On September 13, 2021, proposed regulations were issued that would implement certain provisions of the No Surprises Act, requiring group health plans to submit information related to air ambulance claims to the Department of Health and Human Services (“HHS”) for 2022 and 2023.
Major medical health plans (insured and self-insured, grandfathered and non-grandfathered) are subject to this requirement.
The report must include the following data elements with respect to air ambulance services provided under a group health plan:
As the requested information is claims-level data as opposed to aggregate data, HHS proposes to collect only that claims-level data that would be sufficient for producing the comprehensive report required by the No Surprises Act. HHS also intends to collect and maintain the information using information technology systems that are designed to meet all of the security standards protocols established under federal law or by HHS.
Plans must submit data regarding air ambulance services on a calendar year (“CY”) basis for 2022 and 2023 within 90 days of the end of the calendar year.
An employer with an insured plan satisfies the reporting requirements if it requires the health insurance issuer offering the coverage to report the required information pursuant to a written agreement. In this case, the issuer and not the plan is liable for any failure to file.
An employer with a self-funded plan may satisfy the reporting requirements by entering into a written agreement with the third-party administrator (“TPA”). The plan generally remains liable. However, nothing prevents a self-insured group health plan from including a clause in the written agreement for the TPA indemnifying the plan in the event the TPA fails to submit a complete or timely report.
Employers will not have the required data necessary to report. Therefore, employers should begin reaching out to carriers and TPAs handling their health programs during the calendar year 2022 and enter into written agreements with them, requiring issuers and TPAs to handle reporting. Employers with self-funded plans should consider adding indemnification provisions to their agreements in the event the TPA is not compliant.
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