Last year, regulators said enrollees would have to be notified of an urgent care decision within 24 hours of receipt of a claim. However, according to Business Insurance, in a joint amendment to the 2010 regulations published in the June 24 Federal Register, the Health and Human Services, Labor and Treasury Departments said they will allow plans to make notification of coverage decisions within 72 hours, closely following a Labor Department rule.
The news report said regulators noted that the 72-hour limit is a maximum “and that in cases where a decision must be made more quickly based on the medical exigencies involved, the requirement remains that the decision should be made sooner than 72 hours after the receipt of the claim.”
In addition, under the previous rules, the requirement to provide notices in a language other than English was based on the percentage of plan enrollees who were literate in a common non-English language. For plans that cover more than 100 participants, the threshold was 10% of plan participants, or 500 participants, whichever was less.
According to Business Insurance, under the latest rules, the requirement applies if at least 10% of the population residing in a county where an employer’s health care plan enrollees reside are literate in the same non-English language. Currently, 255 U.S. counties meet this standard, including 78 of which are in Puerto Rico, the regulators noted.