Proposed regulations on air ambulance data reporting requirements

The departments of Health and Human Services (HHS), Labor (DOL) and the Treasury, along with the Office of Personnel Management, released proposed regulations implementing the air ambulance services reporting requirements under the No Surprises Act (NSA) provisions of the Consolidated Appropriations Act, 2021 (CAA).¹

These proposed regulations would establish:

• New reporting requirements for group health plans, health insurers and air ambulance service providers on air ambulance services
• New disclosure and reporting requirements on issuers of individual health insurance coverage and short-term, limited-duration insurance regarding agent and broker compensation
• New procedures for enforcement of Public Health Service Act (PHS Act) provisions against providers and facilities, including providers of air ambulance services, and revisions to existing PHS Act enforcement procedures for plans and issuers

The departments also issued a related fact sheet.

Comments on the proposed regulations must be received no later than October 18, 2021. The proposed regulations will not take effect until they are finalized. The preamble to the proposed regulations acknowledges that the departments will not have time to issue rules for all CAA provisions before the January 1, 2022 effective date; therefore, group health plans are expected to implement those provisions using a good faith, reasonable interpretation of the statute.

Air ambulance data reporting

Timing

Starting January 1, 2022, NSA protects patients from balance billing by air ambulance providers and requires air ambulance providers, group health plans, health insurers and Federal Employee Health Benefits (FEHB) carriers to submit information and data about air ambulances to federal regulators for calendar years 2022 and 2023.

While enforcement of certain other NSA requirements has been delayed,² group health plan air ambulance service reporting remains due on March 31, 2023 (for calendar year 2022) and March 30, 2024 (for calendar year 2023).

Reporting entity

Group health plans would submit information to HHS if the plan received claims or made payments for air ambulance services during the reporting period.

Self-insured group health plans, under a written agreement, may have a third-party administrator (TPA) submit the required information to HHS on behalf of the plan, but the plan retains reporting liability.

Health insurers, under a written agreement, may submit the required information for insured group health plans, with the insurer being liable if the information is not submitted.

Air ambulance reporting requirements do not apply to insurers that offer short-term, limited-duration benefits; excepted benefits; individual coverage health reimbursement arrangements; or other account-based plans. However, the reporting requirements do apply to Affordable Care Act grandfathered plans.

Data to be reported

The regulations propose to collect data on air ambulance services furnished within the calendar year as well as those paid for within the calendar year. The information must be submitted to HHS (and the Department of Transportation, in the case of air ambulance providers). HHS, in consultation with the Secretary of Transportation, will issue a public report that summarizes the data and assesses the air ambulance market.

Under NSA, group health plans and health insurers would be required to submit the following information for air ambulance claims:

• Identifying information for any group health plan, plan sponsor or issuer, and any entity reporting on behalf of the plan or issuer, as applicable
• Market type for the group health plan or health coverage (individual, large group, small group, self-insured plans offered by small employers, self-insured plans offered by large employers and FEHB)
• Date of service
• Billing National Provider Identifier information
• Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information
• Transport information, including aircraft type, loaded miles, and pick-up (origin ZIP code) and drop-off (destination ZIP code) locations; whether the transport was emergent or nonemergent; whether the transport was an inter-facility transport; and, to the extent this information is available to the plan or issuer, the service delivery model of the provider (such as government-sponsored [federal, state, county, city/township, other municipal], public-private partnership, tribally operated program in Alaska, hospital-owned or sponsored program, hospital independent partnership [hybrid] program or independent)
• Whether the provider had a contract with the group health plan to furnish air ambulance services under the plan
• Claim adjudication information (including whether the claim was paid, denied or appealed), denial reason and appeal outcome
• Claim payment information, including submitted charges, amounts paid by each payor and cost-sharing amount, if applicable

Future guidance will provide details on the data submission process.

Going forward

• Employers must prepare to submit the required air ambulance data to HHS by March 31, 2023 (for calendar year 2022) and March 30, 2024 (for calendar year 2023).
• Employers of fully insured group health plans should discuss this requirement with their health insurer and have it in writing that the insurer is responsible for submitting the required information.
• Employers sponsoring self-insured group health plans should consider a written agreement with their TPAs for submitting the required air ambulance services data. Note that TPAs may charge an additional fee for this service, and plans would still maintain the overall responsibility for submitting the information.

Footnotes

¹ For more information on the NSA’s surprise medical billing requirements, see “2020 year-end COVID-19 stimulus law: Health and benefit implications,” Insider, January 2021.

² See “Departments issue FAQs delaying health care transparency requirements,” Insider, September 2021.