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Federal Register / Vol. 86, No. 177 / Thursday, September 16, 2021 / Proposed Rules
OFFICE OF PERSONNEL
MANAGEMENT
5 CFR Part 890
RIN 3206AO28

DEPARTMENT OF THE TREASURY
Internal Revenue Service 26 CFR Part 54
REG11467621
RIN 1545BQ15

DEPARTMENT OF LABOR
Employee Benefits Security Administration 29 CFR Part 2590
RIN 1210AC08

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
45 CFR Parts 144, 148, 149, and 150
CMS9907P
RIN 0938AU61

Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement Office of Personnel Management; Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Centers for Medicare & Medicaid Services, Department of Health and Human Services.
ACTION: Proposed rules.
AGENCY:

This document sets forth proposed rules implementing certain provisions of Title I No Surprises Act and Title II Transparency of Division BB of the Consolidated Appropriations Act, 2021 CAA. These proposed rules would amend and add provisions to existing rules under the Internal Revenue Code Code, the Employee Retirement Income Security Act ERISA, the Public Health Service Act PHS Act, and the Federal Employees Health Benefits FEHB Act. These proposed rules would implement certain provisions of the No Surprises Act that would increase transparency by requiring group health plans and health insurance issuers in the group and individual markets, and FEHB carriers, to submit certain information about air ambulance services to the Secretaries of Health and Human Services HHS,
SUMMARY:

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Labor, and the Treasury, and the Director of the Office of Personnel Management, as applicable, and by requiring providers of air ambulance services to submit certain information to the Secretaries of HHS and Transportation. These proposed rules also include HHS-only proposed rules that would increase transparency by requiring a health insurance issuer offering individual health insurance coverage or short-term, limited-duration insurance to disclose to policyholders and to report to HHS any direct or indirect compensation provided by the issuer to an agent or broker associated with enrolling individuals in such coverage. These proposed rules would also provide the process by which HHS
would investigate complaints and potential violations of PHS Act provisions and, if warranted, take enforcement action, including the imposition of civil money penalties, against providers and facilities, including providers of air ambulance services. These proposed rules would amend existing regulations to clarify the process to investigate complaints and potential violations of the PHS Act and impose civil money penalties against plans and issuers. These proposed rules would also establish the process by which HHS would impose civil money penalties if a provider of air ambulance services fails to submit some or all required data to HHS.
DATES: To be assured consideration, comments must be received at one of the addresses provided below, by October 18, 2021.
ADDRESSES: In commenting, please refer to file code CMS9907P.
Comments, including mass comment submissions, must be submitted in one of the following three ways please choose only one of the ways listed:
1. Electronically. You may submit electronic comments on this regulation to https www.regulations.gov. Follow the Submit a comment instructions.
2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS9907P, P.O. Box 8016, Baltimore, MD 212448016.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS9907P, Mail
PO 00000

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Stop C42605, 7500 Security Boulevard, Baltimore, MD 212441850.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: For matters related to air ambulance reporting: Padma Babubhai Shah, Office of Personnel Management, 202 606
4056; Kari DiCecco, Internal Revenue Service, Department of the Treasury, 202 3175500; Matthew Meidell or Pinar Shapiro, Employee Benefits Security Administration, Department of Labor, 202 6938335; Christina Whitefield, Centers for Medicare &
Medicaid Services, Department of Health and Human Services, 301 492
4172. For matters related to agent and broker disclosures under Part 148:
Adam Wheeler, 410 7863942.
For matters related to enforcement under Part 150: Judah Katz, 410 786
3879 or Lisa Cuozzo, 410 7861746.
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: Comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post comments received before the close of the comment period on the following website as soon as possible after they have been received:
https www.regulations.gov. Follow the search instructions on that website to view public comments. The Centers for Medicare & Medicaid Services CMS
will not post on Regulations.gov public comments that make threats to individuals or institutions or suggest that the individual will take actions to harm the individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments.
I. Background A. Legislative and Regulatory Overview Title I of the Health Insurance Portability and Accountability Act of 1996 HIPAA added Title XXVII to the Public Health Service Act PHS Act to establish various reforms to the group and individual health insurance markets. The Patient Protection and Affordable Care Act, Public Law 111
148, was enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, Public Law 111152, was enacted on March 30, 2010. These statutes are collectively known as the Affordable Care Act or ACA. The ACA reorganized,
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