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:
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.
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).
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.
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:
Future guidance will provide details on the data submission process.
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.
|Insider September 2021