Health Plan & Provider Report Index Summary

CALIFORNIA

– Arbitration, requirement not displayed before BC contract signature line unenforceable (Cal. Ct. App.), 480
– CalPERS

– – HMO premiums, 2009 lowest rate of increase in years, 701
– – Part D, retiree drug subsidy funds distributed to cities, 471
– – PPO premiums, small drop in 2009, 584

– Claims processing

– – Agencies fine PacifiCare, 117
– – ERISA requirements, widower challenging wife's delayed breast cancer treatment approval denied injunctive relief against BS (N.D. Cal.), 481
– – Timely hospital submission discussed, BNA Analysis, 308

– Electronic health records, state groups lead adoption but national progress minimal, reports, 122
– Fair share laws, San Francisco ordinance requiring employer-paid health coverage

– – ERISA preempts (N.D. Cal.), 21; injunction barring ordinance implementation stayed (9th Cir.), 66; en banc review will not be sought, 126; employer group asks Justice Kennedy to vacate stay (U.S., application filed), 211; (denied), 243; injunction reinstatement sought (9th Cir., amicus brief filed), 407
– – Implementation discussed, Special Reports, 102
– – Preemption standard critical, meeting, 452
– – Program enrollment, mayor reports over 18,000, 527

– Health insurance policy rescission

– – Agency regulations under review, 59
– – Arbitration, breast cancer patient whose plan acted in bad faith by rescinding coverage awarded millions, 245
– – Fraud, Los Angeles City Attorney sues Health Net for illegally terminating breast cancer patient's coverage (Cal. Super. Ct.), 245
– – Individual, governor undecided regarding regulatory response, hearing, 397
– – Kaiser, agreement with regulators reached for 1,000 members, 549; PacifiCare third plan to settle, 698
– – Oversight hearing, state regulator orders coverage reinstatement for some, 445
– – Plans must show enrollee deception (Cal. Ct. App.), 19; (pet for reh'g filed), 66; denied (Cal., rev sought), 173; (rev den), 378
– – Reducing incidence, bills passed, 609; senate panel approves, 700
– – Reinstated class action (Cal. Ct. App., vac and reh'g), 39; suit proceeds (revised opinion), 271; (Cal., rev den), 682

– High-risk pools, pending bill would boost, 346
– Hospitals

– – BCBS contract, Alvarado agreement valid despite ownership change (Cal. Super. Ct.), 590
– – Charges unrelated to actual costs, CalPERS study, 91
– – Discounts, no duty to disclose to patients availability of special rates (Cal. Ct. App.), 301
– – Emergency room balance billing, agency issues new rules, 398; more rules proposed, 525; physicians criticize proposed ban, 552
– – Out-of-network emergency room care, Kaiser sued over reimbursement rates (Cal. Super. Ct.), 247
– – Timely claims submission discussed, BNA Analysis, 308
– – Uninsured persons, fewer facilities now charge higher rates than for insured patients, study, 176

– Illegal postclaims underwriting, Los Angeles sues Wellpoint and BC subsidiaries (Cal. Super. Ct.), 445
– Indigent care, San Diego County means test challenged (Cal. Super. Ct.), 304
– Individual health insurance market

– – Pending bill would revise, 346
– – Underwriting standards, regulators to tighten, 373

– Malpractice, HMO cannot compel arbitration because language was not obvious on Kaiser enrollment form (Cal. Ct. App.), 301
– Managed care

– – Office of Admin. Law, timely patient access rules rejected for lack of uniformity, 294
– – Profits and overhead, over $10 billion in 2007, reports, 725

– Medi-Cal

– – Governor proposes $1 billion cuts, 92
– – Program cuts, lawmakers approve $1.6 billion, 235

– Mental health, comprehensive coverage bill passed, 608
– Money laundering, 6 interagency probe arrests in Los Angles scheme to defraud federal programs and private health insurers (Cal. Super. Ct.), 429
– Omnibus health care reform

