QUESTION: We’ve heard that there are non permanent reporting necessities to deal with shock air ambulance payments. What are the necessities, and when do they apply?

ANSWER: Laws addressing affected person protections associated to shock air ambulance payments from nonparticipating suppliers requires group well being plans and insurers to submit details about the air ambulance providers they cowl throughout two calendar years (see our Checkpoint article). Though the IRS, DOL, and HHS have collectively proposed rules outlining the timing and content material for the knowledge experiences (which might be submitted solely to HHS), the due dates won’t be established till these rules are finalized.

Underneath the proposed rules, the reporting necessities would apply to self-insured and insured group well being plans and insurers, however to not well being reimbursement preparations, excepted advantages, and short-term, limited-duration insurance coverage. An insured plan would fulfill the necessities if its insurer offers the knowledge pursuant to a written settlement. A self-insured well being plan might contract with a TPA to report the required info, however the plan would stay chargeable for any reporting failures. For every declare for air ambulance providers obtained or paid for through the reporting interval, required information would come with sure transport info, such because the plane kind, loaded miles, pick-up and drop-off areas, whether or not the transport was emergent or non-emergent, and whether or not the transport was an inter-facility transport. Plans would even be required to report sure declare adjudication info (together with whether or not the declare was paid, denied, or appealed; denial cause; and enchantment consequence) and declare fee info (together with submitted costs, quantities paid by every payor, and cost-sharing quantity).

Primarily based on the expectation that the rules could be finalized throughout 2021, the companies proposed that the required information could be submitted for calendar yr 2022 by March 31, 2023, and for calendar yr 2023 by March 30, 2024. Information for a calendar yr would pertain to air ambulance providers furnished inside the calendar yr, in addition to funds made inside the calendar yr (even when the service was offered in a unique calendar yr). Nevertheless, the rules haven’t but been finalized, so it’s unclear at the moment when the primary report might be required.

For extra info, see EBIA’s Well being Care Reform guide at Part XII.B.4 (“Shock Air Ambulance Billing”) and EBIA’s Group Well being Plan Mandates guide at Part XIII.B (“Affected person Protections”). See additionally EBIA’s Self-Insured Well being Plans guide at Part XIII.C (“Federally Mandated Advantages”).

Contributing Editors: EBIA Workers.