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Federal Register / Vol. 86, No. 177 / Thursday, September 16, 2021 / Proposed Rules including Federal, State, local, or other.
5 Transport information. The following information must be reported separately for each air ambulance transport provided during the reporting period:
i Date of service.
ii Billing NPI information.
iii Current Procedural Terminology CPT code or Healthcare Common Procedure Coding System HCPCS code information.
iv Air ambulance base.
v Loaded miles.
vi Pick-up origin zip code and drop-off destination zip code locations.
vii Duration of flight.
viii Whether the transport was emergent or non-emergent.
ix Whether the transport was a scene response, inter-facility, or other transport;
x Primary payor information, including payor type such as Medicare FFS, Medicare Advantage, Medicaid, Veterans Health Administration, TRICARE, Indian Health Service, group health plan, health insurance issuer, Federal Employees Health Benefits plan, Workers Compensation, patient costsharing, or patient self-pay.
xi Information regarding any contracts the provider has with the group health plan or health insurance issuer, if and as applicable, to provide air ambulance services under the plan or coverage, respectively.
xii Payment methodology such as base rate, mileage, and intervention or other charges, if applicable.
xiii Claim adjudication information, including whether the claim was paid, denied, appealed, denial reason, and appeal outcome, if applicable.
xiv Claim/transport payment information, including submitted charges, amount paid by payor other than patient, cost-sharing amount if applicable, amount billed to patient, amount collected from patient, whether the bill was referred to collections, and payments from sources other than the primary payor.
PART 150CMS ENFORCEMENT OF
GROUP AND INDIVIDUAL INSURANCE
MARKET, AND PROVIDER AND
FACILITY REQUIREMENTS
19. The authority citation for part 150
is revised to read as follows:

Authority: 42 U.S.C. 300gg through 300gg 63, 300gg91, 300gg92, 300gg118, and 300gg134, as amended.

20. The heading for part 150 is revised to read as set forth above.
21. Section 150.101 is amended by revising paragraphs a and b2 and

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adding paragraph b3 to read as follows:
150.101

Basis and scope.

a Basis. This part implements CMSs enforcement authority under sections 2723, 2761, and 2799B4 of the PHS
Act, as well as section 106e of the No Surprises Act Pub. L. 116260, 134
Stat. 2852.
b
2 Enforcement with respect to health insurance issuers. The States have primary enforcement authority with respect to the requirements of Title XXVII of the PHS Act that apply to health insurance issuers offering coverage in the group or individual health insurance market. If CMS
determines under subpart B of this part that a State is not substantially enforcing Title XXVII of the PHS Act, including the implementing regulations in parts 146, 147, 148, and 149 of this subchapter, CMS enforces them under subpart C of this part.
3 Enforcement with respect to providers and facilities. The States have primary enforcement authority with respect to the requirements of Part E of Title XXVII of the PHS Act that apply to providers and facilities. If CMS
determines under subpart B of this part that a State is not substantially enforcing Part E of Title XXVII of the PHS Act, and its implementing regulations in part 149 of this subchapter, CMS enforces them under subpart E of this part. CMS has primary enforcement authority with respect to the provisions of section 106a of the No Surprises Act, including the implementing regulations in part 149 of this subchapter, which CMS enforces under subpart E of this part.
22. Section 150.103 is amended by a. Revising the introductory text;
b. Adding the definition of Facility in alphabetical order;
c. In the definition of Individual health insurance policy or individual policy, revising the introductory text and paragraph 2;
d. Revising the definition of PHS Act requirements; and e. Adding the definitions Provider in alphabetical order.
The revisions and additions read as follows:
150.103

Definitions.

The definitions that appear in parts 144 and 149 of this subchapter apply to this part unless stated otherwise. As used in this part:

Facility means a health care facility, an emergency department of a hospital, and an independent freestanding
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emergency department, as those terms are defined in 149.30 of this subchapter, and any other facility subject to the requirements in Part E of Title XXVII of the PHS Act.

Individual health insurance policy or individual policy means the legal document or contract issued by an issuer to an individual that contains the conditions and terms of the insurance.
Any association or trust arrangement that is not a group health plan as defined in 144.103 of this subchapter or does not provide coverage in connection with one or more group health plans is individual health insurance coverage subject to the requirements of parts 147, 148, and 149
of this subchapter. The term individual health insurance policy includes a policy that is

2 Administered, or placed in a trust, and is not sold in connection with a group health plan subject to the provisions of parts 146, 147, and 149 of this subchapter.
PHS Act requirements means the requirements of Title XXVII of the PHS
Act and its implementing regulations in parts 146, 147, 148, and 149 of this subchapter.

Provider means a physician or other health care provider as defined in 149.30 of this subchapter, and a provider of air ambulance services as defined in 149.30 of this subchapter.

23. Revise the heading for subpart B
to read as follows:
Subpart BCMS Enforcement Processes for Determining Whether States Are Failing to Substantially Enforce PHS Act Requirements 24. Section 150.201 is revised to read as follows:

150.201

State enforcement.

Except as provided in subparts C and E of this part, each State enforces PHS
Act requirements with respect to health insurance issuers that issue, sell, renew, or offer health insurance coverage in the State and with respect to providers and facilities that furnish items or services to individuals in the State.
25. Section 150.203 is amended by revising the introductory text to read as follows:
150.203 Circumstances requiring CMS
enforcement.

CMS enforces PHS Act requirements to the extent warranted as determined
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