On September 20, 2010, the United States Department of Labor issued Technical Release 2010-2, which provides further explanation of Interim Final Regulations issued on July 23 related to the appeals protections included in the Affordable Care Act.

The interim final rules make many changes to existing appeals procedures: they further expedite the appeals process in the case of urgent claims; they  include rescissions as part of adverse determinations that indivdiuals can appeal; they expand health plans’ and insurers’ duties to  provide claimants with all of the relevant evidence they consider; they add further protections against conflicts of interest; they add new language and content requirements to the notices that must be sent; and they specify that, if the plan or issuer fails to comply with the requirements of the rule, claimants will be treated as having exhausted their appeals obligations before proceeding in court.

The September 21st guidance clarifies that group health plans and insurers  that sell group policies have until July 1, 2011 to come into compliance with the new standards related to timeframes for urgent care decisions, and the notice  content and language requirements. The guidance also clarifies that during this grace period, normal exhaustion requirements will apply; that is, claimants will not be treated as having exhausted the appeals process if the insurer or plan is not in compliance with the new regulations.