2045
HR 3590 EAS/PP
pital, including for diagnosis-related groups established
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under section 1886(d)(4) of the Social Security Act.''.
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(g) Section 2719 of the Public Health Service Act, as
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added by section 1001(4) of this Act, is amended to read
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as follows:
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``SEC. 2719. APPEALS PROCESS.
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``(a) I
NTERNAL
C
LAIMS
A
PPEALS
.--
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``(1) I
N GENERAL
.--A group health plan and a
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health insurance issuer offering group or individual
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health insurance coverage shall implement an effective
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appeals process for appeals of coverage determinations
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and claims, under which the plan or issuer shall, at
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a minimum--
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``(A) have in effect an internal claims ap-
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peal process;
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``(B) provide notice to enrollees, in a cul-
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turally and linguistically appropriate manner,
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of available internal and external appeals proc-
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esses, and the availability of any applicable of-
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fice of health insurance consumer assistance or
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ombudsman established under section 2793 to as-
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sist such enrollees with the appeals processes;
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and
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``(C) allow an enrollee to review their file,
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to present evidence and testimony as part of the
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