The Department of Health and Human Services (HHS) releases a list that “indicates the preliminary determination regarding the external appeals review process in each State.” The external review process allows consumers to take their “appeal to an independent third-party for review of the insurer’s decision.” According to HHS, “States will have the opportunity to request reconsideration of these determinations,” and “if a State changes its external review process in the future, the State may request a new determination at any time.” According to the list, 10 states - Alabama, Alaska, D.C., Florida, Georgia, Louisiana, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Pennsylvania, Texas, West Virginia and Wisconsin – will be required to “ choose an HHS-administered process or contract with accredited independent review organizations to review external appeals on their behalf.” An additional 10 states were listed as having “similar” protections to those listed in the interim final rule published on July 23, 2010 which will apply until January 1, 2014, while 23 states were determined to have the strict standards required by HHS. Final determinations will be made by October 1, 2011.