On October 7, 2021, the Personnel Management Office (OPM), the Internal Revenue Service (IRS), the Department of Labor (DOL) and the Department of Health and Human Services Department (HHS) (collectively, the Departments) released the No Surprises Act (NSA) Part II Interim Final Rule. The NSA Part II Rule details some of the NSA requirements not addressed in the previous regulations including the Air Ambulance data reporting requirements. Below is a synopsis of the Air Ambulance data reporting requirements.
The NSA Part II Rules set forth the requirements related to air ambulance transportation services data reporting.
Under the guidelines, the NSA, HHS and the Department of Transportation (Transportation) must develop a comprehensive public report based on air ambulance services data from the 2022 and 2023 calendar years. The HHS and Transportation Secretaries will collect data from group health plans (GHPs), plan sponsors or issuers to create the joint public report.
Specific information must be disclosed under the NSA Part II Rules.
The NSA Part II Rules require air ambulance service providers and GHPs, plan sponsors and issuers to report certain information to HHS and Transportation. The Part II regulations state that plans, issuers and providers of air ambulance services must submit data for each air ambulance claim and transport for the two years covered by the reporting requirements in the NSA. Information that must be reported includes:
- Identifying information for any group health plan, plan sponsor or issuer, and any entity reporting on behalf of the plan or issuer, as applicable;
- Whether the plan or coverage is a(n) individual plan, large group plan, small group plan, self-funded plan offered by a small employer, self-funded plan offered by a large employer or Federal Employees Health Benefits plan;
- Date of service;
- Billing information;
- Medical billing coding information (i.e., Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information);
- 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 (such as government-sponsored (Federal, State, county, city/township, other municipality), public-private partnership, tribally-operated program in Alaska, hospital-owned or sponsored program, hospital independent partnership (hybrid) program, independent);
- Whether the provider had a contract with the plan or issuer to furnish air ambulance services under the plan coverage, respectively;
- 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.
The Part II Rules also establish civil monetary penalties for violations of the regulatory requirements.
The air ambulance reporting requirements of the NSA are effective for two years. According to the rules, the Center for Medicaid and Medicare Services (CMS) must develop processes for determining whether a state is not substantially enforcing the Public Health Service Act (PHS Act) requirements to such requirements related to providers, facilities, and providers of air ambulance services and initiating investigations and determining that a provider, facility, or provider of air ambulance services violated the Part II Rule requirements. The NSA imposes civil monetary penalties of up to $10,000 per violation for any service providers that do not meet its requirements, i.e., failing to submit required data.
EPIC offers this material for general information only. EPIC does not intend this material to be, nor may any person receiving this information construe or rely on this material as, tax or legal advice. The matters addressed in this document and any related discussions or correspondence should be reviewed and discussed with legal counsel prior to acting or relying on these materials.
Compliance Director – Atlanta, GA