The establishment of effective internal and external appeals processes is critical to the implementation and effectiveness of patient protections. We believe that these functions are best provided at the state and local level. NCSL urges you to explore options that would permit federally-regulated plans to participate in appeals processes established in the states where they are located. This could be done through cooperative agreements between the states and the Department of Labor. Provide adequate time for state legislatures to take necessary actions to implement the federal law.
State legislatures are often out of session when major federal legislation is enacted.
In cases where state legislative action is desired or required, that action is delayed until the legislature reconvenes for its next regular session. We believe it is helpful to recognize this reality and to make accommodations for it in federal legislation. NCSL recommends that states should have at least one regular session of the legislature to make changes in state law and regulation related to this legislation that may be required to maintain state enforcement. Establish a clear procedure for the establishment of federal enforcement of some or all provisions of the Act in cases where a state opts for federal enforcement of any of the provisions of the Act. In the event that sufficient transition time is not provided for or that a state opts to have federal enforcement of some of the provisions of this legislation, NCSL recommends the Act establish a mechanism for notifying patients regarding what enforcement authority is responsible for enforcing the various patient protections.