Government regulators responsible for enforcing the Patient Protection and Affordable Care Act recently announced that they plan to wait until Jan. 1, 2012 to enforce certain provisions related to internal claims and appeals.
On March 18, officials at the Employee Benefits Security Administration issued Technical Release 2011-01, explaining that a review of public comments justified a six-month extension of the enforcement grace period.
Previously, under Technical Release 2010-2, regulators had set the enforcement grace period until July 1, 2011 for certain new rules on internal appeals and external claim review procedures.
The interim final rule, published on July 23, 2010, required group health plans and insurers to establish a comprehensive appeals process for patients who appeal decisions on coverage, services and claim payments.
The interim guidance generally applied to plan years beginning on or after Sept. 23, 2010. The guidance, however, did not apply to grandfathered plans under the PPACA.
Federal regulators explain that the new release "is intended to act as a bridge until an amendment to the 2010 interim final regulation is issued."
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