29 U.S.C. § 1185l — Air ambulance report requirements

Page 609 TITLE 29—LABOR § 1185m 1 So in original. There is no subsec. (b). erage, described in paragraph (2) may not re- quire authorization or referral by the plan, issuer, or any person (including a primary care provider described in paragraph (2)(B)) in the case of a female participant or bene- ficiary who seeks coverage for obstetrical or gynecological care provided by a partici- pating health care professional who special- izes in obstetrics or gynecology. Such pro- fessional shall agree to otherwise adhere to such plan’s or issuer’s policies and proce- dures, including procedures regarding refer- rals and obtaining prior authorization and providing services pursuant to a treatment plan (if any) approved by the plan or issuer. (B) Obstetrical and gynecological care A group health plan or health insurance issuer described in paragraph (2) shall treat the provision of obstetrical and gyneco- logical care, and the ordering of related ob- stetrical and gynecological items and serv- ices, pursuant to the direct access described under subparagraph (A), by a participating health care professional who specializes in obstetrics or gynecology as the authoriza- tion of the primary care provider. (2) Application of paragraph A group health plan, or health insurance issuer offering group health insurance cov- erage, described in this paragraph is a group health plan or coverage 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 or health insurance coverage with respect to coverage of obstetrical or gynecological care; or (B) preclude the group health plan or health insurance issuer involved from re- quiring that the obstetrical or gynecological provider notify the primary care health care professional or the plan or issuer of treat- ment decisions. (Pub. L. 93–406, title I, § 722, as added Pub. L. 116–260, div. BB, title I, § 102(b)(2), Dec. 27, 2020, 134 Stat. 2783.) 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. § 1185l. Air ambulance report requirements (a) In general Each group health plan and health insurance issuer offering group health insurance coverage shall submit to the Secretary, jointly with the Secretary of Health and Human Services and the Secretary of the Treasury— (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 plan year imme- diately succeeding the calendar year described in paragraph (1), such information with re- spect 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 or a health insurance issuer offering group health insurance coverage, 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- 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. (Pub. L. 93–406, title I, § 723, as added Pub. L. 116–260, div. BB, title I, § 106(b)(2)(A), Dec. 27, 2020, 134 Stat. 2853.) 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. § 1185m. 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 (or an issuer of health insurance coverage offered in connection with such a plan) may not enter into an agreement with a health care provider, network or asso-