N.M. Admin. Code § 13.10.40.8 - REPORTING REQUIRED
As directed in these rules, every health insurer and group health plan shall annually report to the office of superintendent the number of insured children who are residents of New Mexico under each policy and plan, who were under the age of 19 as of the previous December 31 even if that number is zero.
A.
Report deadline. The required report is due by the date established by the office of superintendent, but no later than July 31 of each year.
(1) Late reports: If a report is submitted after the deadline set by the office of superintendent, the group health plan or health insurer is subject to penalties as set forth below.
(2) Non-Reports: If a report is not submitted by the due date set by the office of superintendent, the group health plan or health insurer is subject to penalties as set forth below.
(3) Failure to report by this deadline shall result in a $500 a day penalty pursuant to Subsection B of Section 24-5A-7 NMSA 1978. The office of superintendent shall issue written notice of failure to submit a timely report which specifies the statutory penalty to the designated contact person for each health insurer or group health plan.
B.
Report contents. The annual report shall include all information requested by the office of superintendent and, at a minimum, shall provide:
(1) the number of covered lives.
(2) the name of a designated contact person(s) for the reporting organization and the group health plan, or health insurer, including title, a current email address, and office phone number.
(a) If the contact person(s) name, title, email address or office phone number changes prior to the billing cycle or the following year's reporting cycle, then an updated contact shall be provided to the department and the office of superintendent as soon as practicable after the change occurs, but no later than 30 days after the change.
(b) Contact person(s) name, title, email address, or office phone number changes made to the OSI must be submitted via the VPA reporting system located on the OSI VPA page website.
(c) Communications to and from the designated contact shall be treated as communications between the office of superintendent and the health insurer or group health plans for all purposes under the VPA. Failure to provide or update contact information shall not relieve a health insurer or group health plan of any obligation under the VPA.
(d) Failure to provide or update contact person(s) name, title, email address, or office phone number shall not relieve a group health plan or health insurer of their obligations under the VPA.
(3) the names of employers or groups on behalf of whom the data is submitted.
(4) if a group health plan or health insurer did not cover any children during the prior year, an attestation of that circumstance.
(5) the annual report shall be submitted even if the number of children to report is zero.
C.
Method of reporting. A health insurer or group health plan shall report in the method prescribed by the office of superintendent.
D.
Responsibility for reporting. A health insurer or group health plan is solely responsible for reporting. A group health plan may delegate reporting obligations to an employer group or plan administrator, but the group health plan or health insurer remains responsible for any late report or reporting error, and corresponding statutory penalties. The office of superintendent is not obligated to remind a group health plan or health insurer of their obligations under the VPA.
E.
Mid-year plan termination. If an employer terminates its plan with a health insurer or group health plan mid-year, the new health insurer or group health plan shall be responsible for reporting and shall be responsible for reimbursing the vaccine purchasing fund for coverage of the prior years' insured children.
F.
Report amendments. An erroneous report may be changed only as approved by the office of superintendent or upon determination of a good faith discrepancy in accordance with Subsection C of Section 24-5A-7 NMSA 1978:
(1) A request to amend a report shall be sent to: vpa.data@osi.nm.gov.
(2) A report amendment must explain the erroneous reporting to the number of covered lives, reporting organization name, contact person(s) name, title, email address, or office phone number to the reporting organization or TPA or group health plan, FEIN's for group health plan.
(3) A report amendment will only be accepted if the dispute was submitted within thirty days of the date of the first quarter invoice.
(4) Requests to amend a report for over or under reported covered lives received by the office of superintendent after the 30-day date of the first quarter invoice, will be rejected by the office of superintendent and must be reconciled by the group health plan or health insurer on the following year's VPA report.
(5) The office of superintendent will allow a reconciliation of the previous year's report only once, and will not accept any report amendment requests for any other reporting year but the year that immediately precedes the current reporting year unless there is an under reporting of covered lives.
G.
Penalties.
(1) Report discrepancies are subject to civil penalty of five hundred dollars ($500) for each report filed for which the office of superintendent determines there is such a discrepancy pursuant to Subsection C of Section 24-5A-7 NMSA 1978.
(2) A failure of a health insurer or group health plan to make a timely payment of an amount invoiced pursuant to Subsection D of Section 24-5A-3 NMSA 1978 shall be subject to a civil penalty of five hundred dollars ($500) for each day from the date the payment is due pursuant to Subsection D of 24-5A-7 NMSA 1978.
H.
Receivership report. Before any health insurer is placed into receivership, it shall report its latest count of covered children to the office of superintendent.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
As directed in these rules, every health
A. Report deadline. The required report is due by the date established by the superintendent, but no later than July 31st of each year.
(1) The superintendent may extend the deadline for good cause. A reporter must file a request for an extension, with the reason for the request, at least five days before the report is due.
(2) Failure to report by this deadline shall result in a $500 a day penalty pursuant to Subsection B of Section 24-5A-7 NMSA 1978. The superintendent shall issue written notice of failure to submit a timely report which specifies the statutory penalty to the designated contact person for each health insurer or group health plan.
B. Report contents. The annual report shall include all information requested by the superintendent and, at a minimum, shall provide:
(1) the number of children who were enrolled in or participated in the plan during any part of the prior year, and who were under the age of 19 as of December 31st, excluding any children who are not residents of New Mexico, were enrolled in Medicaid or in any medical assistance program administered by the department or the human services department, and children who are members of a Native American tribe.
(2) the name of a designated contact person , including title, email address, and office phone number.
(a) If the contact changes prior to the billing cycle referenced in the table below or the following year's reporting cycle, then an updated contact shall be provided to the department and the superintendent as soon as practicable after the change occurs, but no later than 30 days after the change.
(b) Communications to and from the designated contact shall be treated as communications between the superintendent and the health insurer or group health plans for all purposes under the VPA. Failure to provide or update contact information shall not relieve a health insurer or group health plan of any obligation under the VPA.
(3) the names of employers or groups on behalf of whom the data is submitted.
(4) if a group health plan or health insurer did not cover any children during the prior year, an attestation of that circumstance.
(5) the annual report shall be submitted even if the number of children to report is zero.
C. Method of reporting. A health insurer or group health plan shall report in the method prescribed by the superintendent. All such reports to the office of the superintendent shall be copied to the department at vpa.fund@state.nm.us.
D. Responsibility for reporting. A health insurer or group health plan is solely responsible for reporting. A group health plan may delegate reporting obligations to an employer group or plan administrator, but the group health plan or health insurer remains responsible for any late report or reporting error, and corresponding statutory penalties.
E. Mid-year plan termination. If an employer terminates its plan with a health insurer or group health plan mid-year, the new health insurer or group health plan shall be responsible for reporting and shall be responsible for reimbursing the vaccine purchasing fund for coverage of the prior years' insured children.
F. Report changes. An erroneous report may be changed only as approved by the superintendent or upon determination of a good faith discrepancy in accordance with Subsection C of Section 24-5A-7 NMSA 1978.
G. Receivership report. Before any health insurer is placed into receivership, it shall report its latest count of covered children to the superintendent.