Ga. Comp. R. & Regs. R. 111-8-29-.09 - Statistical Information

(1) The HMO shall develop, compile, evaluate, and report statistics to the Department as requested relating to the cost of its operations, the pattern of utilization of its services, and the availability and accessibility of its services. The HMO shall provide the Department with full access to all operational and statistical data to enable the Department to verify the HMO's compliance.

(2) The annual statistical report shall contain the following information and shall be made on forms to be provided by the Commissioner. (Federally qualified HMO's may substitute for this annual statistical report, a copy of their four (4) most recent quarterly reports under the National Data Reporting Requirements).

(a) Enrollee statistics:

1. Number of employer contracts and total number of enrollees served by the contracts;

2. Number of subscriber contracts and total number of enrollees served by the contracts;

3. Number of enrollees at the beginning of the reporting year, and number of enrollees at the end of the reporting year, additions during the reporting year, losses during the reporting year;

4. Number of Medicaid and Medicare enrollees.

(b) Provider contracts:

1. Number by type of provider (i.e. physician, dentist, hospital, etc.);

2. Additions during the year;

3. Number of terminations during the year.

(c) Utilization, availability, accessibility, and cost data on the following:

1. Inpatient services;

2. Ambulatory care;

3. Preventive health care services.

(d) Other relevant information as determined by the Commissioner.

Notes

Ga. Comp. R. & Regs. R. 111-8-29-.09

Ga. L. 1964, pp. 499, 507, 523; Ga. L. 1979, pp. 1153, 1159, 1160, 1161; O.C.G.A. § 33-21-1et seq.

Original Rule entitled "Statistical Information" adopted. F. Oct. 9, 2020; eff. Oct. 29, 2020.