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HHS Issues Proposed Regulations for Air Ambulance Services

On September 13, 2021, the Department of Health and Human Services (HHS) released proposed regulations on reporting requirements for air ambulance services. These reporting requirements were included in the No Surprises Act or Title I of the Consolidated Appropriations Act (CAA).

The proposed regulations require plans and issuers to submit certain data on air ambulance services on a calendar year basis. Plans (including ACA grandfathered plans) and issuers will need to start collecting this data in 2022. The first submission is due on March 31, 2023. Data for the 2023 calendar year must be submitted by March 30, 2024. If an issuer acquires another line or block of business during 2022 or 2023, they are required to report on behalf of the acquired business for the entire applicable calendar year.

Another requirement of the No Surprises Act requires HHS to produce a comprehensive public report. This report must include:

  • Assessments of average charges for air ambulance services
  • Amounts paid by plans and issuers to providers for air ambulance services
  • Amounts paid out-of-pocket by consumers
  • Frequency of patient balance billing
  • Frequency of claims appeals made by providers of air ambulance services to plans and issuers
  • Any other data relating to air ambulance services deemed necessary and appropriate by the Secretaries of HHS and Transportation

In order to provide this report, HHS has proposed that plans and issuers submit the following claims-level data, including:

  • Date of service
  • Billing NPI and Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes information
  • Certain information about each air ambulance transport (loaded miles, whether the transport was inter-facility, etc.)
  • Market type of the plan or coverage associated with the air ambulance service
    • For fully insured plans, this would include the individual, small group, and large group markets
    • For self-insured plans, this would include the identification of the plan sponsor as a large or small employer
    • Federal Employee Health Benefits (FEHB) plans are separately identified
  • Claim adjudication information, including:
    • Whether the claim was paid, partially paid, denied, or appealed (including the reason for the denial and outcome of the appeal, if applicable)
    • Payment information (including submitted charges, amounts paid by the payor, and cost sharing amount)

This is just the first of many proposed regulations expected to explain the provisions of the CAA. Start the conversation with your carrier or TPA now to ensure that you are ready to meet these new reporting requirements.

For more information on these changing regulations, contact your local OneDigital consultant.