Federal regulators are pushing the deadline for state compliance with health insurance decision external review requirements back to Jan. 1, 2012.
The U.S. Treasury Department, the U.S. Labor Department and the U.S. Department of Health and Human Services (HHS) have announced that change and other, related changes in the rules governing handling of internal claims and appeals and external review processes in a preliminary version of a final rule posted on the website of the Labor Department’s Employee Benefits Security Administration.
The rules apply to non-grandfathered group health plans, holders of individual health coverage and members of governmental health plans. Depending on how many insured and self-insured plans retain “grandfathered status,” the rules could apply to about 157 million U.S. residents.
Congress included new federal internal review and external appeals standards in the Patient Protection and Affordable Care Act of 2010 (PPACA), which was signed into law March 23, 2010.
Federal departments issued interim final regulations implementing the PPACA appeal review standards in July 2010, and the Labor Deaprtment put out a technical release that postponed the enforcement data for some of the standards in September 2010. The Labor Department then changed and extended the grace period rules in March.
The Labor Department now is joining with the Treasury Department ahd HHS to change the end of a state external review transition period that was created for states.
The new transition period will end Dec. 31, 2011, rather than July 1, 2011.