Under a proposed rule from the Department of Labor (DOL), Health and Human Services (HHS), and the Treasury, group health plans (including ACA grandfathered plans) and health insurers are required to report air ambulance services.
As we have seen with other transparency reporting, many employers will not have access to the necessary data to do the reporting and will need to rely on their carriers and/or third-party administrators (TPAs).
Employers with fully insured plans can avoid this responsibility by entering into a written agreement that requires their health carrier to submit the report. Employers should work with the carrier or TPAs to confirm if they will complete the reporting requirement on their behalf.
Employers with self-funded plans may have a similar written agreement with their TPAs. The employer, however is responsible for any penalties if the TPA fails to submit the report.
Employers should work with their TPAs to determine what assistance they will be providing related to the reporting requirements and confirm who will complete the reporting.
The data that HHS has asked plans and carriers to submit includes:
- Plan name
- Plan market type (e.g., fully insured, self-insured, large or small group)
- Date of service
- Billing National Provider Identifier (NPI)
- Current Procedural Terminology (CPT) code
- Transport information
- Claim adjudication information and claim payment
As mentioned, this is a proposed rule and it hasn’t been finalized. Even so, employers should communicate with their carrier or TPA soon to ensure that they are ready to meet these new reporting requirements.
Assuming final regulations are issued during the 2023 calendar year, then the first report would be due 90 days after the end of 2024 (i.e., March 31, 2025) for the 2024 calendar year, and the report for calendar year 2025 (the second reporting year) would be due March 31, 2026.