28 Tex. Admin. Code § 21.5502 - Form and Method of Publishing Machine-Readable Files

(a) Required machine-readable files. Issuers must publish the following machine-readable files consistent with Insurance Code Chapter 1662, Subchapter C, concerning Required Public Disclosures, and the rules under this subchapter:

(1) an in-network negotiated rates file, containing in-network provider negotiated rates for all covered health care services and supplies, consistent with Insurance Code § 1662.103(a)(1), concerning Required Information, and §1662.104, concerning Network Rate Disclosures;

(2) an out-of-network allowed amounts file, containing billed charges and allowed amounts for covered health care services or supplies provided by out-of-network providers, consistent with Insurance Code § 1662.103(a)(2) and § 1662.105, concerning Out-of-Network Allowed Amounts; and

(3) an in-network prescription drugs file, containing in-network historical net prices and negotiated rates for prescription drugs, consistent with Insurance Code § 1662.103(a)(3) and § 1662.106, concerning Historical Net Price.

(b) Transport mechanism. An issuer must make all machine-readable files available via HTTPS.

(c) Content type. An issuer must use a nonproprietary and open format for publishing machine-readable files. Examples of acceptable formats include JSON, XML, and YAML. Examples of proprietary formats that are not acceptable include PDF, XLS, and XLSX.

(d) Public discoverability. An issuer must make machine-readable files available to the public consistent with Insurance Code § 1662.107, concerning Required Method and Format for Disclosure, and without restrictions that would impede the reuse of that information. The issuer must provide the location of the URLs for the machine-readable files over HTTPS to ensure the integrity of the data.

(e) Indexing. To allow for search engine discoverability, an issuer may not use a mechanism, such as a robots.txt file or a meta tag on the page where the files are hosted, or other mechanism that gives instructions to web crawlers to not index the page.

(f) Special data types. Dates must be strings in ISO 8601 format (e.g., YYYY-MM-DD).

(g) Different flat files. Issuers must publish three machine-readable files using the following file type names:

(1) "in-network-rates" for the file containing in-network provider negotiated rates for all covered health care services and supplies, consistent with Insurance Code § 1662.103(a)(1) and § 1662.104;

(2) "allowed-amounts" for the file containing billed charges and allowed amounts for covered health care services or supplies provided by out-of-network providers, consistent with Insurance Code § 1662.103(a)(2) and § 1662.105; and

(3) "prescription-drugs" for the file containing historical net prices and negotiated rates for prescription drugs, consistent with Insurance Code § 1662.103(a)(3) and § 1662.106.

(h) Multiple plans per file. An issuer that has multiple plans with the same negotiated rates with the same group of providers for the same covered health care services and supplies may group multiple plans together within a single file. An issuer that groups multiple plans into a single file must create a file with the file type name "table-of-contents" that uses the naming convention and standards required under subsection (i)(2) of this section. The filing convention for single plan files under subsection (i)(1) of this section will not apply to files published as permitted under this subsection.

(i) File-naming convention. An issuer must name each file using the naming convention and standards required under this subsection.

(1) The file naming convention for single plan files includes the elements identified in subparagraphs (A) - (D) of this paragraph, each separated by an underscore, followed by a period and the file extension:

(A) the four-digit year, two-digit month, and two-digit day, each separated by dashes (e.g., "2022-12-01" would be used for a file published December 1, 2022);

(B) the issuer name, with any spaces replaced with dashes (e.g., "issuer-abc" would be used for an issuer called "issuer abc");

(C) the plan name, with any spaces replaced with dashes (e.g., "healthplan-100" would be used for a plan called "healthplan 100"); and

(D) the file type name (e.g., "in-network-rates").

(2) The file naming convention for the table-of-contents file published by an issuer that includes multiple plans per file, as permitted by subsection (h) of this section, includes the elements identified in subparagraphs (A) - (C) of this paragraph, each separated by an underscore, followed by a period and the file extension:

(A) the four-digit year, two-digit month, and two-digit day, each separated by dashes (e.g., "2022-12-01" would be used for a file published December 1, 2022);

(B) the issuer name, with any spaces replaced with dashes (e.g., "issuer-abc" would be used for an issuer called "issuer abc"); and

(C) the word "index."

(3) An issuer may include only alphanumeric characters in the file name. An issuer may not include special characters or punctuation other than the dashes, underscores, and periods specified in the naming convention. An issuer must either remove special characters completely or replace the special characters with a dash ("-").

(4) Examples of the file naming conventions are provided in Figure: 28 TAC § 21.5502(i)(4).

Attached Graphic

(j) Safe harbor. An issuer that publishes machine-readable files in the form and method specified by the federal guidance published on the following website: github.com/CMSgov/price-transparency-guide, and its associated schemas, will be deemed compliant for the purposes of this subchapter.

Notes

28 Tex. Admin. Code § 21.5502

Adopted by Texas Register, Volume 47, Number 21, May 27, 2022, TexReg 3154, eff. 6/2/2022