Doctors & Hospitals Countdown III on PPACA Health Reform Laws – Court & Feds: No Delays for PPACA Health Claims Litigation & Enforcement

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On 03-23-2011, PPACA's 1st Birthday, ERISAclaim.com Will Offer A Free Webinar To Examine New Feds PPACA Claims Enforcement Guidance On March 18, 2011, Clarifying For The Effective Date, Extension Date and No Delays for Private PPACA Health Claims Litigation, And PPACA Awareness & Usage By Doctors and Hospitals Since Sep. 23, 2010.

Accordingly, this guidance seeks to minimize both cost and delay, and avoid confusion for participants and plans alike.

On 03-23-2011, PPACA's 1st Birthday, ERISAclaim.com will hold a free Webinar to review the new 03/18/2011 PPACA Claims Enforcement Guidance from DOL, HHS & IRS, clarifying for the PPACA Claims Regulations’ effective date on Sep 23, 2010, new extension date on 01/01/2012 for non-enforcement on only 3.5 of the 7 new PPACA claims appeals standards (primarily for consumers, practically moot concerns for providers), and no enforcement extension or delays for original effective date on Sep. 23, 2010 for the entire PPACA (ERISA) Claims and Appeals Regulations for the purpose of private PPACA (ERISA) health claims litigation. On March 3, 2011, Federal Court ordered for PPACA to go forward. On March 16, 2011, Congress reported that only a small portion of the claims denials were appealed (0.5% - OH).

“Today is the PPACA’s first Birthday. There has been a great deal of confusion, as if PPACA’s Claims Regulations were constitutionally challenged with judicial and administrative enforcement delays. There is none so far according to the Court and Feds,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert in PPACA & ERISA Appeals and Compliance.

On March 18, 2011, DOL, HHS & IRS (Departments) released a new Technical Release No. 2011-01 (http://www.dol.gov/ebsa/newsroom/tr11-01.html), as new PPACA claims regulations enforcement Guidance, ensuring no administrative enforcement extension or delays for PPACA Claims Regulations' effective date on September 23, 2010, except for 3.5 minor new standards, out of 7 new standards, (Standards #2, #5, #7, & #6, such as 24-hour decision-making for urgent care claims, Spanish or Chinese Notices or possible AIDS/HIV diagnosis and abortion treatment on Notices), which are primarily for consumers and practically moot issues for doctors and hospitals, according to Dr. Zhou.

DOL, HHS & IRS: T.R. 2011-01(http://www.dol.gov/ebsa/newsroom/tr11-01.html)

“Extension of Non-Enforcement Period Relating to Certain Interim Procedures for Internal Claims and Appeals under the Patient Protection and Affordable Care Act”

“This guidance is intended to ensure that plan participants and beneficiaries are promptly accorded the important protections under the Affordable Care Act that provide for fuller and fairer processing of claims, the right to appeal claims that are denied, and the right to obtain effective external review of denials on appeal.”

“Accordingly, this guidance seeks to minimize both cost and delay, and avoid confusion for participants and plans alike.”

“Note: T.R. 2010-02 and this Technical Release 2011-01 describe circumstances in which the Departments will not treat a plan or issuer as being out of compliance for purposes of enforcement by the Departments. However, these documents do not address the rights of private parties in private litigation.”

On March 23, 2011, the ERISAclaim.com’s Webinar will cover the followings:

1.    On March 23, 2010, exactly one year ago, President Obama signed PPACA (Patient Protection and Affordable Care Act) legislation into law, (http://www.whitehouse.gov/blog/2010/03/23/behalf-my-mother).
2.    PPACA adopted ERISA Claim Regulations in its entirety as the minimum internal appeals standards for PPACA Claims and Appeals Regulations, and went into effect on Sep. 23, 2010, (http://www.dol.gov/ebsa/healthreform/)
3.    On March 3, 2011, Federal District Court of Florida ordered for PPACA to go forward, even after it ruled PPACA unconstitutional, pending on appeal, (Case 3:10-cv-00091-RV -EMT Document 167 Filed 03/03/11), (http://www.ERISAclaim.com/Court_Go_PPACA.pdf)
4.    On March 18, 2011, DOL, HHS & IRS (Departments) issued new enforcement guidance, Technical Release No. 2011-01 (http://www.dol.gov/ebsa/newsroom/tr11-01.html)
5.    On March 16, 2011, Congress released PPACA mandated GAO Report indicating only a small portion of denials were appealed (0.5% - OH), while 39% to 59% appeals successfully reversed denials, (http://www.gao.gov/products/GAO-11-268)
6.    On March 4, 2011, AMA reported that 51% of doctors in TX are going broke, “51% of Texas doctors dug into personal funds to keep practices afloat in 2010”, [“More Texas Doctors Dipping Into Personal Reserves To Keep Practices Alive” (http://www.ama-assn.org/amednews/2011/03/14/bisc0314.htm)]
7.    On March 20, 2011, ERISAclaim.com released its Initial Web Search And Survey results indicating that less than 0.001% of provider entities or associations offered PPACA Claims Regulations education (http://www.prweb.com/releases/2011/3/prweb8221802.htm)

The Congress gave $30 million to the States, to establish PPACA Consumer Assistance Programs (PPACA CAP) to educate consumers on PPACA Claims Regulations, how to file PPACA/ERISA claim appeals and enroll in healthcare plans. Although 34 States claimed to be ready for PPACA CAP as of March 18, 2011 per DOL & HHS, none of the States offered PPACA Claims Regulations education to consumers or healthcare providers. (http://cciio.cms.gov/programs/consumer/capgrants/index.html)

ERISAclaim.com is dedicated to offering PPACA Compliance Assistance Program (CAP), exactly as the Congress intended, but no cost to Congress, since PPACA defines the providers, as authorized representatives, as the claimants - the consumers, and without provider's participation, PPACA will never work as intended by Congress:

  • Helping consumers (/Doctors & Hospitals) enroll in any PPACA / ERISA Claims Regulations Education or PPACA Claims Specialist Certification Programs.
  • Helping consumers (/Doctors & Hospitals) file complaints and appeals against health plans
  • Educating consumers (/Doctors & Hospitals) about their rights and empowering them to take action (appeals, lawsuits & class-actions)
  • Tracking consumer (/Doctors & Hospitals) complaints to help identify problems and strengthen enforcement (GAO Report, DOL, HHS & IRS Complaints, Department Of Insurance Complaints)

For more info on ERISAclaim.com’s new services: http://erisaclaim.com/products.htm

For a free PPACA Webinar for your Organization or Institution, please contact Dr. Jin Zhou, President of ERISAclaim.com, at 630-808-7237.

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