External Review Processes Standards

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According to a preliminary determination by the Department of Health and Human Services (HHS), 17 states, the District of Columbia, and 5 territories do not have external review process that meet HHS standards. HHS and the departments of Labor and Treasury issued an interim final rule (applying to non-grandfathered plans) in July 2010 that sets standards for internal appeals and external reviews that group and individual health insurance plans would have to follow under the ACA. Health insurers in jurisdictions that don't meet the federal standards will have to use an external review process set up by HHS or contract with an independent review organization.