HHS, the Department of Labor and the Treasury (referred to as the Departments) amended the 16 minimum consumer protection standards required to be included in the state’s external review process of group health plans and health insurance issuers in the group and individual market.
If a state’s external review process does not meet these standards, group health plans and issuers must implement a process that follows minimum standards established by the Secretary through guidance, meets certain requirements of the PHS Act and is similar to the set of 16 consumer protection standards.
The Departments also amended the transition period allowed for the correction of inadequate external review processes. HHS plans to determine the compliance of state external review processes by July 31, 2011. Noncompliant states will have a transition period until Jan. 1, 2012 to correct the problems. The Departments also established a set of 13 temporary standards for appropriate external review processes that will apply until Jan. 1, 2014.
Until Jan. 1, 2014, the state’s external review process must comply with the temporary standards. Beginning Jan. 1, 2014, the process will have to comply with the permanent, amended regulations or the issuer or plan will undergo a federal external review process.
Read the HHS technical release on external review processes (pdf).
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