Previously, on July 23, 2010, DOL, HHS and Treasury issued interim final rules regarding the claim and appeal requirements under the Affordable Care Act. These new requirements will apply to all non-grandfathered plans beginning January 1, 2011 (for calendar year plans). Yesterday, DOL updated the rules by releasing two additional pieces of guidance - new Federal external appeal rules for self-insured plans and model notices for all plans. The Federal external appeal rules are contained in Technical Release 2010-01 and require self-insured plans to follow a new mandatory external appeal process, once participants complete the internal claim and appeal process. DOL also issued three model notices for adverse determinations of internal claims, internal appeals and external appeals. These notices are commonly referred to as Explanations of Benefits (or EOBs). Based on the claim and appeal rules, as well as the new guidance released yesterday, it is clear that significant changes will be needed with respect to the claims and appeals process for non-grandfathered plans. Plan sponsors will need to make certain their TPAs and other claim fiduciaries can accommodate the new external appeal and notice requirements. The DOL Technical Release can be found here: http://www.dol.gov/ebsa/pdf/ACATechnicalRelease2010-01.pdf
While we are pleased to have you contact us by telephone, surface mail, electronic mail, or by facsimile transmission, contacting Kilpatrick Townsend & Stockton LLP or any of its attorneys does not create an attorney-client relationship. The formation of an attorney-client relationship requires consideration of multiple factors, including possible conflicts of interest. An attorney-client relationship is formed only when both you and the Firm have agreed to proceed with a defined engagement.
DO NOT CONVEY TO US ANY INFORMATION YOU REGARD AS CONFIDENTIAL UNTIL A FORMAL CLIENT-ATTORNEY RELATIONSHIP HAS BEEN ESTABLISHED.
If you do convey information, you recognize that we may review and disclose the information, and you agree that even if you regard the information as highly confidential and even if it is transmitted in a good faith effort to retain us, such a review does not preclude us from representing another client directly adverse to you, even in a matter where that information could be used against you.