Federal agencies will be giving employers and health plans until July 1, 2011, to comply with some provisions of the Affordable Care Act.
The arms of the U.S. Department of Health and Human Services (HHS), the U.S. Treasury Department and the U.S. Labor Department responsible for administering the Affordable Care Act — the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) — posted a copy of PPACA grace period guidance Monday, and they also have posted a list of answers to frequently asked questions (FAQS) about PPACA.
The guidance, given in Technical Release Number 2010-02 by the Labor Department’s Employee Benefits Security Administration (EBSA), describes interim procedures for the internal claims and appeals provisions of PPACA.
HHS, the Treasury Department and the Labor Department joined to release interim final regulations for internal and external appeals in July, and the Labor department released external review process procedures designed specifically for employer plans in August.
The new document deals with an employer plan’s internal claims process and does not apply to health insurers, officials say.
Some employers and health coverage issuers say they cannot
get their computers ready to comply with the interim final regulations quickly enough to meet the deadlines in the interim regulations issued in July, which are aimed at insurers as well as plans, Labor Department officials say.
The Labor Department has responded by creating an enforcement grace period that will last until July 1, 2011, to help issuers and plans get their computer systems ready.
The grace period will apply to:
- Urgent care claims decisions.
- Provisions requiring plans to provide determination notices in a culturally and linguistically appropriate manner.
- An internal appeals notice content provision.
- A substantial compliance provision.
When the urgent care provision takes full effect, it will require health plans to make most decisions about urgent care within 24 hours after receiving a complete, clean claim; today, the Labor Department requires the plans to make the claims within 24 hours.
The substantial compliance provision will permit consumers to seek external reviews, or judicial reviews, if a plan or issuer fails to adhere strictly to its internal claims and appeals process.
The Labor Department and the Internal Revenue Service (IRS), an arm of the Treasury Department, “will not take any enforcement action against a group health plan, and HHS will not take any enforcement action, during the grace period, against a self-funded nonfederal governmental health plan, that is working in good faith to implement such additional standards but does not yet have them in place,” according to officials at the Employee Benefits Security Administration, an arm of the Labor Department.