– – Governor remains committed despite bill's senate panel rejection, 147
– – Legislation approved, 10
– – Mass. plan problems, consumer group says Cal. should consider experience, 35
– – Targeted bills introduced in light of comprehensive legislation failure, 295; some measures advancing, 609
– – Uninsured persons, ballot initiative to fund health coverage expansion, 34; initiative withdrawn, 237

– Physicians, HMOs pay groups millions for quality improvements, 271
– Prescription drug prices inflated, San Francisco sues distributor McKesson (D. Mass.), 590
– Uninsured persons, proposed class action settlement of nonprofit Scripps Health pricing dispute approved (Cal. Super Ct.), 158

CANCER

– ADA, discrimination claims of couple fired during son's treatments proceed under ERISA (10th Cir.), 531
– Brain, HMO must cover child's treatment costs (Wis.), 616
– Breast

See BREAST CANCER

– Clinical trials, new Wyo. law requires insurer coverage, 324
– Colorectal screening, new Me. coverage law, 400
– Drug spending, disease treatment one leading cause of increase, report, 680
– Multiple myeloma, commissioner need not follow independent review organization recommendation to cover out-of-network treatment (Mich.), 482
– Off-label drug use, compendia review addresses Medicare coverage decision needs, audio conference, 420

CARDIOLOGY

– Artificial hearts, CMS seeks comments on proposed reversal of Medicare noncoverage policy, 170
– Dependent son not enrolled, self-funded plan administrator did not abuse discretion by denying heart defects treatment coverage (U.S., rev den), 247
– Preventive care, Allina Hosp. & Clinics to develop Minn. center focusing on heart attacks, 681
– Wrongful discharge, ERISA does not preempt state claims over firing due to heart attack treatment costs (W.D. Mo.), 303

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

– Boston regional office, computer stolen from third-party vendor, 143
– Centers for Beneficiary Choices, renamed office to coordinate Part D and MA contracts, 638

CHARITY CARE

– Hospitals, interim D.C. attorney general sues CareFirst over failure to meet obligations (D.C. Super. Ct.), 728

CHILDREN'S HEALTH CARE

– Brain cancer, HMO must cover treatment costs (Wis.), 616
– Developmental screening, CIGNA to reimburse pediatricians, In Brief, 555
– Disabled persons, Ga. Medicaid must pay for medically necessary skilled in-home nursing care (N.D. Ga.), 683
– Newborns, improper N.Y. Medicaid overpayments for fee-for-service claims, audit, 648
– SCHIP

See STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP)

CHIROPRACTIC SERVICES

– Antitrust, settlement provides Conn. groups must not boycott cost-saving health plan (FTC), 282; consent order approved, 451
– Automobile insurance, class certification denied in provider suit over PIP claims payment caps (S.D. Fla.), 23

CHRONIC AND TERMINAL ILLNESS

– Demonstration projects, Medicare pilot ends, 143
– ESRD

See END-STAGE RENAL DISEASE (ESRD)

– Generic drug copayments, BCBS of N.C. waives for chronic illness, 38
– Medigap, RICO class action alleging insurer told agents to deny supplemental coverage for ill seniors dismissed in part (W.D. Ky.), 477
– N.C., standardized care and coverage agreement for 5 conditions, 400
– Out-of-pocket expenses, annual drug license fee payment proposed to reduce, study, 124

CLAIMS PROCESSING

– California

– – ERISA requirements, widower challenging wife's delayed breast cancer treatment approval denied injunctive relief against BS (N.D. Cal.), 481
– – Hospitals, timely submission discussed, BNA Analysis, 308
– – Unfair handling, agencies fine PacifiCare, 117

– Health insurance eligibility, higher paid account rates with routine verification, study, 178
– Inconsistent rules impact, report, 679
– Medically necessary services, final CMS rule allows Medicare determination prior to treatment, 231
– Medicare Part A and Part B, CMS awards contract for combined administration, 343
– Out-of-network care, Aetna agrees to reimburse students, 732
– Payment delays

