Air Ambulance Data Collection Delayed
The Consolidated Appropriations Act of 2021, created several new transparency requirements for group health plans. Many of those requirements focus on curtailing “surprise billing” which refers to large unanticipated medical bills. One of these new requirements is Air Ambulance Data Collection (AADC) that would collect information on air ambulance services, such as transportation by helicopter or plane, that often result in large surprise bills. AADC is intended to give lawmakers and regulators a better understanding of the cost of air ambulance services and the factors driving those costs.
The Proposed Rule implementing AADC originally set a deadline of March 31, 2023 to report the required data from the 2022 calendar year. While the proposed rule lays out the data that must be reported, it does not indicate how or where the data is to be reported.
The Centers for Medicare & Medicaid Services (CMS) recently announced on their website that AADC reporting would not begin until the final rule is published.
AADC Required Information
While CMS prepares the final rule, employers may want to proactively review the proposed rule that includes the data that must be reported. According to the proposed rule, AADC reporting must contain:
- Identifying information for any group health plan, plan sponsor, or issuer, and any entity reporting on behalf of the plan or issuer, if applicable;
- Market type for the plan (individual, large group, small group, self-insured plans offered by small employers, self-insured plans offered by large employers, and Federal Employees Health Benefits);
- Date of service;
- Billing National Provider Identifier (NPI) information;
- Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code information;
- Transport information including:
- Aircraft type (rotor transport or fixed wing transport);
- Loaded miles;
- Pick up and drop off zip codes;
- Whether the transport was emergent or non-emergent;
- Whether the transport was an inter-facility transport;
- To the extent the information is available to the plan or issuer, whether the service provider is part of a hospital-owned or sponsored program, municipality sponsored program, hospital indemnity partnership (hybrid program), independent program, or tribally operated program in Alaska;
- Whether the service provider had a contract with the plan or issuer;
- Claim adjudication information including whether the claim was paid, denied, appealed; denial reason; and appeal outcome;
- Claim payment information, including submitted charges, amounts paid by each payor, and cost sharing amount, if applicable.
Reporting responsibility will depend on whether an employer sponsors a fully insured or self-funded group health plan.
Fully insured: The plan sponsor/employer can enter into a written agreement with the health insurance carrier to submit the required reporting on their behalf. The written agreement shifts liability for failing to submit the reports from the plan sponsor/employer to the insurance carrier.
Self-funded: The plan sponsor/employer is free to enter into an agreement with their third-party administrator (TPA) to submit the required reports. However, self-funded plan sponsors cannot shift liability for submitting reports to their TPA. This means self-funded plan sponsors are ultimately liable for any failure to submit the report. Because of this, it is important that employers who leverage a self-funded health plan verify what entity is submitting the information on their behalf.
Air Ambulance Data Collection reporting requirement has been delayed until the final rule is published. The final rule will provide more guidance to plan sponsors, particularly on how and where to submit the required information. While plan sponsors do not need to take immediate action, they would be well served to review the proposed rule requirements and monitor the situation for developments.
The information provided is a summary of laws and regulations relating to employee benefit plan compliance. This information should not be construed as legal advice. In all cases, employers should consult with their own legal counsel.