Amendments throughout new Division 1 revise capitalization in catchlines, replace the phrase “is required to” with the word “must,” and remove or revise the word “such” where necessary for consistency with department rule drafting style. Amendments also change the word “subchapter” to “title” where necessary for consistency with department style for references to other sections within rule text. Amendments also update references to “access plan” to state “local market access plan” for consistent use of terminology. Additionally, amendments throughout new Division 1 make nonsubstantive revisions to correct punctuation errors in the current rule text. Amendments to §3.3701 provide effective dates for the rules to preferred provider benefit plans and exclusive provider benefit plans and also address applicability of rules in Title 28 to exclusive provider plans. These provisions are necessary to provide sufficient notice to insurers of the applicability and effective dates of amended and new regulations under the subchapter, to clarify certain limitations on the scope of the amended subchapter, and to ensure conformity with amendments throughout the Insurance Code Chapter 1301 as provided by HB 1772. Amendments to §3.3701(a) provide that the subchapter applies to any preferred or exclusive provider benefit plan that is offered, delivered, or issued for delivery on or after 150 days from the effective date of §3.3701. This effective date is intended to supersede Commissioner’s Bulletin #B-0050-11, in which the department suspended its enforcement of amendments to the preferred provider benefit plan rules that were to become effective May 19, 2012. It is the department’s expectation that insurers whose networks do not comply with the network adequacy requirements of the rule will either
The department estimates that §3.3723(c), (d), and (f) could result in costs to comply for insurers and has determined that the total estimated cost for compliance could vary based upon certain components. The department considered: (i) the cost of identifying, collecting, producing, and printing or copying the required documents for each examination; (ii) the cost of facilitating an examination in compliance with §3.3723(c); (iii) the cost of auto-mapping software (for example, Geo-Access) to make the required maps available for review in compliance with §3.3723(f)(5); and (iv) the cost of information technology staff necessary to use the auto-mapping software. The department estimates that it would be reasonably necessary for an insurer to employ a general operations manager, an administrative assistant, and a functional division director from each of the insurer’s functional divisions to make the required documents available to the department during a subsequent examination. The department estimates that it would be reasonably necessary for a general operations manager to spend an average of three hours identifying and collecting the applicable documents per examination and to spend an average of two to 10 hours reviewing deficiencies and generating corrected responses. This estimate could vary, depending on the accuracy and completeness of the documents produced from each functional division and number of functional divisions an insurer opts to include within its organizational structure. The department additionally estimates that it would be reasonably necessary for an administrative assistant to spend an average of two hours copying or printing and combining the required documents per examination. The department further estimates that it would be reasonably necessary for a functional division director to spend an average of two hours of time gathering, reviewing, and