See PROMPT PAYMENT

– S.D. health insurance filings, new standard document law, 264
– Unpaid benefits, CEO of successor self-insured plan liable (S.D. Ohio), 683

CLASS ACTIONS

– AWP

– – Groups oppose settlement with list publisher First Databank, 40; proposed settlement approval denied (D. Mass.), 128; damages suit certified over objections by FirstDatabank and distributor McKesson, 358; amended settlement filed, 658
– – Overcharges, 11 drug firms pay millions to settle multidistrict suit (D. Mass.), 303

– BCBS

– – Physicians, reimbursement settlement approved (S.D. Fla.), 477
– – Provider reimbursement, RICO conspiracy claims against 20 plans dismissed (S.D. Fla.), 658
– – Reinstated policy rescissions suit (Cal. Ct. App., vac and reh'g), 39; suit proceeds (revised opinion), 271; (Cal., rev den), 682

– Chiropractic services, class certification denied in provider suit over PIP claims payment caps (S.D. Fla.), 23
– Fla. Medicaid pilot, no notice to patients they could change plans for cause (S.D. Fla.), 127
– Medi-Cal and Denti-Cal reimbursement, provider suit to block cuts remanded to state court (Cal. Super. Ct.), 725
– Medigap, RICO suit alleging insurer told agents to deny supplemental coverage for ill seniors dismissed in part (W.D. Ky.), 477
– Pharmacies, drug stores suing insurer and PBM alleging underpayment certified (M.D. Ala.), 710
– SNFs, proposed suit over glucose test claim denial based on invalid local coverage determination dismissed (D.D.C.), 214
– Specialist pay, pathologists' suit against United Healthcare certified (Am. Arbitration Ass'n), 380
– Uninsured persons

– – Dismissal of proposed N.J. patients' suit upheld (3d Cir.), 735
– – Nonprofit Scripps Health pricing dispute, proposed settlement approved (Cal. Super Ct.), 158

CLINICAL LABORATORIES

– Jurisdiction, Part B competition pilot enjoined (S.D. Cal.), 429
– Pathology services, damages award for practice upheld where BCBS HMO withheld payments from hospital-based practice (Fla. Dist. Ct.), 478

CLINICAL TRIALS

– Cancer patients, new Wyo. law requires insurer coverage, 324

CMS

See CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

CODING

– Medical devices, no antitrust claim against professional groups over incontinence equipment designation (11th Cir.), 380
– Mental health, educational and psychiatric coverage arbitrarily denied for disabled son due to treatment center's billing practices (D. Colo.), 156

COLLEGES AND UNIVERSITIES

– Sexual orientation discrimination, school violated state law by denying same-sex marriage partner health coverage (N.Y. App. Div.), 216

COLORADO

– Health care reform

– – Budget request includes millions for expansion, 236; new law improves services for children, 496
– – Commission, lawmakers reject recommendations due to costs, final report, 175
– – Universal coverage, bill requiring study passed, 551

– Health insurance

– – Individual plan mandate, new law creates study process, 650
– – Premiums and rates, senate panel approves bill requiring insurer justification for increases, 496; passed, 523
– – Public-private partnerships for coverage expansion, senate bill passed, 470
– – Restitution for state law violators, approved house bill would authorize collection, 263
– – Standardized benefit cards, new law requires for state-regulated programs, 677

– HMOs, Kaiser pays millions to customers under agreement with state, 727
– Hospitals

– – Arbitration, motion to compel granted in suit over sale of 3 facilities (Colo. Dist. Ct.), 736
– – Attorney general approves sale of nonprofit Denver facilities to Catholic system, 34; suit to block transfer filed (Colo. Dist. Ct.), 101; suit dropped, 327; arbitration ordered, 736

– Malpractice awards, bill defeated, 523
– Medicaid

– – Nonprofit health partnership program for high-risk adults, Special Reports, 626
– – Nursing homes, no insurer duty to defend charges over submission of improper Medicare and Colo. Medicaid claims (10th Cir.), 708
– – SCHIP merger, reform panel recommends, 11

