Under proposed regulations in Section 723 of the Employee Retirement Income Security Act of 1974 (ERISA), added by the No Surprise Act, and published September 16, 2021, by the U.S. Department of the Treasury, U.S. Department of Labor, and U.S. Department of Health and Human Services (HHS), plans, issuers, and providers have responsibility to report specific air ambulance data, including expenses incurred and expenses paid, for calendar years 2022 and 2023.

Following submission of the data, HHS and the Department of Transportation will be required to produce a comprehensive, public report on air ambulance services that is expected to help increase transparency on the costs for these services.

It is important to note that while employers generally hold joint liability to ensure this reporting is completed, practically speaking, these reporting requirements are likely to fall on issuers and third-party administrators (TPAs) due to the fact employers are not likely to have access to the necessary data. Additional guidance on the submission process should be forthcoming.

Compliance Snapshot

  • Reporting Deadline: Reports for the 2022 calendar year must be submitted to HHS by March 31, 2023, and reports for the 2023 calendar year will be due by March 30, 2024.
  • Acquired Entities: If an acquisition occurs during the year, the entity that acquired the other party responsible for reporting (meaning either an air ambulance provider or a health plan issuer) is obligated to report for the entire calendar year.
  • Employers with fully insured plans are exempt from the reporting requirement if they require, by written agreement, the health issuer to report the information.
  • Employers with self-funded plans may utilize a third-party administrator (TPA) to assist with reporting, but employers would remain legally responsible for any reporting failures.
  • Short-term, limited-duration insurance plans are exempt from the reporting requirements.

Reporting Data Elements

Under the proposed rule, the required reporting would need to include for each claim for air ambulance services that was received or paid for during the reporting period the following data elements:

  1. Identifying information for the group health plan, plan sponsor or issuer, and any entity reporting on behalf of the plan or issuer, as applicable;
  2. Market type for the plan or coverage (such as fully insured, self-funded, individual, large group, small group, etc.);
  3. Date of service;
  4. Billing National Provider Identifier (NPI) information;
  5. Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information;
  6. Transport information, such as aircraft type, loaded miles, pick-up and drop-off zip codes, whether the transport was emergent or non-emergent, whether the transport was inter-facility, and, if applicable, the service delivery model of the provider (e.g., government-sponsored, public-private partnership, tribally operated, hospital-sponsored, etc.);
  7. Whether the provider had a contract with the plan or issuer;
  8. Claim adjudication information, such as whether the claim was paid, denied, appealed, denial reason, and appeal outcome; and,
  9. Claim payment information, including submitted charges, amounts paid by each payor, and cost sharing amounts.

Note, while the rule is still pending final review, health insurance issuers and TPAs should already be preparing to collect the data.

Employer Action

  • Reports for the 2022 calendar year must be submitted to HHS by March 31, 2023, and for the 2023 calendar year by March 30, 2024.
  • Employers with fully insured plans should confirm with their issuer (and self-funded plans will want to confirm with their TPAs) whether they will complete reporting requirements on their behalf.
  • Whether the plan is fully insured or self-funded, employers should consider a written agreement with their issuer or TPA if the issuer or TPA will be submitting reports on their behalf. Note, self-funded plans may remain legally responsible for any noncompliance regardless of whether a TPA agrees to complete the reporting.

Additional Resources

The information and materials on this blog are provided for informational purposes only and are not intended to constitute legal or tax advice. Information provided in this blog may not reflect the most current legal developments and may vary by jurisdiction. The content on this blog is for general informational purposes only and does not apply to any particular facts or circumstances. The use of this blog does not in any way establish an attorney-client relationship, nor should any such relationship be implied, and the contents do not constitute legal or tax advice. If you require legal or tax advice, please consult with a licensed attorney or tax professional in your jurisdiction. The contributing authors expressly disclaim all liability to any persons or entities with respect to any action or inaction based on the contents of this blog. © 2023 Sequoia Consulting Group. All Rights Reserved.

Tina Barile — Tina is a Client Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Tina enjoys being with family, cooking, reading, and playing sports.