On Sept 10, the Departments of Labor (DOL), Treasury (IRS), and Health and Human Services (HHS) issued a proposed rule addressing certain aspects of the No Surprises Act (NSA). The proposed rule covers:
- Reporting of claims and related data with respect to the cost of air ambulance services.
- Disclosure of compensation paid to the agents and brokers selling individual health and short-term, limited duration insurance policies to potential purchasers of those policies.
- The allocation of responsibility between HHS and the States for enforcement of the NSA.
Air Ambulance Reporting
The NSA requires air ambulance providers, health plans, and health insurance issuers to report detailed information relevant to the costs and charges incurred for air ambulance services.
Under the proposed rule, the reports for 2022 must be submitted by March 31, 2023; the reports for 2023 must be submitted by March 30, 2024.
The reports would be sent to HHS and include:
(1) Identifying information for any group health plan, plan sponsor, or issuer, and any entity reporting on behalf of the plan or issuer, as applicable.
(2) Market type for the plan or coverage (individual, large group, small group, self-insured plans offered by small employers, self-insured plans offered by large employers, and Federal Employees Health Benefits).
(3) Date of service.
(4) Billing NPI information.
(5) Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information.
(6) Transport information (including aircraft type, loaded miles, pick-up (origin zip code) and drop-off (destination zip code) locations, whether the transport was emergent or non-emergent, whether the transport was an inter-facility transport, and, to the extent this information is available to the plan or issuer, the service delivery model of the provider
(7) Whether the provider had a contract with the group health plan or issuer of group or individual health insurance coverage, as applicable, to furnish air ambulance services under the plan or coverage, respectively.
(8) Claim adjudication information, including whether the claim was paid, denied, appealed; denial reason; and appeal outcome.
(9) Claim payment information, including submitted charges, amounts paid by each payor, and cost sharing amount, if applicable.
If a group health plan is insured, it can satisfy the reporting requirement by entering into a written agreement with its insurer requiring the insurer to file the report. This will relieve the plan of responsibility if the insurer fails to report as required.
Self-insured plans may also enter into reporting agreements with third parties, but remain liable if the third-party fails to file the report.
Enforcement Provisions
Under existing rules, the States are expected to enforce federal health insurance rules (such as those promulgated under HIPAA and the ACA) with respect to the insurers under their jurisdiction. HHS can step in and take over enforcement if a State fails to enforce the law. The proposed rule extends these obligations to most requirements imposed on insurers by the NSA.
Enforcement authority over self-insured plans remains with the Departments.
Compensation Disclosures
The NSA requires insurers to disclose agent compensation to purchasers of individual health and short-term, limited duration insurance policies. Disclosures must be made prior to purchase and at annual renewals. The proposed rule provides details on how those requirements could be satisfied. However, these will not affect sponsors of group health insurance plans. (Another provision of the NSA requires disclosures to plans of compensation paid to brokers and consultants. Rules regarding those requirements have not yet been proposed.)
Comments on the proposed rules must be submitted no later than 30 days after their publication in the Federal Register.