– Mental health, new law requires actuarially sound program payment rates, 427
– Prompt payment, house bill increasing penalties for delay passed, 497; lawmakers approve, 523; new law, 651

CONFERENCES AND MEETINGS

– Ed. Note: The Journal section of each issue provides a list of upcoming conferences and meetings and a list of documents available from BNA PLUS.
– AARP annual policy meeting, 195
– AHIP 2008 Law Forum, 292
– Alliance for Health Reform

– – April briefing, 406
– – May briefing, 583

– Am. Benefits Council meeting, 452
– Am. Health Ins. Plans

– – Annual meeting, 696; 705
– – 2008 Medicare Conf., 440; 442

– Am. Health Lawyers Ass'n teleconference, 63
– AMA House of Delegates annual meeting, 702
– Avalere Health audio conference

– – April, 420
– – January, 170

– BNA

– – Corporate compliance plans audio conference, In Brief, 587
– – Physician/hospital arrangements monitoring, audio conference, In Brief, 587
– – Preventable medical errors audio conference, In Brief, 615

– Cal. Hosp. Ass'n conference, 613
– Center for Business Intelligence 7th Strategic Medicare Compliance and Admin. Summit, 199
– 4th Annual World Cong. Leadership Summit on Medicare, 574
– FTC

– – Forum, 467
– – Public workshop, 474

– Health IT Now! Coalition conference, 200
– HHS forum, 321
– Integrated Healthcare Ass'n conference, 613
– Intl. Ass'n of Privacy Prof'l conference, 369
– Natl. Academy of Soc. Ins. conference, 150
– Natl. Alliance for Health Info. Tech. forum, 96
– Natl. Ass'n of Health Underwriters conference, 170
– PCMA/RxHub e-Prescribing Symposium, 575
– Robert Wood Johnson Found. forum, 15
– Self-Insurance Inst. of Am. legislative and regulatory conference, 289
– 3d Natl. Medicaid Cong., 644
– U.S. Chamber of Commerce seminar, 327
– World Health Care Cong., 464

CONFLICTS OF INTEREST

– Health insurance, case-by-case analysis required where ERISA plan both determines eligibility and pays benefits (U.S.), 707
– PBM, collateral estoppel doctrine no bar to D.C. disclosure law challenge (D.C. Cir.), 451

CONGRESS, U.S.

– Ed. Note: This heading is used for administrative actions only. For coverage of legislation by bill number, see LEGISLATION, FEDERAL. For information on measures not yet assigned numbers, see specific subject headings.

CONNECTICUT

– Antitrust, settlement provides chiropractic groups must not boycott cost-saving health plan (FTC), 282; consent order approved, 451
– Health insurance, Assurant Health settles regulator charges of wrongful short-term policy coverage denial (Conn. Ins. Dep't), 589
– HMOs, physician firing did not violate contract or state unfair trade practices law (Conn.), 68
– Out-of-network care, Aetna agrees to reimburse students for improper claims processing, 732
– Prescription drug prices, attorney general charges McKesson of conspiring with First Databank to inflate drug costs (D. Mass.), 620
– Purchasing pools, law to create would not affect state's pending insurance contracts, attorney general opinion, 647
– Reconstructive plastic surgeon, ERISA preempts state reimbursement claims for BCBS participant's child (D. Conn.), 534

CONSTITUTION, U.S.

