- The Biden administration on Friday proposed rules aimed at consumer protection and transparency, one of which would require marketplace and short-term, limited-duration health plans to disclose their financial relationships with an agent or broker.
- The rule, if finalized, would require plans to report how much they paid to an agent or broker during the previous year, while another requires insurers and providers of air ambulance services to disclose detailed information about air ambulance services.
- Another regulation outlines how CMS will determine whether states are fully enforcing new consumer protections against surprise billing, to make sure the government can hold providers accountable in states that aren't compliant. It's the latest regulatory action from Washington to implement the No Surprises Act passed last year, which prohibits surprise out-of-network billing beginning next year, among other healthcare consumer protections.
The proposed rules from HHS aim to increase transparency by requiring issuers offering individual health insurance coverage or short-term, limited-duration plans to disclose to consumers — before they select a plan, and when they confirm enrollment — the commission rates and compensation structure paid by the issuer to any agent or broker associated with enrolling that person.
It would also require those issuers to report to HHS the total amount of direct and indirect compensation paid to agents and brokers for the proceeding year, aiming to throw additional light on a relatively opaque area of health spending.
In the first rule implementing the No Surprises Act passed in July, the government banned out-of-network air ambulance providers from balance billing privately insured patients.
The new rule proposed Friday sets up a process for CMS to enforce the surprise billing ban for air ambulance transport if states don't act. If finalized, it would allow CMS to fine providers, facilities and air ambulance companies up to $10,000 for improper balance billing, per a fact sheet on the proposed rule.
"No one should avoid seeking health care for fear of receiving a surprise medical bill," CMS Administrator Chiquita Brooks-LaSure said in a statement.
The No Surprises Act also requires providers to submit detailed data to HHS, including data on transportation and medical costs, air ambulance bases and aircraft, payer data and data on claims denials. The new rule adds additional reporting requirements for air ambulance providers, and allows HHS to fine them up to $10,000 for failing to report said data.
"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 on the rules, which he said should allow the government to collect data to analyze market trends and costs in the industry and eventually address "exorbitant air ambulance expenses" in the U.S.
The median cost for air ambulance transportation ranges from roughly $36,000 to $40,000, according to HHS. Providers aren't allowed to send surprise bills to Medicaid or Medicare patients, but government reports estimate more than half of air ambulance trips are out-of-network for patients with private insurance.
HHS and the Department of Transportation plan to use the data collected on air ambulance services to create a report with the goals of increasing market transparency and informing future policymaking, as mandated by the No Surprises Act.
Comments on the proposed rules are due Oct. 18.