Claims Enforcement Grace Period

Technical Release 2010-02 provides an enforcement grace period to July 1, 2011 in order to give plans more time to prepare to comply with certain provisions of the new claims requirements of the Affordable Care Act.

Document Excerpt

This technical release sets forth an enforcement grace period until July 1, 2011 with respect to some of the additional standards set forth in the interim regulations in order to give plans and issuers more time to implement procedures and make changes to computer systems in order to comply fully. Specifically, with respect to standards #2 (regarding the timeframe for making urgent care claims decisions), #5 (regarding providing notices in a culturally and linguistically appropriate manner), #6 (requiring broader content and specificity in notices), and #7 (regarding substantial compliance), the Department of Labor and the Internal Revenue Service (IRS) will not take any enforcement action against a group health plan, and HHS will not take any enforcement action, during the grace period, against a self-funded nonfederal governmental health plan, that is working in good faith to implement such additional standards but does not yet have them in place.(5) Similarly, HHS is encouraging States to provide similar grace periods with respect to issuers and HHS will not cite a State for failing to substantially enforce the provisions of part A of title XXVII of the PHS Act in these situations.


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