– Due process, Part D beneficiaries' claims over premium withholding errors proceed against HHS (D. Mass.), 444
– Standing

See STANDING

CONSULTANTS

– Health insurance, N.Y. worker plan overpaid for outpatient services and facility fees, audit, 37

CONSUMER-DIRECTED PLANS

– Employer savings

– – Aetna study, 178
– – Increase likely with greater quality data access, report, 404

– Enrollment up, survey, 298
– Sustaining, educated enrollees required, brief, 95
– Uninsured persons, drop did not result from plan growth, survey, 350

CONSUMER PROTECTION

– Ill. Consumer Fraud Act, hospital did not violate by charging uninsured patients higher rates (Ill. App. Ct.), 480

CONSUMER SATISFACTION

– Electronic health records, customized health features and benefits preferred, survey, 704
– LSCs, growth to meet demands, Special Reports, 218
– Market trends

– – Greater health care choice and access sought, report, 241
– – Plan details, educating members increases ratings, study, 501

– Or. health insurance claims denials top complaint, report, 699
– Physicians

– – Profiles, Ill. Web site allows comparisons, 427
– – Ranking programs in demand, teleconference, 63

– URAC case management tool, public comments sought, 614

CONTRACTS AND CONTRACTORS

– BCBS

See generally BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Breach of contract

See BREACH OF CONTRACT

– CMS Boston regional office, computer stolen from third-party vendor, 143
– Hospitals

See generally HOSPITALS

– Medicare

See generally MEDICARE

– Physicians

See generally PHYSICIANS; SPECIALISTS

– State

See specific states

COPAYMENTS AND DEDUCTIBLES

– Generic drugs

– – Chronic illness, BCBS of N.C. waives copayments, 38
– – Independence BC of Pa. waives, 706

– High-deductible health plan tax credit, Ga. lawmakers approve bill, 424; new law, 525
– HMOs

– – Jurisdiction, lacking in suit alleging BlueChoice overcharges (E.D. Mo.), 181
– – Standing, beneficiaries cannot sue to recover overcharges (E.D. Mo.), 617

– Hospitals, insurers would pay uncollected balance under R.I. house-passed bill, 401
– Mass. physician rankings, medical society sues to halt state plan (Mass. Super. Ct.), 590
– Part D, arbitration award upheld for pharmacy chain that would not charge prohibited copayment as PBM ordered (D. Minn.), 619

CORPORATE COMPLIANCE PROGRAMS

– BNA audio conference, In Brief, 587

COST OF HEALTH CARE

– Copayments

See COPAYMENTS AND DEDUCTIBLES

– Discount cards and programs

See generally DISCOUNTS

– Employee

See generally EMPLOYEE BENEFITS

– Evidence-based care

See generally EVIDENCE-BASED MEDICINE

– Health delivery models Web site, In Brief, 450
– Hospitals

See generally HOSPITALS

– Imaging services, plans scrutinizing use, study, 240
– Information technology, savings unlikely without provider incentives modification, CBO report, 570
– Medical technology, half of spending increase due to advances, report, 142
– Medicare

See generally MEDICARE

– Out-of-pocket costs

See OUT-OF-POCKET EXPENSES

– Rates

See PREMIUMS AND RATES

– Research, comparative effectiveness

See generally QUALITY OF CARE

– Spending, CMS predicts $4.3 trillion by 2017, article, 266
– State issues

See STATE AND LOCAL GOVERNMENT; specific states

– Transparency

See generally TRANSPARENCY

– Uninsured persons, treatment delays drive expenses up, hearing, 441
– Unions, critics say UAW plan will fail absent cuts, 64
– Universal coverage, trillions in savings possible with concurrent federal health policies revision, study, 16
– Value-based reimbursement, key element of AHIP proposal, report, 614

COVERAGE AND REIMBURSEMENT POLICIES

– Clinical policy bulletins, Aetna CEO urges medical devices providers to check for reimbursement questions, meeting, 267
– Guaranteed individual coverage, AHIP proposes plan for states, 11
– Medicare

See generally MEDICARE

– Mental health services

See generally MENTAL HEALTH

– Preexisting conditions

See PREEXISTING CONDITIONS

CREDENTIALING

See ACCREDITATION AND CERTIFICATION

CRIMINAL PROSECUTION

– Fraud

See generally FRAUD AND ABUSE

– HIPAA, counseling center worker indicted for illegal disclosure of patient information (W.D. Okla.), 270