By Brian M. Pinheiro, Marla G. Roshkoff, and Edward I. Leeds
The U.S. Departments of Treasury, Labor, and Health and Human Services have collectively released amended interim final regulations addressing internal claims and appeals and the external claims review requirements under health care reform.
The new regulations amend initial claims review guidance issued by the Departments on July 22, 2010. (Click here to read our legal alert on the initial guidance.) They also supersede the Department of Labor's Technical Release 2010-02, which extended a non-enforcement reprieve for certain rules affecting health claims and appeals. (Click here to read our legal alert on the reprieve.)
Health care reform requires group health plans to maintain an internal claim and appeal process that meets certain standards and to provide for an external appeal process. The new guidance provides a measure of welcome relief for plans and plan sponsors who will implement the claim and appeal requirements when the non-enforcement period ends on January 1, 2012.
For internal claims and appeals, the changes include:
For external reviews by Independent Review Organizations (IROs), some of the more notable changes include:
In addition, the various agencies also released technical guidance on certain related issues:
If you have questions about how these amendments might affect your operation or any concerns about the effects of health care reform, contact Brian M. Pinheiro, 215.864.8511 or firstname.lastname@example.org; Marla G. Roshkoff, 215.864.8417 or email@example.com; or Edward I. Leeds, 215.864.8419 or firstname.lastname@example.org.
As the federal health care reform effort gained steam, Ballard Spahr attorneys formed an initiative to monitor and analyze legislative developments. With federal health care reform now a reality, our attorneys are assisting health care entities and employers in understanding the relevant changes and planning for the future. For more information on the firm's Health Care Reform Initiative, please click here.
Copyright © 2011 by Ballard Spahr LLP.www.ballardspahr.com(No claim to original U.S. government material.)
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This alert is a periodic publication of Ballard Spahr LLP and is intended to notify recipients of new developments in the law. It should not be construed as legal advice or legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your own attorney concerning your situation and specific legal questions you have.