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Urgent Care Coverage Notification Requirement to Stay at 72 Hours

June 24, 2011
Related Topics: Miscellaneous Legal Issues, Benefit Design and Communication, Medical Benefits Law, Latest News

Revamped health care reform law regulations will keep in place a Labor Department rule on the amount of time to notify health plan enrollees of coverage decisions involving urgent care.

Last year, federal regulators said enrollees would have to be notified of an urgent care coverage decision within 24 hours of receipt of a claim.

That was a major change from a Labor Department rule imposed in 2000 that required such decisions and notification to be made with 72 hours of receipt of a claim.

But in a joint amendment to the 2010 regulations to be published in the June 24 Federal Register, the Health and Human Services, Labor and Treasury departments said that after considering the “costs and benefits of an absolute 24-hour decision-making deadline,” they will continue to allow plans to make notification of coverage decisions within 72 hours.

“At the same time, the departments underscore that the 72-hour time frame remains only an outside limit and that, in cases where a decision must be made more quickly based on the medical exigencies involved, the requirement remains that the decision should be made sooner than 72 hours after the receipt of the claim,” the agencies said in the rules.

Business groups applauded regulators for the change in position.

“You don’t want hasty coverage decisions” made to meet a deadline, said Steve Wojcik, vice president of public policy with the National Business Group on Health in Washington, D.C.  

Filed by Jerry Geisel of Business Insurance, a sister publication of Workforce Management. To comment, email


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