The Affordable Care Act regulators issued another rule today. This time it was the rule implementing the Act’s requirements for internal and external disputed claim procedures. This rule is applicable to non-grandfathered group health plans, including FEHB plans, beginning with the first plan year following September 23, 2010. Business Insurance highlights the differences between this rule and the Labor Department rules currently applicable to ERISA governed plans which Congress deemed to be the gold standard in the new law:
The key difference is that a plan must decide a disputed claim involving urgent services within 24 hours rather than 72 hours of submission as provided under the ERISA rule. The rule also sets standards on conflicts of interest and on providing notices to enrollees in “culturally and linguistically appropriate manner.”
In another interesting development, NCQA announced that it is teaming up with Consumers Union to publish NCQA’s health plan ratings in the November issue of Consumer Reports. Meanwhile, the American Medical Association is complaining about health plan efforts to profile physician quality of care according to MedPage Today.