CMS requiring insurers to submit data on air ambulance services, broker compensation

Nurses and pilot carrying patient on stretcher to helicopter
Air ambulance services are a common source of surprise medical bills and now issuers must disclose data on rates and claims. (Getty/Keith Brofsky)

The Biden administration rolled out new transparency requirements for insurance brokers, short-term plans and air ambulance services, which are a common source of surprise medical bills.

The departments of Labor, Health and Human Services (HHS) and the Treasury issued a notice of proposed rule-making on late Friday that if finalized would require plans, issuers and providers for air ambulance services to give detailed data on the services. The regulations also call for data on the compensation being paid to agents and brokers that help consumers select insurance plans.

“The air ambulance industry is a highly consolidated market that often leads to surprise bills for patients,” HHS Secretary Xavier Becerra said in a statement. “These rules would allow HHS to collect data to analyze the industry’s market trends and costs and provide critical information that will address exorbitant air ambulance expenses.”

HHS said that a single air ambulance trip could cost between $36,000 to $40,000 and more than half of those trips are out-of-network for patients, leading to a surprise bill. Back in July, HHS and the departments of Treasury and Labor issued a rule that bans surprise bills for all patients and limits the patient out-of-pocket cost starting in 2022.

One of the proposed rules released Friday demands plans, issuers and air ambulance providers to submit data for each air ambulance claim and transportation for two years required in the No Surprises Act, legislation that banned surprise medical bills late last year.

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Entities that don’t meet the data submission requirements could face penalties of up to $10,000.

The proposed rule also calls for any issuer of individual market coverage or a short-term plan to disclose the enrollment, commission rates and compensation to agents or brokers associated with enrolling consumers.

“The proposed rules would also require such issuers to report to HHS the actual, total amount of direct and indirect compensation paid by the issuer to the agent and broker for the preceding year,” a fact sheet on the rule said.

The requirement comes after a 2019 investigation from ProPublica that showed insurers provide lavish gifts to sway health brokers that aid employers in choosing benefits.

The agencies are seeking comments on the regulations until Oct. 18.

The three agencies issued back in July the first in a series of regulations to implement the No Surprises Act. The regulation installed new consumer protections against surprise billing. The agencies have yet to issue regulations that set up an independent arbitration process that is triggered to settle disputes among payers and providers over out-of-network charges.