The Patient Protection and Affordable Care Act (“PPACA”) revised the standards that all non-grandfathered group health care plans must meet regarding their claims and appeals procedures. In July 2010, the Departments of Health and Human Services, Treasury, and Labor issued Interim Final Rules explaining PPACA’s revised standards. The Interim Final Rules modified, clarified and expanded the internal claims and appeals procedures that were already applicable to health plans that are covered by the Employee Retirement Income Security Act (“ERISA”).
The new standards set forth in PPACA and the Interim Final Rules technically became effective on September 23, 2010. However, in order to give plans time to implement the more burdensome new standards, the Department of Labor (“DOL”) created an enforcement grace period with regard to some (but not all) of the new claims and appeals procedures. Under the original enforcement grace period, the DOL said it would not enforce these new standards until July 1, 2011, as long as plans work in good faith to implement them.
On March 18, 2011, the DOL announced that it intends to modify the standards covered by the original enforcement grace period based on feedback received regarding the Interim Final Rules. Thus, rather than enforce rules that will most likely change, the DOL extended the enforcement grace period, as shown in the table below. In addition, the DOL removed the requirement that plans work in good faith to implement the standards covered by the grace period.
The chart on the following page summarizes the new internal claims and appeals standards required by PPACA, as well as the dates by which group health plans must comply with such standards.
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On March 16, 2011, the U.S. Citizenship and Immigration Services (“USCIS”) issued a memorandum addressing the exemption of certain tax-exempt entities from the annual quota on H-1B petitions, known as the “H-1B cap.” Under current immigration law, non-profit entities that are related to or affiliated with an institution of higher education are exempt from the H-1B cap, meaning that they can obtain approvals of H-1B petitions even if the annual quota on H-1B petitions has been reached. This exemption has proved particularly useful for hospitals seeking to employ foreign physicians and for many residency programs.
Until recently, the USCIS routinely approved cap-exempt H-1B petitions filed by hospitals based on contractual affiliations with institutions of higher education, such as agreements to provide training to medical students or residents. However, in early 2011, the USCIS began denying petitions that were filed as cap-exempt unless the petitioner could show a direct ownership relationship between it and an educational institution. Most hospitals could not meet this requirement.
In the March 16 memo, the USCIS stated that it is currently reviewing its policy on H-1B cap exemptions for non-profit entities that are related to or affiliated with an institution of higher education. In the meantime, entities that have received approvals of H-1B petitions on a cap-exempt basis since June 6, 2006, will continue to be treated as cap-exempt absent a significant change in circumstances or clear error in the prior adjudication. The USCIS stressed that these are only interim measures, but also indicated that it will engage the public in developing any future guidance.
A copy of the USCIS memorandum can be found here.
