The No Surprises Act (NSA) includes a section requiring carriers and health plans to report information regarding air ambulance service claims to the Centers for Medicare and Medicaid Services (CMS). The reporting is only expected to be required for two years, and that collected information would be used to issue public reports to assist in understanding what drives the high costs of these services.

Proposed rules for air ambulance reporting implementing this section of the NSA were released in September of 2021. Final rules have not yet been published so no action is currently necessary, but we anticipate final rules may be published soon.

The Departments have established an information page relating to air ambulance reporting here which confirms that reporting isn’t due until final regulations establish a deadline.

When is the reporting due?

There has been confusion over when this reporting requirement will first go into effect, largely because the proposed rule suggested a March 2023 deadline.

The NSA specifically states that air ambulance reporting will not begin until 90 days after the first full year following the issuance of final rules for the reporting.  The earliest that reporting could be required is March 2025 (if final rules are released before the end of 2023).

Who is responsible for the air ambulance reporting once it becomes required?

For fully insured group health plans, the carrier has the data necessary to submit the reporting. The rules make it clear that legal responsibility for reporting in a fully insured arrangement can be transferred to the carrier if the plan enters into a written agreement.

For self- insured group health plans, the TPA has the data necessary to submit the reporting. Plans can enter into a written agreement obligating the TPA to submit the necessary reporting; however, the employer cannot transfer legal responsibility.

What do employers need to do now?

No action is necessary at this time as the rules for air ambulance reporting haven’t been finalized. We’ll keep employers posted on developments as soon as final regulations are issued.


IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.

This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.