Page:United States Statutes at Large Volume 124.djvu/914

 124 STAT. 888 PUBLIC LAW 111–148—MAR. 23, 2010 claims and appeals procedures (including urgent claims) set forth at section 2560.503–1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70256), and shall update such process in accordance with any standards established by the Secretary of Labor for such plans and issuers; and ‘‘(B) a health insurance issuer offering individual health coverage, and any other issuer not subject to subparagraph (A), shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures set forth under applicable law (as in existence on the date of enactment of this section), and shall update such process in accordance with any standards established by the Secretary of Health and Human Services for such issuers. ‘‘(b) EXTERNAL REVIEW.—A group health plan and a health insurance issuer offering group or individual health insurance cov- erage— ‘‘(1) shall comply with the applicable State external review process for such plans and issuers that, at a minimum, includes the consumer protections set forth in the Uniform External Review Model Act promulgated by the National Association of Insurance Commissioners and is binding on such plans; or ‘‘(2) shall implement an effective external review process that meets minimum standards established by the Secretary through guidance and that is similar to the process described under paragraph (1)— ‘‘(A) if the applicable State has not established an external review process that meets the requirements of paragraph (1); or ‘‘(B) if the plan is a self-insured plan that is not subject to State insurance regulation (including a State law that establishes an external review process described in para- graph (1)). ‘‘(c) SECRETARY AUTHORITY.—The Secretary may deem the external review process of a group health plan or health insurance issuer, in operation as of the date of enactment of this section, to be in compliance with the applicable process established under subsection (b), as determined appropriate by the Secretary.’’. (h) Subpart II of part A of title XVIII of the Public Health Service Act, as added by section 1001(5) of this Act, is amended by inserting after section 2719 the following: ‘‘SEC. 2719A. PATIENT PROTECTIONS. ‘‘(a) CHOICE OF HEALTH CARE PROFESSIONAL.—If a group health plan, or a health insurance issuer offering group or individual health insurance coverage, requires or provides for designation by a participant, beneficiary, or enrollee of a participating primary care provider, then the plan or issuer shall permit each participant, beneficiary, and enrollee to designate any participating primary care provider who is available to accept such individual. ‘‘(b) COVERAGE OF EMERGENCY SERVICES.— ‘‘(1) IN GENERAL.—If a group health plan, or a health insur- ance issuer offering group or individual health insurance issuer, provides or covers any benefits with respect to services in an emergency department of a hospital, the plan or issuer 42 USC 300gg–19a.