DoL Extends Grace Period for Certain PPACA Rules

March 18, 2011 ( – The Employee Benefits Security Administration has extended the enforcement grace period for certain provisions of the Patient Protection and Affordable Care Act relating to claims and appeals.

Technical Release No. 2011-01 extends, with a few modifications, the enforcement grace period set forth in T.R. 2010-02 (see EBSA Offers Health Reform Provisions Enforcement Grace Period) until plan years beginning on or after January 1, 2012, to give the Departments of Labor, Health and Human Services, and Treasury time to publish new regulations necessary or appropriate to implement the internal claims and appeals provisions of PHS Act section 2719(a). Specifically, it extends the enforcement grace period until plan years beginning on or after January 1, 2012, with respect to standard #2 (regarding the timeframe for making urgent care claims decisions), standard #5 (regarding providing notices in a culturally and linguistically appropriate manner), and standard #7 (regarding substantial compliance).   

During the grace period, the Department of Labor and the IRS will not take any enforcement action against a group health plan, and HHS will not take any enforcement action against a self-funded nonfederal governmental health plan, with respect to these provisions. HHS is encouraging states to provide similar grace periods with respect to issuers, and HHS will not cite a state for failing to substantially enforce PHS Act section 2719(a) in these situations. Moreover, whereas T.R. 2010-02 required plans to be working in good faith to implement such standards for the enforcement grace period to apply, under this technical, no such requirement will apply for either the extended or the original enforcement grace period.  

Federal regulators issued interim final regulations implementing the requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets in July 2010 (see Regulators Issue Rules for Group Health Plans on Claims and Appeals).    

Last August, EBSA issued Technical Release 2010-01 providing an interim enforcement safe harbor for non-grandfathered self-insured group health plans not subject to a state external review process, and therefore subject to the federal external review process (see Agencies Offer Safe Harbor on External Review Processes under PPACA).    

Also see What About the New Claims & Appeals Requirements? for more information.  

Technical Release No. 2011-01 is at