Health Plan & Provider Report Index Summary

ABUSE

– Drugs and alcohol

ACCESS TO CARE

– Ages 55 to 64, insurance options including Medicare buy-in discussed, hearing, 395
– Delivery and efficiency, failures documented as system decline continues, report, 809
– Employer-based system cornerstone, Chamber of Commerce CEO says, 703
– Indigents

See INDIGENT CARE

– Individual insurance policies, most without group coverage do not buy, study, 179
– Medically underserved populations, proposed rule consolidates criteria and designation process, 261
– Policy, coalition recommends private-public sector reform efforts, report, 554
– Uninsured

See generally UNINSURED PERSONS

– Universal coverage

– – Colo. bill requiring study passed, 551
– – Ill. governor proposes business tax to fund, 238
– – N.J. subsidized care bill approved, 726
– – N.M. governor calls on lawmakers to pass requirement, 93; governor urges special session to pass limited reform measures, 912
– – N.Y. expansion project and policy changes, 202
– – Private insurance and Medicare elements combined, plan proposed, 208
– – Purchase requirement for individuals key, study, 151
– – San Francisco, efforts expanded, 805
– – Savings, trillions possible with concurrent federal health policies revision, study, 16

ACCREDITATION AND CERTIFICATION

– Electronic health records, board considers security standards, 842
– NCQA

See NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

– URAC

See UTILIZATION REVIEW ACCREDITATION COMMISSION (URAC)

– Wash. providers, new credentialing and discipline law, 372

ACQUISITIONS

See MERGERS AND ACQUISITIONS

ADA

See AMERICANS WITH DISABILITIES ACT (ADA)

ADEA

See AGE DISCRIMINATION IN EMPLOYMENT ACT (ADEA)

ADVERSE EVENTS

– Hospitals

– – Reporting, Wash. bill approved, 234; new law, 372
– – Serious preventable errors

– – – BNA audio conference, In Brief, 615
– – – Employer costs, $1.5 billion annually for surgeries, study, 867
– – – Pa. Medicaid, no reimbursement, 120
– – – Reduced payment, Pa. house passes bill, 402
– – – Surgery required, WellPoint will not charge patients, 403

– Medication errors, 10 percent of patients admitted to 6 Mass. community hospitals, study, 238
– Part D, CMS protocol guidance for researchers on requesting drug data information, 931
– Part D, final Medicare rule permits claims data sharing to identify safety issues, 572

AGE DISCRIMINATION IN EMPLOYMENT ACT (ADEA)

– EEOC issues retiree health benefits rule on Medicare-eligible recipients, 8
– HIPAA, patient records scored by medical technician suing former employer subject to discovery (W.D. Wash.), 981
– Medicare and retiree benefits coordination, federal statute not violated (U.S., rev den), 354

AGENCIES, FEDERAL

See specific agencies and departments

AHIP

See AMERICA'S HEALTH INSURANCE PLANS (AHIP)

AIDS AND HIV

– Testing, Cal. mandated coverage bill passed, 966

ALABAMA

– Prescription drugs, claim against insurer not arising under Medicare Act remanded to state court on jurisdictional grounds (M.D. Ala.), 182
– State workers, screening for common risk factors awareness program, 970

AMBULATORY CARE

– ASCs

– – Anti-assignment provision, no bar to out-of-network provider's ERISA claims (D.N.J.), 302
– – N.Y. public employee plan, Long Island facility overcharged, audit, 499

AMERICAN MEDICAL ASSOCIATION (AMA)

– Health insurance payroll tax exemption, group supports continuation, meeting, 702
– Medicare providers, physician pay cuts cancellation

See LEGISLATION, FEDERAL, S 2785

– Out-of-network care, injunction request denied in RICO suit over United Healthcare payment practices (S.D.N.Y.), 1006

AMERICANS WITH DISABILITIES ACT (ADA)

– Cancer, discrimination claims of couple fired during son's treatments proceed under ERISA (10th Cir.), 531

AMERICA'S HEALTH INSURANCE PLANS (AHIP)

– Comparative effectiveness institute, key element of cost reduction proposal, report, 614
– Guaranteed individual coverage, plan for states proposed, 11
– HSAs, 6 million covered in 2008, report, 493
– Medicare Advantage

– – Industry agrees to focus on marketing reforms, report, 283
– – Special needs plans, Congress should lift moratorium, report, 473

ANALYSIS AND PERSPECTIVE

– Cal. hospitals, timely claims submission discussed, 308
– E-prescriptions, federal endorsement of incentives to encourage use, 820
– Electronic health records, privacy and security rules adequacy discussed, 621; HHS workgroup recommendations may include HIPAA revisions, 957
– Employer quality improvement initiatives, legal issues related to information collection by race and ethnicity, 760
– Genetic Information Nondiscrimination Act, scope and employer restrictions discussed, 592; correction, 606
– HIPAA Transactions of Code Sets standards and Privacy Rule, patient benefits not realized, 507
– Medicare Improvements for Patients and Providers Act, Part D and MA changes described, 815
– Trauma care, recurring hospital reimbursement issue, 381

ANESTHESIA SERVICES

– Colonoscopies, new Del. mandated benefit law, 837

ANTI-KICKBACK LAWS

– Physician/hospital arrangements monitoring, BNA audio conference, In Brief, 587

ANTITRUST

– Chiropractic services, settlement provides Conn. groups must not boycott cost-saving health plan (FTC), 282; consent order approved, 451
– Hospitals

