18. Section 149.460 is added to read as follows:
(a) Reporting requirements—(1) General requirements. A provider of air ambulance services must submit to the Secretary a report which includes the information described in paragraph (b) of this section for calendar years 2022 and 2023.
(2) Timing and form of report. The reports reflecting the data for each of the 2022 and 2023 calendar year reporting periods must be submitted to the Secretary by March 31, 2023, and by March 30, 2024, respectively, in the form and manner prescribed by the Secretary in guidance. The report must include data relevant to services furnished within the reporting period as well as data relevant to services for which payments were made within the reporting period.
(3) Transfer of business. A provider of air ambulance services that acquires a line or block of business from another provider of air ambulance services must submit the information required in paragraph (b) of this section on behalf of the acquired business, for the entire calendar year during which the acquisition took place. The reporting requirement in this paragraph (a)(3) also applies to the selling and acquiring providers of air ambulance services if a sale or transfer occurs as a result of providers of air ambulance services being merged, combined, spun off, affected by, or engaging in any similar transaction during a calendar year. To ensure completeness and timeliness of reporting of all relevant air ambulance services data, the Secretary may provide in guidance additional examples of what constitutes a transfer or acquisition for purposes of this paragraph (a)(3).
(b) Required data elements. The report required in paragraph (a) of this section must include the following data:
(1) Corporate information. Each provider of air ambulance services must report the following information about their company or organization:
(i) Identifying information for the company or organization.
(ii) Identifying information for the parent organization, owner, other proprietor, or sponsor of the provider of air ambulance services.
(iii) Information on all air ambulance bases owned, leased, operated, or used by the provider of air ambulance services.
(iv) NPIs registered to the provider of air ambulance services.
(2) Air ambulance base information. The following information must be reported separately for each air ambulance base owned, leased, or operated by the provider of air ambulance services:
(i) Location (City and State of the air ambulance base).
(ii) NPIs associated with the base.
(iii) Number, type, and other characteristics of the aircraft located on the base;
(iv) The number and type of staff.
(v) The number and type of air ambulance responses and transports per aircraft.
(vi) Total air ambulance responses per base and total air ambulance responses that did not result in transports.
(vii) Information regarding any contracts the provider has with group health plans or health insurance issuers to furnish air ambulance services associated with the base.
(viii) Air medical subscriptions or ambulance/emergency medical service membership programs associated with the base.
(ix) Non-direct payor contracts (such as waiver, rental, lease, or supplemental arrangements) with group health plans, health insurance issuers, or other entities, such as third-party administrators or provider networks, associated with the base.
(x) Service delivery model(s) (such as government-sponsored (Federal, State, county, city/township, other municipal), public-private partnership, tribally-operated program in Alaska, hospital-owned or sponsored program, hospital independent partnership (hybrid) program, independent), and whether the base shares operational costs with affiliated or sponsor organizations (such as a hospital or municipality), if applicable.
(xi) Whether the base operates ground ambulance services as well as air ambulance services.
(3) Cost information. The following information must be reported separately for each air ambulance base described in paragraph (b)(2) of this section, as well as at the regional or corporate level, if applicable:
(i) Labor costs.
(ii) Facility costs.
(iii) Vehicle costs.
(iv) Equipment and supplies costs.
(v) Vendor costs.
(vi) Overhead costs (including administrative and general expenses, insurance costs, and training costs).
(4) Revenue information. The following information must be reported separately for each air ambulance base described in paragraph (b)(2) of this section, as well as at the regional or corporate level, if applicable:
(i) Revenue from paid air ambulance transports, by payor type (including Medicare fee-for-service (FFS), Medicare Advantage, Medicaid, Veterans' Health Administration, TRICARE, Indian Health Service, group health plan, health insurance issuer, Federal Employees Health Benefits plan, Worker's Compensation, patient cost sharing, or patient self-pay).
(ii) Revenue from other sources including, but not limited to: Contracts with facilities such as hospitals, prisons, and nursing homes; revenue from emergency air medical services other than for transports (such as transportation of medical personnel or equipment); revenue from sub-contracted ambulance services; fees for standby events; payments from non-direct contracts such as waiver, rental, lease, and supplemental arrangements; air medical subscriptions and ambulance or emergency medical service membership programs; charitable donations and foundation funding; program-related investments; receipt of local taxes earmarked for emergency medical services; contract revenues from local governments in return for air ambulance services; enterprise funds and utility rates; sales of assets and services; bond or debt financing; State or local donation of vehicles or durable equipment; or funding grants or the provision of time-limited funding from a government (including Federal, State, local, or other)).
(5) Transport information. The following information must be reported separately for each air ambulance transport provided during the reporting period:
(i) Date of service.
(ii) Billing NPI information.
(iii) Current Procedural Terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code information.
(iv) Air ambulance base.
(v) Loaded miles.
(vi) Pick-up (origin zip code) and drop-off (destination zip code) locations.
(vii) Duration of flight.
(viii) Whether the transport was emergent or non-emergent.
(ix) Whether the transport was a scene response, inter-facility, or other transport;
(x) Primary payor information, including payor type (such as Medicare FFS, Medicare Advantage, Medicaid, Veterans' Health Administration, TRICARE, Indian Health Service, group health plan, health insurance issuer, Federal Employees Health Benefits plan, Workers' Compensation, patient cost-sharing, or patient self-pay).
(xi) Information regarding any contracts the provider has with the group health plan or health insurance issuer, if and as applicable, to provide air ambulance services under the plan or coverage, respectively.
(xii) Payment methodology (such as base rate, mileage, and intervention or other charges), if applicable.
(xiii) Claim adjudication information, including whether the claim was paid, denied, appealed, denial reason, and appeal outcome, if applicable.
(xiv) Claim/transport payment information, including submitted charges, amount paid by payor other than patient, cost-sharing amount (if applicable), amount billed to patient, amount collected from patient, whether the bill was referred to collections, and payments from sources other than the primary payor.