual interim enrollment
				report by the end of the 90 day period, the plan will not receive an interim
				payment for that period.
(b) The
				semiannual interim enrollment report shall be submitted for each program
				graduate enrolled in the Pilot Program standard benefit plan during the
				semiannual interim period, and consist of:
(1) A signed certification that all program
				graduates for whom the Pilot Program health plan has made claim are enrolled in
				a Pilot Program standard benefit plan.
(2) The following information, to be
				submitted electronically, in a format specified by the Board, which consists of
				the following elements for each Program Graduate enrolled in the Pilot Program
				standard benefit plan during the semiannual interim period:
(A) The Program Graduate's unique
				identification number,
(B) The
				Pilot Program health plan's own identification number for the Program
				Graduate,
(C) The Program
				Graduate's full name,
(D) The
				Program Graduate's home address including house or unit number, street, city,
				county, state, and zip code,
(E)
				The name of each Program Graduate dependent who is covered under the Pilot
				Program at the same time as the program graduate,
(F) The date of birth of each Program
				Graduate and Program Graduate dependent,
(G) The Program Graduate's and any Program
				Graduate dependent's date of disenrollment from the Program, as indicated on
				the Certificate of Program Completion,
(H) The Program Graduate's and any Program
				Graduate dependent's date of enrollment in the Pilot Program health
				plan,
(I) The Program Graduate's
				and any Program Graduate dependent's date of enrollment in the Pilot Program
				health plan, when transferred from one Pilot Program health plan to
				another.
(J) The Program Graduate's
				and any Program Graduate dependent's date of disenrollment in the Pilot Program
				health plan, if disenrollment has occurred during the interim semiannual
				reporting period.
(3) The
				semiannual interim enrollment report shall include an estimate, adjusted for
				incurred but not reported (IBNR) costs, of the amount expended for program
				graduates and program graduate dependents, and the total amount of premium
				payments received to the Pilot Program health plan during the reporting
				period.