Legislative updates

Affordable Care Act - U.S. Department of Health and Human Services (HHS)

Preexisting conditions

Children under 19 cannot be denied coverage because of a pre-existing condition for policy years beginning on or after September 23, 2010. These questions and answers will assist issuers with implementation of the requirement.

Beginning in 2014, no one with a pre-existing condition will be excluded from coverage. Until then, uninsured Americans with pre-existing conditions may be covered by the Pre-Existing Condition Insurance Plan (PCIP), which makes coverage available at the same rate as for an individual who does not have such a condition. The program, funded by the federal government, is temporary and will last until 2014.

The U.S. Dept. of Health and Human Services (HHS) issued an interim final regulation on July 30 laying out the rules for the PCIP program.

The regulation describes the options for determining who has a pre-existing condition, how to verify citizenship, and how an individual can appeal a PCIP decision. It also details how federal funding will be allocated, ways to prevent "dumping" of already-insured people into the program, and strategies to prevent fraud. The regulation also lists the benefits that can and can't be covered under this temporary federal program. Covered benefits include hospitalization, outpatient care, maternity care, and hospice and home health care. 

Right to appeal Insurance Plan decisions

New rules give consumers the right to appeal decisions by their health plans. The interim final rules give consumers:

• The right to appeal decisions made by their health plan through the plan’s internal process.
• The right to appeal decisions made by their health plan to an outside, independent decision-maker, no matter what state consumers live in or what type of health coverage they have.

DOT issues final rule on drug and alcohol testing policy

A final rule amending Department of Transportation drug testing procedures to make them consistent with some Department of Health and Human Services' requirements is scheduled to go into effect Oct. 1, according to DOT's Office of Drug and Alcohol Policy and Compliance.

A notice published in the Aug. 16 Federal Register said some changes will affect the procedures for laboratory testing of urine specimens and the roles of and standards for medical review office.

Form I-9: The U.S. Department of Homeland Security (DHS)

On July 22, 2010, DHS published a final rule in the Federal Register amending an interim final rule on the electronic signature and storage of the Form I-9. Like the interim final rule, the final rule permits employers to complete, sign, scan and store the Form I-9 electronically, as long as certain performance standards set forth in the final rule for the electronic filing system are met.

DHS noted that the final rule makes minor modifications to the interim final rule to clarify that employers:

• Must complete a Form I-9 within three business—not calendar—days.
• May use paper, electronic systems or a combination of paper and electronic systems.
• May change electronic storage systems as long as the systems meet the performance requirements of the regulations.
• Need not retain audit trails for each time a Form I-9 is viewed electronically, but only when the Form I-9 is created, completed, updated, modified, altered or corrected.
• May provide or transmit a confirmation of a Form I-9 transaction but are not required to do so unless the employee requests a copy.