• EBSA Announces Enforcement Grace Period for New Internal Claims Review Procedures; Additional Health Care Reform Guidance Released
  • October 6, 2010 | Author: Catherine M. Stowers
  • Law Firm: Krieg DeVault LLP - Indianapolis Office
  • Additional guidance has been released to assist group health plans, health insurance issuers, and health plan administrators working to implement the more immediately effective provisions of the Patient Protection and Affordable Care Act ("PPACA"). 

    On September 20, 2010, the Department of Labor's Employee Benefits Security Administration ("EBSA") released Technical Release 2010-02, which provides an enforcement grace period for compliance with certain internal claims review requirements enacted under PPACA and its implementing regulations.  This enforcement grace period extends until July 1, 2011, and is considered by many to be a welcome temporary reprieve from these new compliance obligations.  It is in direct response to valid concerns raised by plan administrators and insurers that computer systems and internal claims review and notification processes cannot be modified fast enough to incorporate the new standards before the initial effective date of the new rules for some plans.  New model notices have also been issued related to initial claims decisions, final internal appeal decisions, and final external review decisions.  These new rules are effective for non-grandfathered health plans for plan years beginning on or after September 23, 2010.  

    The Departments of Health and Human Services, Labor, and Treasury also released a set of frequently asked questions (FAQs) related to the numerous interim final regulations that have been issued since enactment of PPACA.  Issues addressed in the FAQs include maintaining grandfathered health plan status, internal claims review and appeals, extended eligibility for adult children to age 26, and balance billing for out-of-network emergency services.   According to the Departments, final regulations will be issued beginning in early 2011.