The Departments of Health and Human Services (HHS), Treasury, and Labor (together, the “Departments”) released proposed rules implementing Section 106 of the No Surprises Act regarding required disclosures on September 16, 2021 (the “Proposed Rule”). While the Departments have not yet issued the final rule on air ambulance reporting, it is expected to be published any day. The Proposed Rule would require plans and issuers to submit air ambulance reporting for the 2022 plan year by March 31, 2023, and for the 2023 plan year by March 30, 2024. However, no other details are available. It is possible, as it has been done with other similar recent transparency and reporting requirements, that this could be delayed. Be sure you are subscribed to the Leavitt Group news alerts to be kept abreast of any changes in these requirements.
The Consolidated Appropriations Act of 2021 (“CAA 2021”) included the No Surprises Act (“NSA”). The NSA expanded patient protections from the recently enacted ban on surprise balance billing for certain out-of-network emergency and non-emergency services. Part of the process to ensure payment for services and not balance bill the plan participant – patient, is the Independent Dispute Resolutions (IDR) process. There are very specific terms and reporting required for those involved in the IDR process. Another element of NSA is the ban on balance billing or “surprise” billing for air ambulances. Reporting was slated to begin March 2023 but is pending the release of guidance. The information in this article will show plans what CMS will likely be asking for in a reporting that will (or most likely will not with full enforcement) begin in March 2023. This will allow plans and their Leavitt Group trusted advisors to plan ahead for the data collection, contracts with plan service providers to submit the report on behalf of the plan sponsor and any other relevant considerations.
The Proposed Rule requires plans and issuers to report the following data to the Departments for the 2022 and 2023 plan years, for each claim for air ambulance services received or paid for during the applicable plan year:
- Identifying information for the group health plan, plan sponsor or issuer, and for any entity reporting on behalf of the plan or issuer, as applicable.
- The type of coverage (e.g., self-insured plan offered by a large employer, fully-insured large group, etc.)
- Date of service
- Billing National Provider Identifier (NPI) information
- Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code information
- Transport information, including type of aircraft, loaded miles, pick-up and drop-off zip codes, whether the transport was emergent or non-emergent, whether the transport was an inter-facility transport, and, if available, the service delivery model of the provider (e.g., government-sponsored, hospital-owned, etc.).
- Whether the provider had a contract with the plan or the issuer
- Claim adjudication information, including whether the claim was paid, denied or appealed, and the denial reason and appeal outcome, as applicable.
- Claim payment information, including submitted charges, amounts paid by each payor, and cost-sharing amount, if applicable.
Plans and issuers may enter into contractual arrangements to have another party submit the reporting on their behalf, such as a third-party administrator (TPA). However, the Proposed Rule will only transfer legal responsibility for the reporting to the contracted party for fully-insured group health plans, if the plan enters into a written agreement with the issuer requiring the issuer to submit the reporting. The legal responsibility will not transfer to a TPA or other vendor, even when there is a written agreement between the TPA and a self-insured plan or issuer (of course, parties are free to negotiate indemnification contractually).
Plans should start coordinating with plan service providers, such as the TPA, to determine who will submit to the reporting. Always get a contract where another party agrees to report on the plans’ behalf. It is most likely the associated reporting requirements will fall on issuers and TPAs. Plans and issuers should review their service agreements to determine how air ambulance reporting requirements will be covered and to ensure that everything is on track for when the reporting requirements take effect.