Feds: No Delays For 99% PPACA Claims & Appeals Laws Except For 3 Minor Standards

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ERISAclaim.com Adds New Webinars For The PPACA Enforcement Guidance On 03/18/2011 By DOL, HHS & IRS: No Grace period or Extension For The 99% PPACA Claims Laws, Effective On Sept. 23, 2010, Except For 3 Minor New Standards (<1% of PPACA) with Extension on 01/01/2012.

Doctors and hospitals must be aware of and act on PPACA reimbursement laws for all improper claim denials and delays

There have been a widespread confusion and misunderstanding of the enforcement effective date, Sep 23, 2010, for the PPACA Claims Regulations, under Health Reform Law, Patient Protection and Affordable Care Act (PPACA), also called as new Patient Bill’s of Rights Regulation by the Obama administration. The vast majority of the healthcare industry news media failed to clearly report that 99% of the PPACA Claims Regulations went into effect on Sep. 23, 2010, and the Feds enforcement grace period and the extension, July 01, 2011 and 01/01/2012, are only for less than 1% of the PPACA Claims Regulations - 3 minor new standards. On March 18, 2011, DOL, HHS & IRS issued the second enforcement guidance to clarify that the delay for ONLY 3 minor standards are ONLY “to avoid enforcing standards that the Departments intend to modify in the near future.”

In responding to the numerous phone and email inquires, ERISAclaim.com added new PAPCA Webinars to closely examine the new PPACA enforcement guidance issue by DOL, HHS & IRS on March 18, 2011.

“There is no delay as the most perceived, doctors and hospitals must be aware of and act on PPACA reimbursement laws for all improper claim denials and delays,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

The new Webinar will cover and closely examine the PPACA Regulations and DOL, HHS & IRS Guidance on March 18, 2011:

1.    PPACA Claims Regulations provide internal and external appeals as consumer protections, and went into effective on Sep. 23, 2010, as statutorily provided under PPACA. No one but the Congress or Supreme Court may change it;
2.    PPACA adopted ERISA Claim Regulation in its entirety as the minimum PPACA internal appeal standards, and added seven new standards for PPACA internal appeals;
3.    PPACA adopted NAIC External Appeal Model with sixteen PPACA external appeal standards;
4.    ERISA Claim Regulations, as the Federal laws for 36 years, are the minimum, but 95% of PPACA internal appeal standards;
5.    The original grace period enforcement date of July 01, 2011 in DOL, HHS & IRS Guidance in 2010 and new extension grace period on 01/01/2012 in 2011 are only for 3 minor new standards, less than 1% of the entire PPACA Claims Regulations, and have NO Effect on the PPACA statutory effective date on Sep. 23, 2010 for the 99% of the entire PPACA Claims Regulations;
6.    The original and extended grace periods do not affect PPACA external appeals;
7.    PPACA Claims Regulations generally do not apply to all Grandfathered Health Plans, the plan in existence on or before 03/23/2010;
8.    With or without PPACA, ERISA was signed into law on 09/02/1974 and governs all employer sponsored health plans in private sector, both self-insured and fully-insured (through the purchase of insurance). ERISA pre-empts any and all state insurance laws, impermissibly connected with ERISA plans;
9.    No delays or extensions for 99% of the PPACA Claims Regulations, effective on Sep. 23, 2010;
10.    Most news and industry reports mostly or perceivably misled the nation that entire PPACA Claims Regulations are delayed or extended to 01/01/2012

03-18-2011: DOL, HHS & IRS Technical Release No. 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”

“To avoid enforcing standards that the Departments intend to modify in the near future, the relief contained in this Technical Release 2011-01 is intended to act as a bridge until an amendment to the 2010 interim final regulations is issued”.

“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.”

“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.”

“Specifically, this Technical Release 2011-01 extends the enforcement grace period until plan years beginning on or after January 1, 2012 with respect to standard #2 above (regarding the timeframe for making urgent care claims decisions), standard #5 above (regarding providing notices in a culturally and linguistically appropriate manner), and standard #7 above (regarding substantial compliance).”

“Note: Any enforcement grace period with respect to disclosure requirements that has been provided under T.R. 2010-02 or this Technical Release 2011-01 does not affect disclosure requirements still in effect for ERISA plans under the 2000 DOL claims procedure regulation and/or Part 1 of ERISA.” (http://www.dol.gov/ebsa/newsroom/tr11-01.html)

“Less than 1% PPACA claims regulation delay is insignificant or moot for doctors and hospitals”, said Dr. Zhou, “99% PPACA Claims Regulations went into effect on September 23, 2010, except for 3 minor new standards, the Standards #2, #5, #7, & #6, such as 24-hour decision-making for urgent care claims, Spanish or Chinese Notices (EOB’s) or possible AIDS/HIV diagnosis and abortion treatment on Notices (EOB's).”

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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