Quiero saber acerca de...

Federal Register / Vol. 86, No. 177 / Thursday, September 16, 2021 / Proposed Rules duration insurance effective during the preceding calendar year.
4 Reporting deadline. The report required under this paragraph d for a specific calendar year must be submitted to HHS no later than the last business day of July of the calendar year following the applicable reporting period.
e Applicability. The requirements of this section apply with respect to contracts executed on or after December 27, 2021, between an agent or broker and a health insurance issuer offering individual health insurance coverage or short-term, limited-duration insurance, as applicable. For the purpose of determining the date of contract execution, the execution of contractual addenda or revisions to the material terms of a pre-existing contract is deemed the execution of a new contract.
PART 149SURPRISE BILLING AND
TRANSPARENCY REQUIREMENTS
13. The authority citation for part 149
continues to read as follows:

Authority: 42 U.S.C. 300gg111 through 300gg139, as amended.

14. Section 149.10 is amended by revising paragraph a to read as follows:

149.10

Basis and scope.

a Basis. This part implements Parts D and E of Title XXVII of the PHS Act, as well as section 106a of the No Surprises Act Pub. L. 116260, 134
Stat. 2852.

15. Section 149.20 is amended by revising paragraph a1 to read as follows:
149.20

Applicability.

a
1 The requirements in subparts B, C, and D of this part apply to group health plans and health insurance issuers offering group or individual health insurance coverage including grandfathered health plans as defined in 147.140 of this subchapter, except as specified in paragraph b of this section.

16. Section 149.30 is amended by adding the definitions of Air ambulance base and National Provider Identifier NPI in alphabetical order to read as follows:
149.30

Definitions.

Air ambulance base means a site from which a provider of air ambulance services operates to provide air ambulance services.

VerDate Sep<11>2014

16:57 Sep 15, 2021

Jkt 253001

National Provider Identifier NPI has the meaning given in 45 CFR 162.406.

17. Add subpart C to read as follows:
Subpart CTransparency and Reporting Requirements for the Group and Individual Health Insurance Markets Sec.
149.210149.220 Reserved 149.230 Reporting requirements regarding air ambulance services for plans and issuers.
149.210149.220

Reserved
149.230 Reporting requirements regarding air ambulance services for plans and issuers.

a Reporting requirements1
General requirements. A group health plan or health insurance issuer offering group or individual health insurance coverage must submit to the Secretary a report that includes the information described in paragraph b of this section for calendar years 2022 and 2023.
2 Timing and form of report. The reports reflecting the data for each of the 2022 and 2023 calendar year reporting periods must be submitted to the Secretary by March 31, 2023, and by March 30, 2024, respectively, in the form and manner prescribed by the Secretary in guidance. The report must include data relevant to services furnished within the reporting period as well as data relevant to services for which payments were made within the reporting period.
3 Transfer of business. A health insurance issuer offering group or individual health insurance coverage that acquires a line or block of business from another issuer offering group or individual health insurance coverage must submit the information required in paragraph b of this section on behalf of the acquired business, for the entire calendar year during which the acquisition took place. The reporting requirement in this paragraph a3 also applies to the selling and acquiring issuers if a sale or transfer occurs as a result of issuers being merged, combined, spun off, affected by, or engaging in any similar transaction during a calendar year. To ensure completeness and timeliness of reporting of all relevant air ambulance services data, the Secretary may provide in guidance additional examples of what constitutes a transfer or acquisition for purposes of this paragraph a3.
b Required data elements. The report required in paragraph a of this
PO 00000

Frm 00043

Fmt 4701

Sfmt 4702

51771

section must include the following data elements with respect to air ambulance services provided under a group health plan or group or individual health insurance coverage to participants, beneficiaries, or enrollees during the relevant reporting period, for each claim for air ambulance services that was received or paid for during the reporting period:
1 Identifying information for any group health plan, plan sponsor, or issuer, and any entity reporting on behalf of the plan or issuer, as applicable.
2 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.
3 Date of service.
4 Billing NPI information.
5 Current Procedural Terminology CPT code or Healthcare Common Procedure Coding System HCPCS code information.
6 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, independent.
7 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.
8 Claim adjudication information, including whether the claim was paid, denied, appealed; denial reason; and appeal outcome.
9 Claim payment information, including submitted charges, amounts paid by each payor, and cost sharing amount, if applicable.
c Special rules to prevent unnecessary duplication1 Special rule for insured group health plans. To the extent coverage under a group health plan consists of group health insurance coverage, the plan satisfies the requirements of paragraph a of this section if the plan requires the health insurance issuer offering the coverage to report the information required by this section pursuant to a written agreement.

E:FRFM16SEP2.SGM

16SEP2