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Proposed Regulations Implementing 90-Day Waiting Period Limitation under PPACA

The federal Departments of Health and Human Services, Treasury, and Labor (collectively, the ?Ç£Departments?Ç¥) recently issued proposed regulations (the ?Ç£Proposed Regulations?Ç¥) implementing the 90-day waiting period limitation (the ?Ç£90-Day Limit?Ç¥) under the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥) and also proposing amendments to existing portability regulations under the Health Insurance Portability and Accountability Act of 1996 (the ?Ç£HIPAA Regulations?Ç¥) to conform those regulations to PPACA?ÇÖs requirements.?á PPACA provides that, effective for plan years beginning on or after January 1, 2014, grandfathered and non-grandfathered group health plans (both insured and self-funded) and health insurance issuers are prohibited from applying a waiting period for coverage that exceeds the 90-Day Limit.?á The definition of ?Ç£waiting period,?Ç¥ as currently in effect under the HIPAA Regulations and adopted by the Proposed Regulations, is the timeframe imposed by a plan or insurance policy that must pass before coverage for an eligible employee or dependent becomes… Continue Reading

Temporary Standards for State-Administered External Review Processes under PPACA Extended until 2016

The Departments recently issued Technical Release 2013-01, which extended transitional relief that was set to expire on January 1, 2014, permitting the use of temporary standards for state-administered external review processes required under PPACA.?á Until January 1, 2016, the Departments will consider non-grandfathered group health plans and health insurance issuers, in both the group and individual markets, to be compliant with PPACA?ÇÖs state external review process standards, even if the external review process does not include all of the consumer protection standards required by PPACA, if the plans or issuers comply with a state-administered external review process that otherwise complies with the temporary standards established in Technical Release No. 2011-02. Technical Release 2013-01 can be found here. Technical Release 2011-02 can be found here.

March 2013