HHS-Administered Federal External Review Process

The purpose of the HHS-administered Federal External Review Process (FERP) Statement of Work (SOW) is to detail the requirements necessary to provide consumers with external review services as required by the Affordable Care Act. The contractor shall conduct standard and expedited reviews of adverse benefit determinations and final internal adverse benefit determinations that are eligible for external review as described in the November 18, 2015 Final Rule. Additionally, the Contractor shall provide external reviews for drug exceptions as described 45 CFR 156.122 (c) and the 2016 Payment Notice for consumers in policies offered by issuers who are required to provide Essential Health Benefits (EHB) and are located in States eligible to participate in the HHS-administered FERP and have elected to do so.