Proposed Rules: Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement, 5 CFR Part 890, 26 CFR Part 54, 29 CFR Part 2590, 45 CFR Parts 144, 148, 149, and 150, 86 Fed Reg 51730 (Sept. 16, 2021); Air Ambulance NPRM – Fact Sheet (Sept. 10, 2021)
HHS, DOL, and the IRS have proposed regulations describing how health plans and insurers would temporarily report data on air ambulance services to the agencies, as required by the Consolidated Appropriations Act, 2021 (CAA) (see our Checkpoint article). As background, for plan years beginning on or after January 1, 2022, the CAA imposes requirements to address patient protections related to surprise air ambulance bills provided by nonparticipating providers, including a requirement that group health plans and insurers submit information about the air ambulance services they covered for two years. (Reports would be made only to HHS, satisfying corresponding Code and ERISA reporting obligations.) These proposed regulations outline the timing and content for the information reports. Here are highlights:
Applicability. The reporting requirements would apply to self-insured and insured group health plans and insurers, but not to health reimbursement arrangements, excepted benefits, and short-term, limited-duration insurance. An insured plan would satisfy the requirements if its insurer provides the information pursuant to a written agreement. A self-insured health plan could contract with a TPA to report the required information, but the plan would remain responsible for any reporting failures.
Timing. Based on the expectation that the regulations will be finalized during 2021, the agencies propose that the required data will be submitted for calendar year 2022 by March 31, 2023, and for calendar year 2023 by March 30, 2024. Data for a calendar year would pertain to air ambulance services furnished within the calendar year, as well as payments made within the calendar year (even if the service was provided in a different calendar year).
Content. For each claim for air ambulance services received or paid for during the reporting period, required data would include certain transport information, such as the aircraft type, loaded miles, pick-up and drop-off locations, whether the transport was emergent or non-emergent, and whether the transport was an inter-facility transport. Plans would also be required to report certain claim adjudication information (including whether the claim was paid, denied, or appealed; denial reason; and appeal outcome) and claim payment information (including submitted charges, amounts paid by each payor, and cost-sharing amount). The agencies intend to propose a data template and instructions for reporting.
EBIA Comment: This regulatory action continues the agencies’ rulemaking to implement the surprise billing requirements of the CAA (see, e.g., our Checkpoint article). Although the reporting for plans and insurers is temporary and relatively limited, the proposal outlines more extensive reporting requirements for air ambulance service providers. HHS intends to use the combined information from the reports to issue a comprehensive public report on air ambulance services, as required under the CAA. For more information, see EBIA’s Health Care Reform manual at Section XII.B.5 (“Expanded Patient Protections: Surprise Air Ambulance Billing”) and EBIA’s Group Health Plan Mandates manual at Section XIII.B (“Patient Protections”). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C (“Federally Mandated Benefits”). You may also be interested in our upcoming webinar, “Group Health Plans Quarterly Update: Q3 2021” (live on 9/29/2021).
Contributing Editors: EBIA Staff.