The Biden administration on Friday issued a proposed rule requiring marketplace and short-term, limited-duration plans to disclose whether they have a financial relationship with an agent or broker.
Plan issuers would have to report how much they paid an agent or broker during the previous year under the proposed rule. Insurers that sell group or individual market plans would also have to report more information about coverage for air ambulance services to the federal government.
The proposed rule also outlines how the Centers for Medicare and Medicaid Services would decide whether states are enforcing the new surprise billing ban for air ambulance transport. It sets up a process for CMS to go after air ambulance providers and facilities if states don't act.
"No one should avoid seeking health care for fear of receiving a surprise medical bill. 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," CMS Administrator Chiquita Brooks-LaSure said in a news release.
CMS could slap providers, facilities and air ambulance companies with fines of up to $10,000 for improper balance billing, according to a fact sheet.
Air ambulance providers would have additional reporting requirements under the proposed rule. The agency could penalize air ambulance providers up to $10,000 for failing to report the data.
"The air ambulance industry is a highly consolidated market that often leads to surprise bills for patients," Health and Human Services Secretary Xavier Becerra said in a news release. "Today's proposed rules are part of the Biden-Harris Administration's agenda to protect patients from unreasonably high costs and make health care more affordable. 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."
Regulators banned out-of-network air ambulance providers from balance billing people with private health coverage in its first rule stemming from 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 and 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," according to an HHS news release.
Congress called for federal regulators to issue such rules in the No Surprises Act and last December's end-of-year spending package.
Comments on the proposed ruled are due October 18.
