Comply With Us

The Employer Reporting Requirement (Almost) Everyone Forgot

February 16, 2023

Recently, we were talking about our to-do lists and had a slight panic attack. We were positive we forgot a critical new group benefit plan reporting requirement, but we couldn’t remember all the details (which was terrifying because one of our mottos is “details matter”). A quick review of our trusty notebooks and the Google machine cleared things up. We didn’t forget anything, exactly. Or, at least we didn’t forget anything that the federal government hadn’t also forgotten.

The Consolidated Appropriations Act of 2021 (CAA21) requires group health plan sponsors and health insurance issuers to report information about air ambulance claims incurred during 2022 and 2023 to federal regulators. A proposed rule issued by the federal Departments of Health and Human Services, Labor, and Treasury on September 16, 2021 suggested that reporting on 2022 calendar year data would be due on March 31, 2023 (or, in approximately six weeks), and 2023 data would be due on March 31, 2024. However, to-date, this regulation has not been finalized. More importantly, none of the federal Departments issuing the proposed regulation have taken any outwardly facing action to: 

  1. Tell anyone that they plan to go with their original end-of-March due date; 
  2. Develop any type of final reporting instructions or other information a group plan sponsor, health insurance carrier, third-party claims administrator (TPA), or any other health plan service provider could use to collect and prepare their data properly; or 
  3. Build any type of reporting form or electronic system for any issuer, plan sponsor, or vendor acting on their behalf to deliver the required data.  

As a reminder, the proposed rule specifies that the following data elements must reported:

  • Identifying information for any group health plan, plan sponsor, or issuer, and any entity reporting on behalf of the plan or issuer, as applicable;
  • 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);
  • Date of service;
  • Billing National Provider Identifier (NPI) information;
  • 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 municipal), public-private partnership, tribally-operated program in Alaska, hospital-owned or sponsored program, hospital independent partnership (hybrid) program, or independent;
  • 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;
  • Claim adjudication information, including whether the claim was paid, denied, appealed, denial reason, and appeal outcome; and
  • Claim payment information, including submitted charges, amounts paid by each payor, and cost sharing amount, if applicable.

So, where does that leave us, friends? Can we just continue to “forget” about air ambulance claims reporting and hope that our federal friends have added finalizing this regulation and nailing down reporting details somewhere below issuing a rule to define “church plans” on their list of priorities? We wish we could say yes, friends, carry on as if this pesky air ambulance thing never happened. But honestly, we’re not sure that’s a good idea. While we believe that the proposed March 31, 2023 deadline will not be the real date for the submission of 2022 claims data, it is unlikely that this requirement will languish unresolved for years and years.

The Departments claim that they’ll be publishing a final regulation “soon.” We know the publication is not immediately imminent because the proposal is not on the Office of Management and Budget’s regulatory review dashboard, the final place measures like this go before they’re issued publicly. We also know that sometimes, “soon” in federal regulatory parlance translates to “many months and possibly many years from now,” but more often it means “within the next couple of months.” “Soon” also frequently translates to “at 4:30pm the day before the next upcoming major holiday,” and we note both Presidents’ Day and Mardi Gras are right around the corner!

To be prudent, while we are waiting, plan sponsors should review the list of items that the proposed rule would require them to report and determine: 

  1. Does the Plan have access to these data elements? 
  2. If not, who does and how could the Plan get access to that data? 
  3. If a TPA and/or issuer has most of this data (a very likely scenario), will that service provider be able to help the Plan prepare and submit their reports when ultimately required? 
  4. Is assisting with air ambulance claims data reporting part of the Plan’s service agreement with their TPA and/or issuer? If not, can the Plan get that added to the list of service agreement changes they need to be negotiating/adopting with their vendors in order to comply with all of the other new Plan obligations mandated by the CAA21?
  5. Would it be possible to pull together all or most of the 2022 data specified in the proposed rule soonish, so the Plan will have something to work with if and when the federal government gets its act together? 

Meanwhile, we are here friends, patiently checking in with regulators and federal dashboards for you, poised to tell you the moment our other besties at HHS, Treasury and Labor are ready with specific deadlines and instructions on when, where, and how to get that air ambulance claims data into them to review!