Department of Labor Delays Implementation of PPACA Internal Claims and Appeals Requirements

The Department of Labor has again delayed enforcement of the new requirements for internal claims and appeals that apply to non-grandfathered plans pursuant to the Patient Protection and Affordable Care Act.

The extension was prompted by the DOL’s intention to amend the interim final regulations issued in July 2010 in light of feedback received during the comment period.

Technical Release 2011-01 extends and slightly modifies the enforcement grace period that was set to expire on July 1, 2011. The non-enforcement period now extends until plan years beginning on or after July 1, 2011 for certain requirements, and plan years beginning on or after January 1, 2012 for others.

For example, the following timelines and requirements apply to non-grandfathered plans beginning on or after July 1, 2011:

• Notices of adverse benefit determinations must include specific information that identifies the claim, date of service, health care provider, and claim amount.
• Notices of adverse benefit determinations must include the reasons for the denial.
• Plans must provide a description of the available internal appeals and external review processes.
• Plans must disclose availability of and contact information for an office of health insurance consumer assistance or ombudsman.

For more information on PPACA compliance issues and implementation requirements, please visit www.CSTedge.com for our contact information and additional resources.