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Federal Register / Vol. 86, No. 177 / Thursday, September 16, 2021 / Proposed Rules emergency basis; revenue from subcontracted ambulance services; fees for standby events; payments from nondirect contracts such as waiver, rental, lease, and supplemental arrangements;
air medical subscriptions and ambulance or emergency medical service membership programs;
charitable donations and foundation funding; program-related investments;
receipt of local taxes earmarked for emergency medical services; contract revenues from local governments in return for air ambulance services;
enterprise funds and utility rates; sales of assets and services; bond or debt financing; state or local donation of vehicles or durable equipment; and funding grants or the provision of timelimited funding from a government entity including Federal, state, local, or other. The revenue data would enable the Secretaries of HHS and Transportation to conduct the holistic assessments required in various provisions of section 106c1 of the No Surprises Act, including with respect to the ability of providers of air ambulance services to compete on the basis of price and services in various geographic areas, these providers financial capability to serve rural areas, the relationship of the average charges for air ambulance services to business costs and market dynamics and characteristics, potential anticompetitive behaviors by providers of air ambulance services, and other factors that may affect the costs of air ambulance services.
Finally, section 106a2 of the No Surprises Act requires providers of air ambulance services to submit the following data regarding air ambulance transports: The number of transports by payor mix group health plans, health insurance issuers, state and Federal Government payors, and the uninsured;
the number of claims for air ambulance services that have been denied payment by plans or issuers and the reasons for such denials; and the number of emergent and non-emergent transports disaggregated by air ambulance base and type of aircraft. In 45 CFR 149.460b5, HHS proposes to require submission of transport-level data on air ambulance services in order to satisfy these statutory reporting requirements, as well as to collect the data necessary to enable HHS, in consultation with the Secretary of Transportation, to conduct the assessments required in section 106c of the No Surprises Act.
The transport-level data elements in addition to those specifically identified in section 106a of the No Surprises Act that HHS proposes to collect from providers of air ambulance services
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include: Date of service; billing NPI and CPT/HCPCS codes information; and certain information about the transport such as the air ambulance base, flight duration, loaded miles, pick-up origin and drop-off destination locations and the point of ambulance pick-up zip code, and whether the transport was a scene response patient transport, interfacility patient transport, or other transport such as organ, medical personnel, or medical supplies transport. These data elements would enable the Secretaries of HHS and Transportation to identify, combine, and validate the information collected from plans and issuers, and the information collected from providers of air ambulance services, as well as evaluate potential gaps in rural access.
Consistent with the requirements in section 106a of the No Surprises Act and to enable HHS to combine and validate the information collected from providers of air ambulance services under these proposed rules with air ambulance data from other sources, as well as to enable HHS to assess abusive patient collection practices across various payors as required in section 106c1I of the No Surprises Act, HHS proposes requiring identification of the primary payor type for each transport, such as Medicare fee-forservice FFS, Medicare Advantage, Medicaid, Veterans Health Administration, TRICARE, Indian Health Service, group health plan, health insurance issuer, FEHB plan, Workers Compensation, patient costsharing, and patient self-pay. Further, to satisfy the requirements for the comprehensive public report described in section 106c of the No Surprises Act, HHS proposes that the transportlevel data elements should include information regarding the contractual arrangement with the plan or issuer, if applicable, to furnish air ambulance services under the plan or coverage, respectively, to support the assessment required in section 106c1F of the No Surprises Act, as well as the payment methodology for the transport such as the base rate, mileage, and intervention or other charges, if applicable, as recommended by experts.
For the same reasons, HHS proposes that the transport-level data elements should also include: Certain claim adjudication information including whether the claim was paid, denied, or appealed, and the reason for the denial or the outcome of the appeal, if applicable to support the data collection and analyses required in sections 106a2E and c1J of the No Surprises Act; certain payment
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information including submitted charges, amounts paid by the payor not including the patient, and cost-sharing amount if applicable to support the assessment required in section 106c1C of the No Surprises Act; the amount billed to the patient, the amount collected from the patient, and whether the bill was referred for collection, including lawsuits, liens, or wage garnishment actions to support the assessments required in section 106c1G and c1I of the No Surprises Act; and information on any payments from sources other than the primary payor, such as membership fees and state or municipal subsidies to support the analyses required in section 106c1B, c1H, and c1K of the No Surprises Act.
In order to protect stakeholder and consumer privacy, particularly when collecting transport-level data, HHS
would take precautions to protect the confidentiality of transport-level data.
HHS proposes to collect only that transport-level data that would be sufficient for producing the comprehensive report required by the statute. HHS intends to collect and maintain the information using information technology IT systems that are designed to meet all of the security standard protocols established under Federal law or by HHS relevant to such information.
HHS is publishing the proposed information collection for public comment at the same time as or shortly after these proposed rules. The proposed information collection would include a proposed data template and instructions.
HHS seeks comment on the use of the calendar year as the reporting period, including the time it typically takes payors to fully adjudicate and pay claims for air ambulance services furnished by either participating or nonparticipating providers of air ambulance services, the proposed data elements described in this section of the preamble, the appropriate levels for reporting of these data elements regional/corporate, base, transport, and potential challenges that providers of air ambulance services may face in reporting the proposed data elements, including any special considerations for the reporting of the proposed data elements with respect to municipality and other government-owned or sponsored providers of air ambulance services. HHS also seeks comment on the potential format for reporting the data.

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