Health Plan & Provider Report Index Summary

DATABASES AND DATA BANKS

– AWP, settlements approved in class actions against prescription drug price database publishers (D. Mass.), 345; chain drugstores to appeal, 531; court approves McKesson accord, 951; pharmacy interest groups lose appeal (1st Cir.), 1065
– Breach notification

– – Mo., protected information includes health data under new law, 897
– – Tex., new law extends requirements to health information, 801

– Comparative effectiveness research, infrastructure is greatest need for $400 million allocated for HHS funding, report, 796
– Health insurers' deceptive practices, Senate panel releases report on database creation, 768
– HMOs

– – Computer theft of private data, 30,000 Kaiser workers affected, 191
– – Information technology, data management agreement with IBM cuts hundreds of Kaiser jobs, 352

– Laptop computer stolen from employee car has personal information on doctors, BCBSA confirms, 2026
– Medical records

See generally ELECTRONIC HEALTH RECORDS

– Out-of-network provider reimbursement

– – CIGNA and Aetna, AMA and state medical societies file class actions alleging knowing underpayment (D.N.J.), 184
– – Hospitals, Anthem BCBS sues over use of manipulated information to underpay (Cal. Super. Ct., C.D. Cal.), 921
– – UnitedHealth Group and N.Y. attorney general reach agreement on system revision, 57; similar agreement reached with WellPoint and CIGNA, 221; 2 more insurer agreements, 295; greater transparency needed, hearing, 369; group plans must adjust, consulting firm says, 390; Rockefeller (D-WVa) calls for probe of industry calculation methods, 405; Health Net pays to settle, 746
– – WellPoint sued over use of Ingenix data (C.D. Cal.), 381

– Prescription data mining

See PRESCRIPTION DATA MINING

– Provider data quality, errors and remedies described, BNA Analysis, 135

DEBT COLLECTION

– Interest rate violated state usury laws, state attorney general sues Allina Health Sys. (Minn. Dist. Ct.), 128
– Medical debt, cited in 62 percent of bankruptcy filings, study presented at hearing, 919

DECEPTIVE PRACTICES

– Cholesterol-lowering medications, state worker health plan sues Vytorin and Zetia makers (E.D. Pa.), 707
– Discount drug cards, company settles charges over marketing (Pa. Commw. Ct.), 192
– Health insurance, Senate panel releases report on database creation, 768
– Medigap policies, BCBS of Mich. warned, 16
– Zoladex pricing for AWP compendiums, AstraZeneca appeal of $12.9M judgment denied (1st Cir.), 1128

DEDUCTIBLES

See COPAYMENTS AND DEDUCTIBLES

DELAWARE

– BCBS, regulator fines insurer for consumer privacy violations resulting from printing error, 74
– Developmental screenings for infants and toddlers, governor signs mandated benefits bill, 1073
– Health insurance rate increases, new law allows state regulators to approve, 828
– SCHIP, governor signs bill expanding program, 1073
– Telemedicine, Prince Frederick, Md., hospital links to Wilmington tertiary care facility, 682

DEMONSTRATION PROJECTS

– CalPERS, risk sharing to cut costs and improve outcomes, 503
– Chronic illness

– – Care management, CMS ability to lead challenged by MedPAC, 305
– – Medicare disease management pilot shows limited impact of interventions, report, 33; AMA study confirms, 178

– Electronic health records, Fla. Medicaid pilot to provide patient access, 437
– Medical home pilot program, CIGNA partners with Tex. clinic, 1075
– Prescription drugs, 2-state BCBS/CVS pilot on giving instant access to prior authorizations, 570
– Uninsured persons, online N.C. pilot provides immediate price information for patients and doctors, 832

DENTAL CARE

– Dependents, plan acted arbitrarily to deny mentally disabled 23-year-old son's enrollment (N.D. Ill.), 387
– FEHBP, OPM proposes amended benefit rules, 671
– Low-income children access to services under Medicaid managed care needs to improve, GAO report, 1183
– Out-of-network care, ERISA claims over payment proceed against Wellpoint (S.D. Fla.), 126
– SCHIP reauthorization, CMS issues coverage guidelines to states, 2018

DEPENDENTS

– Fla. state university students, house passes bill requiring private insurance use, 503
– Group health care policy covering sole owner of real estate business and family members is ERISA plan (N.D.N.Y.), 101
– Mental health

