26 U.S.C. § 9823 — Air ambulance report requirements

Page 4207 TITLE 26—INTERNAL REVENUE CODE § 9823 1 So in original. No section 9821 has been enacted. individual believes that such a provider or fa- cility has violated any requirement described in paragraph (1) with respect to such indi- vidual. (Added Pub. L. 116–260, div. BB, title I, § 116(c), Dec. 27, 2020, 134 Stat. 2884.) Editorial Notes REFERENCES IN TEXT Section 2799B–9 of the Public Health Service Act, re- ferred to in subsec. (a)(2)(C), is classified to section 300gg–139 of Title 42, The Public Health and Welfare. Sections 2799B–1 and 2799B–2 of the Public Health Service Act, referred to in subsec. (c)(1)(A), are classi- fied to sections 300gg–131 and 300gg–132, respectively, of Title 42, The Public Health and Welfare. § 9822.1 Other patient protections (a) Choice of health care professional If a group health plan requires or provides for designation by a participant or beneficiary of a participating primary care provider, then the plan shall permit each participant and bene- ficiary to designate any participating primary care provider who is available to accept such in- dividual. (b) Access to pediatric care (1) Pediatric care In the case of a person who has a child who is a participant or beneficiary under a group health plan if the plan requires or provides for the designation of a participating primary care provider for the child, the plan shall per- mit such person to designate a physician (allopathic or osteopathic) who specializes in pediatrics as the child’s primary care provider if such provider participates in the network of the plan. (2) Construction Nothing in paragraph (1) shall be construed to waive any exclusions of coverage under the terms and conditions of the plan with respect to coverage of pediatric care. (c) Patient access to obstetrical and gyneco- logical care (1) General rights (A) Direct access A group health plan described in paragraph (2) may not require authorization or referral by the plan, issuer, or any person (including a primary care provider described in para- graph (2)(B)) in the case of a female partici- pant or beneficiary who seeks coverage for obstetrical or gynecological care provided by a participating health care professional who specializes in obstetrics or gynecology. Such professional shall agree to otherwise adhere to such plan’s policies and procedures, in- cluding procedures regarding referrals and obtaining prior authorization and providing services pursuant to a treatment plan (if any) approved by the plan. (B) Obstetrical and gynecological care A group health plan described in paragraph (2) shall treat the provision of obstetrical and gynecological care, and the ordering of related obstetrical and gynecological items and services, pursuant to the direct access described under subparagraph (A), by a par- ticipating health care professional who spe- cializes in obstetrics or gynecology as the authorization of the primary care provider. (2) Application of paragraph A group health plan described in this para- graph is a group health plan that— (A) provides coverage for obstetric or gynecologic care; and (B) requires the designation by a partici- pant or beneficiary of a participating pri- mary care provider. (3) Construction Nothing in paragraph (1) shall be construed to— (A) waive any exclusions of coverage under the terms and conditions of the plan with re- spect to coverage of obstetrical or gyneco- logical care; or (B) preclude the group health plan in- volved from requiring that the obstetrical or gynecological provider notify the primary care health care professional or the plan or issuer of treatment decisions. (Added Pub. L. 116–260, div. BB, title I, § 102(c)(2), Dec. 27, 2020, 134 Stat. 2795.) Statutory Notes and Related Subsidiaries EFFECTIVE DATE Section applicable with respect to plan years begin- ning on or after Jan. 1, 2022, see section 102(e) of div. BB of Pub. L. 116–260, set out as an Effective Date of 2020 Amendment note under section 8902 of Title 5, Govern- ment Organization and Employees. § 9823. Air ambulance report requirements (a) In general Each group health plan shall submit to the Secretary, jointly with the Secretary of Labor and the Secretary of Health and Human Serv- ices— (1) not later than the date that is 90 days after the last day of the first calendar year be- ginning on or after the date on which a final rule is promulgated pursuant to the rule- making described in section 106(d) of the No Surprises Act, the information described in subsection (b) with respect to such plan year; and (2) not later than the date that is 90 days after the last day of the calendar year imme- diately succeeding the plan year described in paragraph (1), such information with respect to such immediately succeeding plan year. (b) Information described For purposes of subsection (a), information de- scribed in this subsection, with respect to a group health plan is each of the following: (1) Claims data for air ambulance services furnished by