Background

Air ambulance services often present a challenge to plan sponsors because the services are frequently provided by non-contracted service providers and individuals receiving the services often have no alternatives due to an urgent medical situation. Effective for plan years beginning on or after January 1, 2022, the No Surprises Act prevents patients from being balance billed for certain out-of-network emergency services, including air ambulance services. The No Surprises Act will regulate payments made by plans to air ambulance services.

In addition, the Act requires both air ambulance companies and plans to report certain data to the federal government for the 2022 and 2023 calendar years. The Departments of HHS and Transportation will use this data to develop a public report on air ambulance services.

The proposed air ambulance data reporting requirements

Under the proposed rule, plan sponsors would be required to report data on air ambulance services and payments for calendar year 2022 by March 31, 2023, and for calendar year 2024 by March 31, 2024. Plan sponsors would be required to report the following data elements for each air ambulance claim received or paid for during the reporting period:

• Plan name
• Market type for the plan (individual, large insured group, small insured group, self-insured plans offered by small employers with fewer than 50 employees, self-insured plans offered by large employers that have at least 51 employees on average and Federal Employees Health Benefits)
• Date of service
• Billing National Provider Identifier
• Current Procedural Terminology code or Healthcare Common Procedure Coding System code
• Transport information (including aircraft type, loaded miles, pick-up by origin zip code and drop-off by destination zip code locations, whether the transport was emergent or non-emergent, whether the transport was an inter-facility transport, and the service delivery model of the provider if that information is known to the plan (e.g., government-sponsored, public-private partnership, tribally-operated program in Alaska, hospital-owned or sponsored program, hospital independent partnership program or independent))
• Whether the provider had a contract with the group health plan to provide air ambulance services
• Claim adjudication information, including whether the claim was paid, denied or appealed, the denial reason and the appeal outcome
• Claim payment information, including submitted charges, amounts paid by each payer, and cost-sharing amount, if applicable

To facilitate the reporting process, the Departments will publish additional technical details including a proposed data template and instructions. Plans are not required to report information if they did not receive claims or make or expect to make payments for air ambulance services during the reporting period.

Insured group health plans may enter into a written agreement to delegate reporting responsibility to their health insurer. If such an agreement exists, the insurer would be responsible for any penalties, not the plan.

Self-insured group health plans may enter into a written agreement under which another party (such as a third-party administrator) reports the required information. However, the group health plan retains responsibility if the entity fails to report the information properly.

The reporting requirements will apply to grandfathered plans as well as non-grandfathered plans. However, excepted benefits (e.g., dental and vision programs) and account-based plans (such as health reimbursement arrangements) are not subject to the reporting rules.

Next steps

Plan sponsors that wish to provide input on the reporting requirements may file comments on or before October 18, 2021. In addition, plan administrators should prepare to complete data reporting for 2022 by assuring that plan service providers are able to collect information for that year and report it to the Departments by March 31, 2023.