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September 07, 2011 at 08:00 PM
Advocacy groups say proposed federal external review regulations could let self-insured health plans choose friendly independent review organizations (IROs).
The groups make that argument in a comment on an amendment to the interim final rule implementing the internal claims and appeals and external review processes provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
The interim final rule – which was developed by the U.S. Department of Health and Human Services, the Internal Revenue Service and the Employee Benefits Security Administration (EBSA) — applies to non-grandfathered group health plans, holders of individual health coverage and members of governmental health plans.
The amendment, released in June, creates a “safe harbor” for self-insured employer plans that are not subject to a state external review process or a process supervised by HHS.
The safe harbor will let self-insured plans start meeting the external review requirements by hiring accredited IROs.
Plans are supposed to contract with at least 2 IROs by Jan. 1, 2012, and at least 3 IROs by July 1, 2012, and assign cases to the IROs on a rotating basis.
Elizabeth Ysla Leight, a commenter from the Society of Professional Benefit Administrators (SPBA), Chevy Chase, Md., says plan administrators are having a hard time finding IROs and would like to see regulators push the compliance deadline back to July 1, 2013.
