By: Jessica Waltman – Principal, Forward Health Consulting
On Thursday, September 9, the Biden Administration released a new COVID-19 Action Plan. The plan states that the Occupational Safety and Health Administration will be issuing a rule requiring all private businesses with 100 or more employees to ensure their employees are fully vaccinated or produce a negative COVID-19 test weekly. The plan also indicates that any health care organization receiving funding from CMS and all federal contractors will be required to ensure their employees are fully vaccinated to retain their federal funding. However, the Administration still needs to issue the actual rules effectuating the changes.
We are carefully monitoring the situation and will provide you with additional information when it becomes available.
In other news…
On Friday, September 10, the Departments of Health and Human Services, Labor, and Treasury issued proposed rules laying out their plans for implementing specific provisions of the No Surprises Act. This Act, which is part of the Consolidated Appropriations Act of 2021, includes the national prohibition on surprise billing, new transparency requirements for health plans, a mandate that health plans analyze how they comply with the Mental Health Parity and Addiction Equity Act, and more.
Last Friday’s guidance concerns two less-known reporting requirements: (1) related to air ambulances and (2) related to broker compensation in the individual health insurance market.
Air Ambulance Reporting
The No Surprises Act’s prohibition on balance billing does not extend to air ambulance expenses. Instead, the Act seeks additional information on air ambulance usages, cost, etc., to facilitate a report from HHS (with the help of the Department of Transportation) to Congress on the widespread concerns surrounding air ambulances expenses. Under the Act, health plans (including employer-sponsored self-funded and fully insured plans) must report to the Administration on air ambulance claims.
The proposed rules require these reports on a calendar year basis (even for non-calendar year plans) for 2022 and 2023. They will need to include the following data elements for each air ambulance claim received or paid for during the applicable year:
- Information identifying the plan, plan sponsor, and carrier or reporting entity, as applicable;
- The plan’s market category (i.e., small group, large group, self-funded, etc.);
- Date of service;
- National Provider Identification information for the billing entity;
- The CPT Code or HCPCS Code;
- Transport information (including aircraft type, loaded miles, pick-up, and drop-off, whether transportation was emergent, etc.)
- Whether the plan had a contract with the air ambulance provider;
- Claims adjudication information (including if denied, the reason for such a denial); and
- Claims payment information (including submitted charges, amounts paid, and cost-sharing amount, if applicable).
Presumably, claims payors will handle much of this reporting rather than employers. However, plan sponsors do have responsibilities related to these requirements.
- For fully insured plans: The health insurance issuer can assume responsibility for this reporting (as they also have an independent obligation to complete the reporting). However, to avoid liability if an insurer fails to do so, the plan sponsor should ensure that their carrier contract expressly addresses how the insurer will assume responsibility for this requirement.
- For self–funded plans: The plan sponsor can contract with a TPA to provide this reporting. However, if the TPA fails to meet its contractual obligations, the group plan will be in violation of the reporting requirement.
Compensation Disclosure in the Individual Health Insurance Market
The proposed rules also provide additional details about the requirement that individual market health insurance carriers give their policyholders information about compensation paid to insurance agents and brokers. These rules apply to both major medical policies and short-term limited-duration policies, and carriers will need to report both direct and indirect compensation paid to brokers and agents. The insurance carrier must disclose this information before the point of purchase and annually at renewal (either in renewal paperwork or, if none, as part of the first bill for the new policy year). This requirement will apply to new contracts (or revisions to material terms to existing contracts) with brokers or agents entered into on or after December 27, 2021.
Notably, the proposed regulations do not address the similar but more extensive compensation disclosure requirements for brokers and other consultants who serve group health plans. These requirements are scheduled to go into effect for contracts between advisors and plans entered into or renewed on or after December 27, 2021. The No Surprises Act does not require the development of regulations on the group plan disclosure requirements. It is unclear if the Biden Administration will publish any implementation rules or sub-regulatory guidance this fall.