Seyfarth Synopsis: Under a Tri-Agency Proposed Rule, health plans could be required to report information relating to air ambulance services by March 31, 2023. As this proposed deadline approaches, plan sponsors should reach out to their third party administrators to determine what assistance, if any, will be provided relating to these reporting requirements.
Just as health plans wrap up their 2020 and 2021 prescription drug reports, attention must now shift to the impending air ambulance reporting requirements under the No Surprises Act ("NSA"). The NSA requires health plans and health insurance issuers to disclose certain data to the Department of Health and Human Services (HHS) regarding the use of air ambulance services. In 2021, the Departments of Treasury, Health and Human Services, and Labor issued a Proposed Rule requiring health plans and issuers to report data relating to air ambulance services for the 2022 plan year by March 31, 2023. Although the Proposed Rule has not yet been finalized, plan sponsors should start preparing for the reporting requirements and understanding their obligations under the NSA.
In order to satisfy reporting requirements under the Proposed Rule, plan sponsors will need to submit data for each air ambulance claim received or paid for during the applicable reporting period, including:
- Plan name;
- Plan market type (e.g., large or small, fully insured or self-funded);
- Date of service;
- Billing National Provider Identifier (NPI);
- Current Procedural Terminology code (CPT);
- Transport information;
- Whether the air ambulance provider was contracted with the plan; and
- Information on claim adjudication and claim payment.
Similar to the prescription drug reporting requirements, many plan sponsors might expect their third party administrators or insurance carriers to either complete these filings or assist them with the reporting requirements. However, while the insurer will be responsible for reporting on behalf of fully-insured plans, plan sponsors of self-funded plans will retain responsibility for the reports. We encourage plan sponsors of self-funded plans to reach out to their third party administrators now in order to determine whether the TPA will file the air ambulance reporting on behalf of their plans, or just assist (e.g., provide necessary information) the sponsor in filing the report. Plan sponsors should consider a written agreement if the third party administrator will be submitting the reports on the plan's behalf. If not, plan sponsors should begin gathering the necessary data from their third party administrators and understanding what assistance, if any, their brokers, consultants, or other vendors might provide with respect to the reporting obligations.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
