Health: Internal Claims and Appeals and External Review Procedures


Legislative — proposals, bills and analysis from 2006-present
Regulatory — administrative rules and information from U.S. offices and agencies
Judicial — current and past court cases and amicus briefs
Press Releases — Council statements and advisories to the news media
See Also — for related information



(Items in italic are available only to Council members.)

Council Materials

For legislative items — source documents and council materials — released prior to enactment of PPACA on March 23, 2010, please go to the PPACA Archive Page.

Click here for the Council's comprehensive chart highlighting
PPACA regulatory developments.

Official Source Documents

November 17, 2011 — DOL FAQs About Affordable Care Act Implementation Part VII and Mental Health Parity Implementation

June 23, 2011 — Amendment to Interim Final Rule on PPACA Internal Claims and Appeals and External Review Processes

June 23, 2011 — Notice of Proposed Rulemaking on PPACA Internal Claims and Appeals and External Review Processes

June 22, 2011 — DOL/HHS Technical Guidance on PPACA External Review Processes

June 22, 2011— HHS Technical Guidance for Self-Insured Plans on How to Elect a Federal External Review Process

June 22, 2011 — HHS Technical Guidance on Culturally and Linguistically Appropriate Standards under Internal Claims and Appeals and External Review Processes

April 1, 2011 — FAQs on PPACA Implementation Part VI

March 18, 2011 — DOL Technical Release 2011-01: Extension of Non-Enforcement Period Relating to Certain Interim Procedures for Internal Claims and Appeals under PPACA

December 22, 2010 — DOL FAQs About Affordable Care Act Implementation Part V and Mental Health Parity Implementation

November 18, 2010 — Request for Information Regarding PPACA Federal External Review Process

November 1, 2010 — FAQs about the Affordable Care Act Implementation Part IV

October 18, 2010 — FAQS about the Affordable Care Act Implementation Part III

October 8, 2010 — FAQS about the Affordable Care Act Implementation Part II

September 20, 2010 — DOL Technical Release 2010-02: Interim Procedures for Internal Claims and Appeals under the Patient Protection and Affordable Care Act

September 20, 2010 — FAQS about the Affordable Care Act Implementation Part I

September 20, 2010 — Revised Model Notice of Adverse Benefit Determination (Microsoft Word version | PDF version)

August 23, 2010 — Tri-Agency Guidance on PPACA External Review Processes

August 23, 2010 — DOL Technical Release 2010-1: Interim Procedures for PPACA Federal External Review

July 23, 2010 — Interim Final Rule on PPACA Internal Claims and Appeals and External Review Processes

July 23, 2010 — IRS Proposed Regulations by cross-reference to temporary regulations on PPACA Internal Claims and Appeals and External Review Processes

July 22, 20100 — Fact Sheet on PPACA Internal Claims and Appeals and External Review Processes

Official Source Documents
Council Materials

Council commends reexamination of PPACA claims & appeals, external review regulations
June 27, 2011

Council welcomes new health care reform guidance
September 21, 2010

Condition Critical: Ten Prescriptions for Reforming Health Care Quality, Cost and Coverage

Health Care Reform (PPACA)