providers of such services, disaggregated by each of the following factors: (A) Whether such services were furnished on an emergent or nonemergent basis. (B) Whether the provider of such services is part of a hospital-owned or sponsored pro- Page 4208 TITLE 26—INTERNAL REVENUE CODE § 9824 1 So in original. There is no subsec. (b). gram, municipality-sponsored program, hos- pital independent partnership (hybrid) pro- gram, independent program, or tribally oper- ated program in Alaska. (C) Whether the transport in which the services were furnished originated in a rural or urban area. (D) The type of aircraft (such as rotor transport or fixed wing transport) used to furnish such services. (E) Whether the provider of such services has a contract with the plan or issuer, as ap- plicable, to furnish such services under the plan or coverage, respectively. (2) Such other information regarding pro- viders of air ambulance services as the Sec- retary may specify. (Added Pub. L. 116–260, div. BB, title I, § 106(b)(3)(A), Dec. 27, 2020, 134 Stat. 2854.) Editorial Notes REFERENCES IN TEXT Section 106(d) of the No Surprises Act, referred to in subsec. (a)(1), is section 106(d) of div. BB of Pub. L. 116–260, which is set out as a note under section 300gg–118 of Title 42, The Public Health and Welfare. § 9824. Increasing transparency by removing gag clauses on price and quality information (a) 1 Increasing price and quality transparency for plan sponsors and consumers (1) In general A group health plan may not enter into an agreement with a health care provider, net- work or association of providers, third-party administrator, or other service provider offer- ing access to a network of providers that would directly or indirectly restrict a group health plan from— (A) providing provider-specific cost or quality of care information or data, through a consumer engagement tool or any other means, to referring providers, the plan spon- sor, participants or beneficiaries, or individ- uals eligible to become participants or bene- ficiaries of the plan; (B) electronically accessing de-identified claims and encounter information or data for each participant or beneficiary in the plan, upon request and consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Infor- mation Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990, including, on a per claim basis— (i) financial information, such as the al- lowed amount, or any other claim-related financial obligations included in the pro- vider contract; (ii) provider information, including name and clinical designation; (iii) service codes; or (iv) any other data element included in claim or encounter transactions; or (C) sharing information or data described in subparagraph (A) or (B), or directing that such data be shared, with a business asso- ciate as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations), consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amend- ments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990. (2) Clarification regarding public disclosure of information Nothing in paragraph (1)(A) prevents a health care provider, network or association of providers, or other service provider from placing reasonable restrictions on the public disclosure of the information described in such paragraph (1). (3) Attestation A group health plan shall annually submit to the Secretary an attestation that such plan is in compliance with the requirements of this subsection. (4) Rules of construction Nothing in this section shall be construed to modify or eliminate existing privacy protec- tions and standards under State and Federal law. Nothing in this subsection shall be con- strued to otherwise limit access by a group health plan or plan sponsor to data as per- mitted under the privacy regulations promul- gated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990. (Added Pub. L. 116–260, div. BB, title II, § 201(c), Dec. 27, 2020, 134 Stat. 2893.) Editorial Notes REFERENCES IN TEXT Section 264(c) of the Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (a)(1)(B), (C), (4), is section 264 of Pub. L. 104–191, which is set out as a note under section 1320d–2 of Title 42, The Public Health and Welfare. The Genetic Information Nondiscrimination Act of 2008, referred to in subsec. (a)(1)(B), (C), (4), is Pub. L. 110–233, May 21, 2008, 122 Stat. 881. For complete classi- fication of this Act to the Code, see Short Title note set out under section 2000ff of Title 42, The Public Health and Welfare, and Tables. The Americans with Disabilities Act of 1990, referred to in subsec. (a)(1)(B), (C), (4), is Pub. L. 101–336, July 26, 1990, 104 Stat. 327, which is classified principally to chapter 126 (§ 12101 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see Short Title note set out under sec- tion 12101 of Title 42 and Tables. § 9825. Reporting on pharmacy benefits and drug costs (a) In general Not later than 1 year after the date of enact- ment of the Consolidated Appropriations Act, 2021, and not later than June 1 of each year