As of February 21, 2023, it has been confirmed that group health plans and health insurance issuers will not be required to submit required reports on air ambulance services by March 31, 2023. CMS has informally confirmed that since final regulations have not yet been issued, no reporting is required in 2023.
The proposed regulations had indicated that the initial reporting deadline would be March 31, 2023 (for 2022 calendar-year reporting). However, that deadline assumed final regulations would be issued before the end of the calendar year 2021. As it stands, final regulations have not yet been issued.
If the final regulations are issued in 2023, the first report would be due 90 days after the end of 2024 (March 31, 2025) for the 2024 calendar year.
The originally published article has been updated to reflect this change. (See below.)
Overview
Proposed regulatory guidance for the No Surprises Act requires health plans, issuers, and providers to report certain air ambulance data for calendar years 2022 and 2023. Reporting for these plan years assumed that regulations would be finalized in 2021. Given that they were not, the first reporting year will now be 2024.
The data will be used by the HHS and the Department of Transportation to produce a comprehensive public report on air ambulance services. The goal is to help increase transparency on the cost for these services.
Employer Responsibility
Technically, employers hold joint responsibility for reporting the data. In practice, employers/plan sponsors don’t hold or have access to the data that is required for reporting purposes. As such, the responsibility will fall to insurers (for fully insured plans) and ASO providers (for self-funded plans).
Fully Insured Employers
Employers with fully insured plans are exempt from reporting, but only to the extent that they have a written agreement with their insurer to report the information.
Employer Action Item: Execute a written agreement with the insurer confirming that all reporting obligations are transferred to the insurer and that filings will be made by the insurer on behalf of the employer.
Self-Funded Employers
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. While executing an agreement to transfer reporting obligations is likely to be the norm, self-funded plans will remain legally responsible for any noncompliance regardless of whether their TPA agrees to complete the reporting. Of course, parties are free to negotiate indemnification contractually, but the legal obligation will remain with the self-funded employer.
Employer Action Item: Execute a written agreement with TPA confirming that reporting obligations will be completed by the TPA and that filings will be made by the TPA on behalf of the employer.
Timing
The regulations have not yet been finalized, and HHS has yet to establish a method for submitting the reports. Nonetheless, health insurance issuers and TPAs should be looking forward and preparing systems to enable reporting in the future. Reports must be submitted to the HHS by the dates indicated below:
- Reports for the 2024 calendar year are due by March 30, 2025.
- Reports for the 2025 calendar year are due by March 30, 2026.
Required Data to Report
The regulatory guidance requires group health plans and issuers to report the following data elements for each claim for air ambulance services. Reporting must reflect claims received or paid for each of the two calendar years required.
- Identifying information for the group health plan, plan sponsor, or issuer, and any entity reporting on behalf of the plan or issuer
- Market type for the plan or coverage (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, including the 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 applicable, the service delivery model of the provider (e.g., government-sponsored, public-private partnership, hospital-sponsored, etc.)
- Whether the provider had a contract with the plan or issuer
- Claim adjudication information, including whether the claim was paid, denied or appealed, the denial reason, and appeal outcome
- Claim payment information, including submitted charges, amounts paid by each payor, and cost-sharing amounts.
Employer Action Item
Execute an agreement or an amendment to a current service agreement to transfer responsibility for required air ambulance data filings to the insurance carrier or TPA.
With the extension of the deadline, employers will have additional time to ensure that written agreements are in place with carriers and TPAs. That said, we recommend that employers keep the momentum of getting written agreements in place at this time. This will create smoother sailing once the new deadline approaches in a few years.
