Reporting requirements
(k) Reporting requirements. (1) The State, through its contracts, must require each MCO, PIHP, or PAHP to submit a report to the State that includes at least the following information for each MLR reporting year: (i) Total incurred claims. (ii) Expenditures on quality improving activities. (iii) Fraud prevention activities as defined in paragraph (e)(4) of this section. (iv) Non-claims costs. (v) Premium revenue. (vi) Taxes, licensing and regulatory fees. (vii) Methodology(ies) for allocation of expenditures, which must include a detailed description of the methods used to allocate expenses, including incurred claims, quality improvement expenses, Federal and State taxes and licensing or regulatory fees, and other non-claims costs, as described in 45 CFR 158.170(b). (viii) Any credibility adjustment applied. (ix) The calculated MLR. (x) Any remittance owed to the State, if applicable. (xi) A comparison of the information reported in this paragraph with the audited financial report required under 438.3(m). (xii) A description of the aggregation method used under paragraph (i) of this section. (xiii) The number of member months. (2) A MCO, PIHP, or PAHP must submit the report required in paragraph (k)(1) of this section in a timeframe and manner determined by the State, which must be within 12 months of the end of the MLR reporting year. (3) MCOs, PIHPs, or PAHPs must require any third party vendor providing claims adjudication activities to provide all underlying data associated with MLR reporting to that MCO, PIHP, or PAHP within 180 days of the end of the MLR reporting year or within 30 days of being requested by the MCO, PIHP, or PAHP, whichever comes sooner, regardless of current contractual limitations, to calculate and validate the accuracy of MLR reporting.