– – Eating disorders, Horizon BCBS of N.J. settlement of coverage claims approved (D.N.J.), 494
– – Mentally disabled, medical and denial plan acted arbitrarily to deny 23-year-old son's enrollment (N.D. Ill.), 387
– – Residential treatment, claim over coverage denial barred (S.D.N.Y.), 347

– Pa. adult children, bill to expand coverage reaches senate floor, 416
– Speech therapy coverage, plan administrator violated ERISA by failing to provide participant with internal guidelines (7th Cir.), 287; (U.S., rev den), 1186
– Students, out-of-network care

See generally OUT-OF-NETWORK CARE

– Tex. college student health coverage bills passed, 716; vetoed, 744
– Young adults from 19 to 29, lawmakers urged to require health coverage under parents' plans, 946

DIABETES

– Obesity, Medicare covers bariatric surgery for some, 181

DIAGNOSIS-RELATED GROUPS (DRGs)

– ICD-10 transition, HHS delays rule implementation until 2013, 60; delay canceled, In Brief, 310

DIAGNOSTIC TESTS

See TESTS AND SCREENING

DIALYSIS

See END-STAGE RENAL DISEASE (ESRD)

DISABLED PERSONS

– Ariz. Medicaid, order upheld requiring state to improve home and community services for recipients (D. Ariz.), 531
– COBRA, ERISA does not preempt former casino worker's claim for additional medical payments (E.D. Mo.), 565
– Hawaii Medicaid, plan has no federal law claim against state over contract denial (9th Cir.), 862
– Long-term disability, ERISA plan participant may conduct discovery of conflicts related to history of medical reviewers who denied benefits claim (E.D. Ky.), 99
– Sponsor's ERISA claim against disability plan administrator for breach of fiduciary duty denied (7th Cir.), 1001
– Tex. Medicaid, UnitedHealth Group's Evercare contract terminated, 349
– Wrongful discharge, ERISA preempts disabled participant's claim but complaint amendment allowed for remand to state court (N.D. Va.), 10

DISCLOSURE

– AARP indemnity health plans, Grassley (R-Iowa) calls for limits data for policyholders, 486
– BCBS, Del. regulator fines insurer for consumer privacy violations resulting from printing error, 74
– HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Long-term care insurance, model marketing disclosures

See LEGISLATION, FEDERAL, S 1177

– PBM conflicts of interest, federal law preempts D.C. law (D.D.C.), 331
– Pa. Medicaid managed care agreements, nonprofit entitled to information under state's right to know law (Pa. Commw. Ct.), 714
– Speech therapy coverage, plan administrator violated ERISA by failing to provide participant with internal guidelines (7th Cir.), 287; (U.S., rev den), 1186
– Tennessee

– – Health insurance, new law, 717
– – PPOs, new law, 801

– Vytorin

– – Clinical study results delay caused plan losses, Merck employees ERISA claim can proceed (D.N.J.), 1064
– – Merck and Schering-Plough settle class action over failure to reveal unfavorable clinical test results (D.N.J.), 953

– Wash. discount plans, requirements under new law, 533
– Zetia, Merck and Schering-Plough settle class action over failure to disclose unfavorable clinical test results (D.N.J.), 953

DISCOUNTS

– Cal. medical plans

– – Cease and desist orders, state issues to 2 companies, 1069
– – Regulators to license, 713

– Deceptive prescription drugs card marketing practices charges (Pa. Commw. Ct.), 192
– Low-income persons, N.Y. drug card program, 387
– Medicaid rebates, Senate panel considers policy option, 615
– Provider reimbursement, Regence BS suit alleging members are not given negotiated rates dismissed absent provider participation in suit (W.D. Wash.), 710
– Wash., health plan disclosure requirements under new law, 533
– Wis. SeniorCare drug program, application filed for extension to 2012, 192

DISCOVERY

– HMO underpayment for services alleged in class action, sanction order vacated (3d Cir.), 1061
– Long-term disability, ERISA plan participant may conduct discovery of conflicts related to history of medical reviewers who denied benefits claim (E.D. Ky.), 99

DISCRIMINATION

– Domestic partners

See generally DOMESTIC PARTNERS

– Genetic data use

See generally GENETIC INFORMATION NONDISCRIMINATION ACT (GINA)

– Sex

See SEX DISCRIMINATION

DISEASE MANAGEMENT

– Autism

See AUTISM

– Cancer

See CANCER