Labor and Employment Alert: More Guidance Under The Affordable Care Act: External Review of Denied Appeals - and - New Rules for FSA, HRA and HSA Reimbursement of OTC Drugs

External Review of Denied Appeals

One of the mandates under the Patient Protection and Affordable Care Act (ACA) is that non-grandfathered health plans must adopt new standards for claims and appeals and provide external review of denied appeals. Regulations issued July 23, 2010 (and summarized in a Vorys Client Alert available at healthcarereform) spelled out stringent new requirements for claims and appeals, but included only a general framework for external review of denied appeals under self-insured health plans. The Department of Labor (DOL) has now issued Technical Release 2010-01 (available at http://www.dol.gov/ebsa/healthreform//) creating a safe harbor interim external review process. 

Click on the link below to download the Labor and Employment Alert which discusses this review process.