Or. Admin. Code § 409-065-0015 - Data Submission Requirements

(1) Annual data submission dates are provided in the CGT-2; the data submission dates must not be before September 1st of each year.

(2) Annual data submissions must be submitted on the CGT-1 in accordance with instructions published by the Authority in the CGT-2.

(3) Mandatory reporters, and voluntary reporters who agree to participate, must submit data files for all required lines of business as defined in the CGT-2 and OAR 409-065-0015 (3)(a). Mandatory and voluntary reporters may submit data files for the voluntary lines of business and may not submit data files for any excluded lines of business as defined in the CGT-2 and OAR 409-065-0015 (3)(b). Mandatory and voluntary reporters must submit data files without subtracting or adjusting any costs including those listed as reasonable causes of cost growth in OAR 409-065-0035.

(a) Required lines of business include:

(A) Commercial;

(B) Medicare; and

(C) Medicaid.

(b) Excluded lines of business include:

(A) Accident policy;

(B) Disability policy;

(C) Hospital indemnity policy;

(D) Long-term care insurance;

(E) Medicare supplemental insurance;

(F) Stand-alone prescription drug plans;

(G) Specific disease policy;

(H) Stop-loss plans;

(I) Supplemental insurance that pays deductibles, copays or coinsurance;

(J) Vision-only insurance;

(K) Workers compensation; and

(L) Dental-only insurance.

(c) A mandatory reporter that contracts with another entity remains responsible for reporting all required lines of business. If the mandatory reporter elects to have the data reported by a contracted entity, the mandatory reporter must notify the Authority and provide contact information for the contracted entity.

(4) The Authority must validate the submitted data on the CGT-1 in accordance with CGT-2.

(5) The Authority must review a submitted CGT-1 within 90 calendar days after confirming receipt. If the Authority finds errors during its review through edit checks or validation, the Authority must issue a notice of the error(s) to the mandatory or voluntary reporter, as applicable.

(a) Mandatory reporters must correct and resubmit data to the Authority within 30 calendar days after the date the Authority issues notice of the error(s). The Authority will consider the annual data submission complete after the mandatory reporter submits all necessary corrections and resubmissions, as determined by the Authority.

(b) Voluntary reporters may correct and resubmit data to the Authority, as applicable.

Notes

Or. Admin. Code § 409-065-0015

OHP 2-2021, temporary adopt filed 06/02/2021, effective 6/2/2021 through 11/27/2021; OHP 5-2021, adopt filed 11/19/2021, effective 11/19/2021; OHP 4-2024, amend filed 07/22/2024, effective 7/22/2024

Statutory/Other Authority: ORS 442.386

Statutes/Other Implemented: ORS 442.385 & 442.386