ER Regulations: Key Requirements

October 24, 2019

 

Does the state have an ER provision?

Timeframe Standard Appeals

Timeframe Expedited Appeal

Timeframe Experimental Appeal

ACA Compliant?

Alabama

No No

Alaska

Yes 45 days 72 hours 20 days Yes, NAIC-parallel

Arizona

Yes 21 days (medical necessity);15 days (coverage) 72 hours  (medical necessity); 2 days (coverage) No provision. Yes, meets similar

Arkansas

Yes 45 working days 72 hours 20 days (standard); 5 days or 48 hours, if not in writing (expedited) Yes, meets parallel

California

Yes 30 days 3 days 7 days (expedited) Yes, meets parallel

Colorado

Yes 45 calendar days 72 hours No provision. Yes, meets parallel

Connecticut

Yes 45 days 72 hours; 24 hours (behavioral health) 20 days (standard); 5 days (expedited) Yes, meets parallel

Delaware

Yes 45 days 72 hours No provision. Yes, meets similar

DC

Yes 45 calendar days 72 hours No provision. Yes, meets similar

Florida

No No

Georgia

Yes 15 working days 72 hours 15 working days (standard); 72 hours (expedited) No

Guam

No No

Hawaii

Yes 45 working days 72 hours 20 days (standard); 48 hours (expedited) Yes, meets parallel

Idaho

Yes 42 days 72 hours No provision. Yes, meets parallel

Illinois

Yes 45 days 72 hours 20 days (standard); 5 calendar days (expedited) Yes, meets parallel

Indiana

Yes 15 business days 72 hours No provision. Yes, meets similar

Iowa

Yes 45 days 72 hours 20 days Yes, meets parallel

Kansas

Yes 30 business days 72 hours No provision. Yes, meets parallel

Kentucky

Yes 21 calendar days 24 hours 21 calendar days (standard); 24 hours (expedited) Yes, meets parallel

Louisiana

Yes 45 days 72 hours 20 days (standard); 48 hours (expedited) Yes, meets parallel

Maine

Yes 30 days 72 hours No provision. Yes, meets parallel

Maryland

Yes 45 days 20 hours No provision. Yes, meets parallel

Massachusetts

Yes 45 calendar days 72 hours No provision. Yes, meets parallel

Michigan

Yes 7 days (medical issue); 14 days (coverage) 24 hours 7 days (medical issue); 14 days (coverage) Yes, meets parallel

Minnesota

Yes 45 days 72 hours No provision Yes, meets parallel

Mississippi

Yes 45 days 72 hours 20 days Yes, meets parallel

Missouri

Yes 25 calendar days 72 hours No provision. Yes, meets parallel

Montana

Yes 45 days 72 hours 20 days (standard); 48 hours (expedited) Yes, meets parallel

Nebraska

Yes 45 days 72 hours 20 days (standard); 5 calendar days or 48 hours, if not in writing (expedited) Yes, meets parallel

Nevada

Yes 15 days 48 hours 20 days (standard); 5 calendar days (expedited) Yes, meets parallel

New Hampshire

Yes 20 days 72 hours No provision. Yes, meets parallel

New Jersey

Yes 90 days No provision. No provision. Yes, meets parallel

New Mexico

Yes 20 days 72 hours or 48 hours, if telephone notification No provision. Yes, meets similar

New York

Yes 30 days 72 hours 30 days (standard); 72 hours (expedited) Yes, meets parallel

North Carolina

Yes 45 days 3 days 45 days (standard); 3 days (expedited) Yes, meets parallel

North Dakota

Yes 45 days 72 hours No provision. Yes, meets parallel

Ohio

Yes 30 days 72 hours 30 days (standard); 72 hours (expedited) Yes, meets parallel

Oklahoma

Yes 45 days 72 hours No provision. Yes, meets parallel

Oregon

Yes 30 days 72 hours 30 days (standard); 72 hours (expedited) Yes, meets parallel

Pennsylvania

Yes 60 days 2 business days No provision. No

Puerto Rico

Yes 45 days 72 hours 20 days Yes, meets parallel

Rhode Island

Yes 10 calendar days 72 hours 10 calendar days (standard);72 hours (expedited) Yes; meets parallel

South Carolina

Yes 45 days 72 hours No provision. Yes, meets parallel

South Dakota

Yes 45 days 72 hours 20 days (standard); 48 hours (expedited) Yes, meets parallel

Tennessee

Yes 40 days 72 hours 20 days Yes, meets parallel

Texas

Yes 15-20 days 3 days No provision. Yes, meets similar

Utah

Yes 45 calendar days 72 hours 20 calendar days (standard); 48 hours (expedited) Yes, meets parallel

Vermont

Yes 30 days 3 days 30 days (standard); 3 days (expedited) Yes, meets parallel

Virgin Islands

No No

Virginia

Yes 45 working days 72 hours 20 days (standard); 7 days (expedited) Yes, meets parallel

Washington

Yes 15-25 days 72 hours 15-25 days (standard); 72 hours (expedited) Yes, meets parallel

West Virginia

Yes 45 days 72 hours  20 days (standard); 48 hours (expedited) Yes, meets parallel

Wisconsin

Yes 30 business days 72 hours 30 days (standard); 72 hours (expedited) No

Wyoming

Yes 45 days 72 hours No provision. Yes, meets similar