– – Evanston Northwestern Healthcare

– – – Managed care contracts with government payers, order sets negotiating terms (FTC), 461
– – – Sherman and Clayton Act, claims by individuals injured by merger proceed (N.D. Ill.), 657

– – Inova Health Sys. Found./Prince William Health Sys. merger challenged (FTC), 532; plan abandoned (E.D. Va.), 645

– Ill. CON laws deter competition, Justice Dep't and FTC statement, 1025
– Independent pharmacies negotiating prices

See LEGISLATION, FEDERAL, HR 971

– LSCs, proposed Ill. regulatory bill may have negative impact on competition, FTC analysis, 642
– Medical devices, coding designation for incontinence equipment proper (11th Cir.), 380
– PBMs, online prescription vendor's suit against Medco and Caremark dismissed (E.D. Tex.), 333
– PPOs

– – DME, network agreement with suppliers legal (6th Cir.), 535
– – Radiology services, excluded providers' monopolization claim properly dismissed (9th Cir.), 588
– – Specialty hospital, managed care contract interference suit settled (D. Kan.), 355

– Price fixing

– – Arbitration, insurer clauses in physician contracts enforceable (Mo. Ct. App.), 812; correction, 897
– – Generic drugs, damages for insurers where maker retained anxiety medication supplies (D.D.C.), 155
– – Tex. medical group, FTC finding of illegal contract negotiation upheld (5th Cir.), 556

ANY WILLING PROVIDER (AWP) LAWS

– Pharmacists and pharmacies, ERISA preempts claim alleging plans violated Tex. law by denying out-of-network coverage (5th Cir.), 918
– Provider excluded from network, damages suit against affiliated insurers proceeds (E.D. Ark.), 22

APPEALS

– Medicare providers and suppliers, rule published, 746
– Part D

See MEDICARE DRUG COVERAGE

ARBITRATION

– BC of Cal., requirement not displayed before contract signature line unenforceable (Cal. Ct. App.), 480; (Cal., rev den), 780
– Breast cancer, patient whose plan acted in bad faith by rescinding coverage awarded millions, 245; Health Net of Cal. agrees to pay fine and change practices, 997
– Hospitals, motion to compel granted in suit over sale of 3 facilities (Colo. Dist. Ct.), 736
– Malpractice, HMO cannot compel because language was not obvious on Kaiser enrollment form (Cal. Ct. App.), 301
– Part D, award upheld for pharmacy chain that would not charge prohibited copayment as PBM ordered (D. Minn.), 619
– Price fixing, insurer clauses in physician contracts enforceable (Mo. Ct. App.), 812; correction, 897
– Prompt payment, N.J. decisions posted on Web site, 234
– Specialist pay, pathologists' class action against United Healthcare certified (Am. Arbitration Ass'n), 380
– Trauma care, recurring hospital reimbursement issue, BNA Analysis, 381

ARIZONA

– BCBS, 87 percent surveyed say health needs improvement, report, 120
– Hospitals, full rate payment due from insurer without contract (Ariz., rev den), 68
– Medicare personal health records pilot, 908

ARKANSAS

– Provider excluded from network, damages suit against affiliated insurers proceeds under AWP statute (E.D. Ark.), 22

ASCs (AMBULATORY SURGICAL CENTERS)

See AMBULATORY CARE

ATTORNEYS

– Corporate compliance programs, revised Justice Dep't guidelines on attorney-client privilege waivers, 962
– Right to counsel, BCBS billing fraud trial postponement denial deprived DME supplier (Ala.), 452

ATTORNEYS' FEES

– Retiree benefits, no award for employer-sponsored plan that is secondarily liable for medical expenses (E.D. Mich.), 712

AUDITS

– Dependent eligibility, employer benefits costs can be cut, Special Reports, 1011
– Health insurance, New York

– – ASCs, Long Island facility overcharged public employee plan, 499
– – Outpatient consultant services and facility fees, state worker plan overpaid, 37

– Medicaid

– – Ky. reforms, savings unclear due to inconsistent reporting, audit, 11
– – Newborns, improper N.Y. fee-for-service claims, 648

– Medicare Recovery Audit Contractor Program, small business providers report negative experiences, hearing, 545
– PBM, Tex. contract revisions to increase agency authority recommended, report, 998

AUTOMOBILE INSURANCE

– No-fault insurer, ERISA preempts Mich. coordination of benefits law (E.D. Mich.), 352
– PIP, class certification denied in chiropractors' suit over payment caps (S.D. Fla.), 23

AVERAGE WHOLESALE PRICE (AWP)

– Overcharges, 11 drug firms pay millions to settle multidistrict class action (D. Mass.), 303; consumer claims submission allowed, 1010
– PBM, not an ERISA fiduciary absent discretionary authority to set drug and rebate prices (E.D. Mo.), 894
– RICO

– – Conn. attorney general charges McKesson of conspiring with First Databank to inflate drug costs (D. Mass.), 620
– – Groups oppose class action settlement with list publisher First Databank, 40; proposed settlement approval denied (D. Mass.), 128; damages suit certified over objections by First Databank and distributor McKesson, 358; amended settlement filed, 658; objections filed to second proposed agreement, 757
– – San Francisco sues distributor McKesson (D. Mass.), 590

– Utah Medicaid, state's claims remanded in multidistrict suit (D. Mass.), 711

AWP

See AVERAGE WHOLESALE PRICE (AWP)