2021-19797: Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement

Summary

This document sets forth proposed rules implementing certain provisions of Title I (No Surprises Act) and Title II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021 (CAA). These proposed rules would amend and add provisions to existing rules under the Internal Revenue Code (Code), the Employee Retirement Income Security Act (ERISA), the Public Health Service Act (PHS Act), and the Federal Employees Health Benefits (FEHB) Act. These proposed rules would implement certain provisions of the No Surprises Act that would increase transparency by requiring group health plans and health insurance issuers in the group and individual markets, and FEHB carriers, to submit certain information about air ambulance services to the Secretaries of Health and Human Services (HHS), Labor, and the Treasury, and the Director of the Office of Personnel Management, as applicable, and by requiring providers of air ambulance services to submit certain information to the Secretaries of HHS and Transportation. These proposed rules also include HHS-only proposed rules that would increase transparency by requiring a health insurance issuer offering individual health insurance coverage or short-term, limited-duration insurance to disclose to policyholders and to report to HHS any direct or indirect compensation provided by the issuer to an agent or broker associated with enrolling individuals in such coverage. These proposed rules would also provide the process by which HHS would investigate complaints and potential violations of PHS Act provisions and, if warranted, take enforcement action, including the imposition of civil money penalties, against providers and facilities, including providers of air ambulance services. These proposed rules would amend existing regulations to clarify the process to investigate complaints and potential violations of the PHS Act and impose civil money penalties against plans and issuers. These proposed rules would also establish the process by which HHS would impose civil money penalties if a provider of air ambulance services fails to submit some or all required data to HHS.

The agency’s own summary, as published.

What this changes

Amends 7 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 5 CFR 890 Federal Employees Health Benefits Program
• 26 CFR 54 Pension Excise Taxes
• 29 CFR 2590 Rules and Regulations for Group Health Plans
• 45 CFR 144 Requirements Relating to Health Insurance Coverage
• 45 CFR 148 Requirements for the Individual Health Insurance Market
• 45 CFR 149 Surprise Billing and Transparency Requirements
• 45 CFR 150 CMS Enforcement in Group and Individual Insurance Markets