National Association of Insurance Commissioners Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule
The comment was co-signed by
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The
The proposed rule details a number of areas where the
Air Ambulance Services
The No Surprises Act requires a public, comprehensive report summarizing the air ambulance data HHS and the
We particularly support the collection of information on air ambulance subscription programs. In addition to revenue amounts, we request that the Departments require reporting of subscription enrollment totals, state of residence of enrollees, and enrollment duration to give greater context to the revenue data.
Given the need for this air ambulance data, we are concerned, however, that the proposed penalty for noncompliance may not be adequate. We recommend HHS consider whether the maximum penalties it proposes for failure to report are sufficient to ensure complete reporting by providers. As recent experience with hospital price transparency requirements shows, fines set too low can delay access to important price data. Providers may have certain incentives to keep even de-identified data confidential; fines for failure to report must be significant enough to overcome such incentives. We urge HHS to judge whether air ambulance providers who frequently bill tens of thousands of dollars per transport will find a maximum
Agent and Broker Commissions
States license and regulate insurance agents and brokers. Under the proposed rule, health insurance issuers would report to HHS on the direct and indirect compensation they pay to agents and brokers. This data, too, should be shared with states to inform and facilitate their regulation of agents and brokers. While states could collect this information on their own, making use of the data collected by the Departments would reduce duplicative reporting burdens and allow states to make consistent comparisons to other states.
No Surprises Act Compliance
State regulators are pleased to see that HHS proposes that it may negotiate to "ma[k]e available" to states transitioning to the primary enforcement role for the No Surprises Act certain records related to issuer, provider, and facility compliance "to the extent practicable, as permitted by law, and as applicable." (Proposed 45 C.F.R. Sec. 150.221(b)). However, other states could also make use of such records in their oversight efforts. We encourage HHS to complete negotiations and provide the records, as permitted by law, to all interested states.
Other Data Reporting
The information that the Departments anticipate collecting through the data reporting structures described throughout the Proposed Rule is extensive. NAIC and state regulators expect that it will be invaluable in informing states' enforcement authority. Therefore, we encourage the Departments to make compliance and other implementation, enforcement, and reporting records available as expeditiously and robustly as possible, so that states may fully exercise their primary enforcement authority as contemplated by the Public Health Service Act for federal laws and as embodied in state law authority to regulate agents, brokers, issuers, and providers.
Thank you for this opportunity to comment. State regulators will continue to review regulations under the No Surprises Act and other authorities for their potential impact on market competition, premiums, and consumer protections and we will continue to provide comments. We are available to discuss these or other issues as the proposed rules are finalized.
Sincerely,
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The proposed rule can be viewed at: https://www.regulations.gov/document/CMS-2021-0147-0001
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