Christy Tinnes will participate in the EBIA webinar, “Appeals and External Review for Self-Funded Health Plans: Where the Rules Stand Now,” on Wednesday, September 28, 2011 from 1:00-2:30 p.m. ET. Topics to be covered include:
- What health plans are affected (including exceptions for grandfathered plans and “excepted benefits,” like limited-scope vision and dental plans, and most health FSAs).
- Now that the scope of review has been narrowed by the amended regulations, what types of claims are subject to external review? What open issues remain?
- The amended regulations also impose a new “culturally and linguistically appropriate” standard, based on county-by-county language statistics from the census bureau: Which employer plans are affected, and what new administrative requirements may be created?
- How do the enforcement grace periods work: Which requirements are effective later and which ones must be followed now?
- What are the biggest challenges for complying with the external review rules (including notices, performing the preliminary review, and contracting with IROs)?
- How to create a checklist of notice content requirements.
- How do the amended regulations change the strict compliance rule, and what are the consequences of noncompliance?
