Update: CMS recently announced on their website that the data reporting deadline will be postponed until after the final rules are published. As such, no reporting will be required in 2023. We will provide an update once the regulations are finalized and there is more information available.
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.
- 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. Note: 2022 calendar year reporting has been postponed.
- 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:
- Identifying information for the group health plan, plan sponsor or issuer, and any entity reporting on behalf of the plan or issuer, as applicable;
- Market type for the plan or coverage (such as fully insured, self-funded, individual, large group, small group, etc.);
- Date of service;
- Billing National Provider Identifier (NPI) information;
- Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information;
- 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.);
- Whether the provider had a contract with the plan or issuer;
- Claim adjudication information, such as whether the claim was paid, denied, appealed, denial reason, and appeal outcome; and,
- 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.
- 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.
- U.S. Accountability Office Report on the Need for Air Ambulance Data Collection
- HHS Proposed Rule related to Air Ambulance Services
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