EBSA Offers Health Reform Provisions Enforcement Grace Period

September 23, 2010 (PLANSPONSOR.com) – The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) is offering health plan sponsors and insurers an enforcement grace period for compliance with provisions of the Patient Protection and Affordable Care Act dealing with internal claims and appeals.

Technical Release 2010-02 sets forth an enforcement grace period until July 1, 2011, with respect to some of the additional standards set forth in the interim regulations in order to give plans and issuers more time to implement procedures and make changes to computer systems in order to comply fully.  

Specifically, with respect to standards #2 (regarding the timeframe for making urgent care claims decisions), #5 (regarding providing notices in a culturally and linguistically appropriate manner), #6 (requiring broader content and specificity in notices), and #7 (regarding substantial compliance), the DoL and the Internal Revenue Service (IRS) will not take any enforcement action against a group health plan, and the Department of Health and Human Services (HHS) will not take any enforcement action, during the grace period, against a self-funded non-federal governmental health plan, that is working in good faith to implement such additional standards but does not yet have them in place, according to the technical release.  

EBSA said HHS are also encouraging states to provide similar grace periods with respect to issuers.  

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 (see Regulators Issue Rules for Group Health Plans on Claims and Appeals).  

In 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).  

More about internal claims procedures changes is here 

EBSA Technical Release 2010-02 is here