QUESTION: We’ve heard that there are temporary reporting requirements to address surprise air ambulance bills. What are the requirements, and when do they apply?
ANSWER: Legislation addressing patient protections related to surprise air ambulance bills from nonparticipating providers requires group health plans and insurers to submit information about the air ambulance services they cover during two calendar years (see our Checkpoint article). Although the IRS, DOL, and HHS have jointly proposed regulations outlining the timing and content for the information reports (which would be submitted only to HHS), the due dates will not be established until those regulations are finalized.
Under the proposed regulations, 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. 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).
Based on the expectation that the regulations would be finalized during 2021, the agencies proposed that the required data would 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). However, the regulations have not yet been finalized, so it is unclear at this time when the first report will be required.
For more information, see EBIA’s Health Care Reform manual at Section XII.B.4 (“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”).
Contributing Editors: EBIA Staff.