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Pension Resource

Treas. Reg. § 54.9817-2T

Independent dispute resolution process for air ambulance services (temporary).
eCFR amendment effective 2022-10-25 · current · last amended by T.D. 9965, 87 FR 52648, Aug. 26, 2022
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Amended effective Oct 25, 2022 by T.D. 9965, 87 FR 52648, Aug. 26, 2022. See what changed
(a) Definitions. Unless otherwise stated, the definitions in § 54.9816-3T apply.
(b) Determination of out-of-network rates to be paid by group health plans; independent dispute resolution process.
(1) For further guidance see § 54.9817-2(b)(1).
(2) For further guidance see § 54.9817-2(b)(2).
(3) For further guidance see § 54.9817-2(b)(3).
(4) Reporting of information relating to the IDR process. In applying the requirements of § 54.9816-8T(f), within 30 business days of the close of each month, for services furnished on or after January 1, 2022, the information the certified IDR entity must report, in a form and manner specified by the Secretary, with respect to the Federal IDR process involving air ambulance services is:
(i) The number of notices of IDR initiation submitted under the Federal IDR process to the certified IDR entity that pertain to air ambulance services during the immediately preceding month;
(ii) The number of such notices of IDR initiation with respect to which a final determination was made under § 54.9816-8T(c)(4)(ii) (as applied by paragraph (b)(1) of this section);
(iii) The number of times the payment amount determined (or agreed to) under this subsection has exceeded the qualifying payment amount, specified by services;
(iv) With respect to each notice of IDR initiation under § 54.9816-8T(b)(2) (as applied by paragraph (b)(1) of this section) for which a determination was made, the following information:
(A) A description of each air ambulance service included in such notification, including the relevant billing and service codes;
(B) The point of pick-up (as defined in 42 CFR 414.605) for the services included in such notification;
(C) The amount of the offers submitted under § 54.9816-8T(c)(4)(i) (as applied by paragraph (b)(1) of this section) by the group health plan and by the nonparticipating provider of air ambulance services, expressed as a dollar amount and as a percentage of the qualifying payment amount;
(D) Whether the offer selected by the certified IDR entity under § 54.9816-8T(c)(4)(ii) (as applied by paragraph (b)(1) of this section) to be the payment amount applied was the offer submitted by the plan or by the provider of air ambulance services;
(E) The amount of the selected offer expressed as a dollar amount and as a percentage of the qualifying payment amount;
(F) For further guidance see § 54.9817-2(b)(4)(iv)(F);
(G) Air ambulance vehicle type, including the clinical capability level of such vehicle (to the extent this information has been provided to the certified IDR entity);
(H) The identity for each plan and provider of air ambulance services, with respect to the notification. Specifically, each certified IDR entity must provide each party's name and address, as applicable; and
(I) For each determination, the number of business days elapsed between selection of the certified IDR entity and the selection of the payment amount by the certified IDR entity.
(v) The total amount of certified IDR entity fees paid to the certified IDR entity under paragraph § 54.9816-8T(d)(1) (as applied by paragraph (b)(1) of this section) during the month for determinations involving air ambulance services.
(c) Applicability date. The provisions of this section are applicable with respect to plan years beginning on or after January 1, 2022, except that paragraphs (b)(1), (2), and (3) and (b)(4)(iv)(F) of this section regarding payment determinations are applicable with respect to services provided or furnished on or after October 25, 2022, for plan years beginning on or after January 1, 2022.
Source credit, amendments & notes

[T.D. 9955, 86 FR 56109, Oct. 7, 2021, as amended by T.D. 9965, 87 FR 52648, Aug. 26, 2022]

Treas. Reg. § 54.9817-2T — Independent dispute resolution process for air ambulance services (temporary). · eCFR amendment effective 2022-10-25 · https://pensionresource.website/EAMain?content=EAMain.Law&id=cfr26-54.9817-2T · printed Oct 16, 2026
On this page
  • (a) Definitions.
  • (b) Determination of out-of-network rates to be paid by group h…
  • (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)(2)
  • 86 FR 55756Proposed Oct 7, 2021 — Requirements Related to Surprise Billing; Part II Comments due Dec 6, 2021
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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
Oct 7, 2021Aug 25, 2022eCFR amendment effective 2021-10-07 run 6T.D. 9955, 86 FR 56109, Oct. 7, 2021View
Aug 26, 2022Oct 24, 2022eCFR amendment effective 2022-08-26 run 6T.D. 9955, 86 FR 56109, Oct. 7, 2021View · Redline (sign in)
Oct 25, 2022currenteCFR amendment effective 2022-10-25 run 6T.D. 9965, 87 FR 52648, Aug. 26, 2022View · Redline (sign in)
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