Brief Case

Treas. Reg. § 54.9817-1T

Preventing surprise medical bills for air ambulance services (temporary).
eCFR editorial change effective 2021-09-13 · current · last amended by T.D. 9951, 86 FR 36950, July 13, 2021
Amended effective Sep 13, 2021 by T.D. 9951, 86 FR 36950, July 13, 2021. See what changed
(a) In general. If a group health plan provides or covers any benefits for air ambulance services, the plan must cover such services from a nonparticipating provider of air ambulance services in accordance with paragraph (b) of this section.
(b) Coverage requirements. A plan described in paragraph (a) of this section must provide coverage of air ambulance services in the following manner—
(1) The cost-sharing requirements with respect to the services must be the same requirements that would apply if the services were provided by a participating provider of air ambulance services.
(2) The cost-sharing requirement must be calculated as if the total amount that would have been charged for the services by a participating provider of air ambulance services were equal to the lesser of the qualifying payment amount (as determined in accordance with § 54.9816-6T) or the billed amount for the services.
(3) The cost-sharing amounts must be counted towards any in-network deductible and in-network out-of-pocket maximums (including the annual limitation on cost sharing under section 2707(b) of the Public Health Service Act) (as applicable) applied under the plan (and the in-network deductible and out-of-pocket maximums must be applied) in the same manner as if the cost-sharing payments were made with respect to services furnished by a participating provider of air ambulance services.
(4) The plan must—
(i) Not later than 30 calendar days after the bill for the services is transmitted by the provider of air ambulance services, determine whether the services are covered under the plan and, if the services are covered, send to the provider an initial payment or a notice of denial of payment. For purposes of this paragraph (b)(4)(i), the 30-calendar-day period begins on the date the plan receives the information necessary to decide a claim for payment for the services.
(ii) Pay a total plan payment directly to the nonparticipating provider furnishing such air ambulance services that is equal to the amount by which the out-of-network rate for the services exceeds the cost-sharing amount for the services (as determined in accordance with paragraphs (b)(1) and (2) of this section), less any initial payment amount made under paragraph (b)(4)(i) of this section. The total plan payment must be made in accordance with the timing requirement described in section 9817(b)(6), or in cases where the out-of-network rate is determined under a specified State law or All-Payer Model Agreement, such other timeframe as specified by the State law or All-Payer Model Agreement.
(c) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022.
Source credit, amendments & notes

[T.D. 9951, 86 FR 36950, July 13, 2021]

Treas. Reg. § 54.9817-1T — Preventing surprise medical bills for air ambulance services (temporary). · eCFR editorial change effective 2021-09-13 · https://pensionresource.website/EAMain?content=EAMain.Law&id=cfr26-54.9817-1T · printed Oct 16, 2026
On this page
  • (a) In general.
  • (b) Coverage requirements.
  • (c) Applicability date.
Cited by (code & regs)
Guidance addressing this section

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Also cited in 4 other documents
IRS / Treasury
Proposed Rules
  • 88 FR 75744Proposed Nov 3, 2023 — Federal Independent Dispute Resolution Operations Comments due Jan 2, 2024 (b)(4)(i)
  • 86 FR 36870Proposed Jul 13, 2021 — Requirements Related to Surprise Billing; Part I Comments due Sep 13, 2021
Final Rules

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Each row is a version of the text as published by the official source. Code dates are the edition/release point that first reflected the change; regulation dates are eCFR effective dates. The library checks the official sources automatically, so new versions appear here on their own; “run” opens the sync that recorded a version.

EffectiveThroughSourceAmended by
Jul 13, 2021Sep 12, 2021eCFR amendment effective 2021-07-13 run 6View
Sep 13, 2021currenteCFR editorial change effective 2021-09-13 run 6T.D. 9951, 86 FR 36950, July 13, 2021View · Redline (sign in)
Provision-level history (blame)