Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 8.00 - MUNICIPAL HEALTH COVERAGE › Section 8.06 - Data Management and Communication

Current through Register 1525, July 5, 2024
(1) Municipal Employers shall report all
			 changes to an enrollee's coverage on forms designated by the Commission. Upon
			 notification from the Commission, Municipal Employers shall be required to
			 enter on the Commission's eligibility system (MAGIC system), an enrollee's
			 coverage and/or coverage changes.
(2) The Commission determines the effective
			 date of enrollees' coverage changes including, but not limited to: individual
			 to family, family to individual, and cancellation of coverage and shall notify
			 the Municipal Employer directly via the Premium Deduction Change Notice. The
			 Municipal Employer shall accept this notice and update its records
			 accordingly.
(3) Municipal Employers
			 shall reconcile their entire insured membership on a monthly basis via the
			 Statement of Verification that is included with the monthly bill and roster.
			 Municipal Employers shall report any discrepancies to the Commission at a time
			 determined by the Commission. Late notification of discrepancies to the
			 Commission may result in a delay in the effective date of insurance coverage
			 changes.
(4) Any Municipal Employer
			 that transfers its insureds to the Commission with more than one enrollee
			 percentage contribution towards a particular individual, family or Medicare
			 health plan premium shall provide the Commission with enrollment data by
			 enrollee percentage contribution for said health plan(s). Reporting shall be
			 monthly, or less frequently as required by the Commission, on a form that will
			 be provided by the Commission.
(5)
			 A participating Municipal Employer or its Public Employee Committee may request
			 data for the sole purpose of determining whether it will continue to
			 participate after its initial three years, as specified in its executed Public
			 Employee Committee agreement or order from the three-person arbitration panel.
			 Requests for such data shall be made in the calendar year in which a given
			 agreement is open to negotiation, and such requests shall be limited to one
			 request in the calendar year in which a political subdivision is considering
			 withdrawing from coverage.
(a) Entities
			 requesting utilization data should assess the amount of time they will need to
			 analyze data and conduct negotiations before making a decision about whether to
			 remain in the Commission. Such entities must submit their requests to the
			 Commission at least 30 days before the data are to be provided to them to use
			 in their decision-making process. In a City, the request must be signed by the
			 City Manager or the Mayor, in a Town by the Town Manager or the Chairman of the
			 Board of Selectmen, and in a regional school district, by the Chairman of the
			 Regional School District Committee. For a Public Employee Committee, the
			 request must be signed by a majority of the representatives of the Public
			 Employee Committee, or by a weighted majority of representatives of the Public
			 Employee Committee. The Commission will notify the relevant Municipal Employer
			 of a data request from a Public Employee Committee.
(b) The Commission will provide the following
			 data to each requesting entity with more than 50 subscribers:
1. A monthly claims report consisting of the
			 following data elements:
a. the subscriber
			 count;
b. the covered lives
			 count;
c. the total paid medical
			 claims; and
d. the total paid
			 prescription drug claims.
2. A yearly large loss report,
i.e
., for claimants who have incurred $25,000 or more paid
			 claims in a given year consisting of the following elements:
a. the de-identified claimant ICD-9 or ICD-10
			 codes (diagnoses); and
b. the
			 de-identified claimant total paid claims (medical and prescription drug).
The Commission will provide Protected Health Information to
				requesting entities as the Commission's Business Associates subject to the
				HIPAA Privacy Rule after each signs the Commission's Business Associate
				Agreement (BAA) as specified below. In the event that a Municipal Employer or a
				Public Employee Committee both request data in the same year, the Commission
				will supply data for the same time period to both entities.
Municipal Employers and Public Employee Committees that have
				requested these data will be required to designate a single person to handle
				these data, and such persons will be required to sign a BAA in which they agree
				not to share these data with other parties. Before receiving these data, the
				requesting entities agree to execute a BAA with the Commission in which they
				agree that only their single designated person shall handle these data, and
				that these data shall not be shared with anyone other than insurance brokers,
				benefits consultants, and health plans for the limited purpose of securing bids
				for the procurement of health insurance.
Requesting entities wanting Medicare HMO data or fully insured
				retiree dental coverage data should use the monthly premium as a substitute for
				actual cost. Administrative costs are not included in the data provided.