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Federal Register / Vol. 86, No. 131 / Tuesday, July 13, 2021 / Rules and Regulations department of a hospital or independent freestanding emergency department, the provider satisfies the requirements of paragraphs c2 and 3 of this section if the facility makes the information available, in the required form and manner, pursuant to a written agreement. Accordingly, if a provider and facility enter into a written agreement under which the facility agrees to make the information required under this section available on a sign posted prominently at the facility and to provide the one-page notice to individuals in compliance with this section, and the facility fails to do so, then the facility, but not the provider, violates the disclosure requirements of this section.
g Applicability date. The provisions of this section are applicable beginning on January 1, 2022.
149.440 Balance billing in cases of air ambulance services.

a In general. In the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer who is furnished air ambulance services for which benefits are available under such plan or coverage from a nonparticipating provider of air ambulance services, with respect to such plan or coverage, the provider must not bill, and must not hold liable, the participant, beneficiary, or enrollee for a payment amount for the air ambulance services furnished by the provider that is more than the costsharing amount for such service as determined in accordance with 26 CFR
54.98171Tb1 and 2, 29 CFR
2590.7171b1 and 2, and 149.130b1 and 2, as applicable.
b Applicability date. The provisions of this section are applicable with respect to air ambulance services furnished during a plan year in the individual market, policy year beginning on or after January 1, 2022.

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149.450 Complaint process for balance billing regarding providers and facilities.

a Scope and definitions1 Scope.
This section establishes a process for HHS to receive and resolve complaints regarding information that a health care provider, provider of air ambulance services, or health care facility may be failing to meet the requirements under subpart E of this part, which may warrant an investigation.
2 Definitions. In this section i Complaint means a communication, written, or oral, that
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indicates there has been a potential violation of the requirements under this subpart, whether or not a violation actually occurred.
ii Complainant means any individual, or their authorized representative, who files a complaint as defined in paragraph a2i of this section.
b Complaints process. 1 HHS will consider the date a complaint is filed to be the date upon which HHS receives an oral, written, or electronic statement that identifies information about the complaint sufficient to identify the parties involved and the action or inaction complained of.
2 HHS will notify complainants, by oral or written means, of receipt of the complaint no later than 60 business days after the complaint is received.
HHS will include a response acknowledging receipt of the complaint, notifying the complainant of their rights and obligations under the complaints process, and describing the next steps of the complaints resolution process. HHS
may request additional information that may be needed to process the complaint as part of the response. Such additional information may include:
i Health care provider, air ambulance provider, or health care facility bills;
ii Health care provider, air ambulance provider, or health care facility network status;
iii Information regarding the participants, beneficiarys, or enrollees health care plan or health insurance coverage;
iv Information to support a determination regarding whether the service was an emergency service or non-emergency service;
v Documents regarding the facts in the complaint in the possession of, or otherwise attainable by, the complainant; or vi Any other information HHS needs to make a determination of facts for an investigation.
3 HHS will make reasonable efforts consistent with agency practices to notify the complainant of the outcome of the complaint after the submission is processed through appropriate methods as determined by HHS. A complaint is considered processed after HHS has reviewed the complaint and accompanying information and made an outcome determination. Based on the nature of the complaint, HHS may i Refer the complainant to another appropriate Federal or State resolution process;

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ii Notify the complainant and make reasonable efforts to refer the complainant to the appropriate State or Federal regulatory authority if HHS
receives a complaint where another entity has enforcement jurisdiction over the health care provider, air ambulance provider or health care facility;
iii Refer the health care provider, air ambulance provider or health care facility for an investigation for enforcement action under 45 CFR part 150; or iv Provide the complainant with an explanation of resolution and any corrective action taken.
PART 156HEALTH INSURANCE
ISSUER STANDARDS UNDER THE
AFFORDABLE CARE ACT, INCLUDING
STANDARDS RELATED TO
EXCHANGES
19. The authority citation for part 156
continues to read as follows:

Authority: 42 U.S.C. 1802118024, 18031
18032, 1804118042, 18044, 18054, 18061, 18063, 18071, 18082, and 26 U.S.C. 36B.

20. Section 156.155 is amended by:
a. Revising paragraph a3;
b. Redesignating paragraph c as paragraph d; and c. Adding a new paragraph c.
The revision and addition read as follows:

156.155
plans.

Enrollment in catastrophic
a
3 Provides coverage of the essential health benefits under section 1302b of the Affordable Care Act, except that the plan provides no benefits for any plan year except as provided in paragraphs a4, b, and c of this section until the annual limitation on cost sharing in section 1302c1 of the Affordable Care Act is reached.

c Coverage to prevent surprise medical bills. A catastrophic plan must provide benefits as required under sections 2799A1 and 2799A2 of the Public Health Service Act and their implementing regulations in 149.110, 149.120, and 149.130 or any applicable State law providing similar protections to individuals, and will not violate paragraph a3 of this section solely because of the provision of such benefits before the annual limitation on cost sharing is reached.

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