Certain insurers required to disclose payment to agents or brokers under proposed rule
Surprise bills due to out-of-network air ambulance services would be banned and out-of-pocket costs limited.
Photo: Keith Brofsky/Getty images
The Department of Health and Human Services, the Department of Labor and the Department of the Treasury, along with the Office of Personnel Management, have released a proposed rule requiring certain health insurers to inform consumers of how agents or brokers who assist consumers with enrollment in individual coverage and short-term, limited-duration insurance are compensated, including both direct and indirect compensation provided for such enrollment.
The proposed rule also bans surprise bills for patients who use out-of-network air ambulance services and limits the amount they pay out-of-pocket starting next year.
It would also require plans, issuers and providers of air ambulance services to submit detailed data regarding air ambulance services specified in the reporting requirements of the No Surprises Act. The data collected on air ambulance services would shed light on the other unknown or less known costs associated with air ambulance services. It would be used in a comprehensive, publicly-available HHS and Department of Transportation report to increase transparency and help inform future policy development aimed at addressing these costs.
WHY THIS MATTERS
The proposals are to help consumers understand the compensation being paid to agents and brokers who help them select health insurance.
It is to avoid surprise bills by air ambulance services and to allow HHS to collect data on these expenses.
The median cost for air ambulance transportation ranges from over $36,000 to $40,000, according to CMS.
Air ambulance providers are not allowed to send surprise bills to Medicaid or Medicare patients. For patients with private insurance, however, an HHS Assistant Secretary of Planning and Evaluation report estimates that over 50% percent of air ambulance trips are out-of-network, resulting in surprise billing.
"The air ambulance industry is a highly consolidated market that often leads to surprise bills for patients," said Health and Human Services Secretary Xavier Becerra. "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."
The proposed rule also details the process that the Centers for Medicare and Medicaid Services would use to determine if states are substantially enforcing new surprise billing and other consumer protections.
These proposed rules would ensure CMS can take action against providers and facilities to further protect consumers from surprise bills in states that fail to substantially enforce these requirements.
Comments are being taken until October 18.
THE LARGER TREND
This is the latest regulatory action in a series of rulemaking implementing the No Surprises Act.
Out of that legislation, HHS issued an interim final rule banning surprise medical bills and some out-of-network charges that will go into effect on January 1, 2022.
ON THE RECORD
"No one should avoid seeking healthcare for fear of receiving a surprise medical bill," said CMS Administrator Chiquita Brooks-LaSure. "The new consumer protections released today are critical to shielding consumers from the devastating financial impacts that may occur as a result of an unlawful surprise bill, and CMS is committed to vigorous enforcement of these protections."
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
