S.Amdt. 2919

SA 2919. Mr. MENENDEZ submitted an amendment intended to be proposed
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 33, strike line 5 and all that follows
through line 4 on page 34 and insert the following:

``SEC. 2719. APPEALS PROCESS.

``(a) Internal Claims Appeals.--A group health plan and a
health insurance issuer offering group or individual health
insurance coverage shall implement an effective appeals
process for appeals of coverage determinations and claims,
under which the plan or issuer shall, at a minimum--
``(1) have in effect an internal claims appeal process;
``(2) provide notice to enrollees, in a culturally and
linguistically appropriate manner, of available internal and
external appeals processes, and the availability of any
applicable office of health insurance consumer assistance or
ombudsman established under section 2793 to assist such
enrollees with the appeals processes; and
``(3) allow an enrollee to review their file, to present
evidence and testimony as part of the appeals process, and to
receive continued coverage pending the outcome of the appeals
process.
``(b) External Review.--A group health plan and a health
insurance issuer offering group or individual health
insurance coverage--
``(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
paragraph (1)).''.
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