Health >> Health Care Reform (PPACA) >> Other PPACA Provisions >> Claims and Appeals


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

Official Source Documents
Council Materials
Official Source Documents

November 13, 2015 — Tri-Agency Final Regulations on Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections

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

June 23, 2011 — Amendment to Interim Final Rule 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

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

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

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

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 — Revised Model Notice of Adverse Benefit Determination (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, 2010 — Fact Sheet on PPACA Internal Claims and Appeals and External Review Processes

Official Source Documents
Council Materials

June 27, 2011 — Council commends reexamination of PPACA claims & appeals, external review regulations
September 21, 2010 — Council welcomes new health care reform guidance