Health Plan & Provider Report Index Summary

E-HEALTH

– Personal electronic medical records

– Prescriptions, electronic

E-PRESCRIPTIONS

– CalPERS pilot project, 387
– Colo. panel recommends increased use, report, 534
– Medicare and Medicaid payments, maximized if practice is used by 2011, 738; standards advisory panel recommendations expected in 60 days, 769
– Natl. eHealth Collaborative, leaders of successor to HHS advisory board meets with technology institutions to prioritize agenda, 75
– Part D

– – Community pharmacists want federal incentives, 489
– – Technical issues prevent plan sponsors from complete implementation of standards in 2008, survey finds, 2012

– Physician financial incentives to adopt information technology will increase use, study, 351

EATING DISORDERS

– Horizon BCBS of N.J., settlement of coverage claims for dependents approved (D.N.J.), 494
– Out-of-network care, claim over denial of residential treatment barred (S.D.N.Y.), 347

EBSA

See EMPLOYEE BENEFITS SECURITY ADMINISTRATION (EBSA)

ECONOMY

See generally HEALTH CARE REFORM, FEDERAL

EDUCATION AND TRAINING

– Gifts for medical students and staff

See generally GIFTS

EEOC

See EQUAL EMPLOYMENT OPPORTUNITY COMMISSION (EEOC)

ELECTRONIC HEALTH RECORDS

– American Recovery and Reinvestment Act

– – CMS to propose rules in 2009, 525
– – Incentives for adoption outlined, webinar, 410
– – Timetable, national information technology coordinator says adjustment may be necessary, 587

– BCBS, Highmark funding for small primary care practices, 571
– CalRHIO exchange initiative, UnitedHealthcare supports, 653
– Claims processing, savings expected under new Minn. billing law, 866
– Colo. panel recommends increased use, report, 534
– Consumer notice of security breaches, proposed FTC rule, 453; commission urged to adopt HHS approach, 668; final rule issued, 973; interim final HHS rule includes delayed enforcement date and risk of harm notification threshold, 995; harm provision, House committees leaders urge HHS to revise, 1180
– Data exchanges increase, survey, In Brief, 902
– Florida

– – Medicaid pilot provides patient access, 437
– – Patient release form development, new law, 776

– Grants, state agency provides for Los Angeles County, 223
– Hospitals, 1 in 10 only, survey, 389
– Incentive arrangements, provider payments exceeding $45 billion predicted, symposium, 793
– Loan program, new La. implementation law, 868
– Md. provider incentives bill passed, 502; new law, 625
– Natl. eHealth Collaborative, leaders of successor to HHS advisory board meets with technology institutions to prioritize agenda, 75; advisory panel nominees sought, 308
– N.M., part of reform plan passed, 388; new law, 416
– Privacy

See PRIVACY AND CONFIDENTIALITY

– Provider data

– – Insurer exchanges could save billions, study, 683
– – Quality, errors and remedies described, BNA Analysis, 135

– Security protocols, CMS says health care organizations should strengthen, meeting, 795
– State participation, rapid action required to tap $19 billion federal stimulus funds, meeting, 265; careful choices and incremental approach best, article, 285

EMERGENCY SERVICES

– Balance billing

– – Banned for managed care plans (Cal.), 41; impact explored, BNA Analysis, 393
– – Lawsuits expected to increase in light of recent Cal. rulings, 219

– BCBS

– – GM participants over Mich. coverage denials, no ERISA fiduciary duty breach claim (E.D. Mich.), 413
– – Unethical tactics to deter use, Bayonne Hosp. sues Horizon (D.N.J.), 891

– ERISA, no preemption of state law requiring plans to reimburse providers for member care (Cal. Ct. App.), 593
– LSCs, some relief for hospital departments but regulatory challenges problematic, 227
– Managed care of Medi-Cal beneficiaries, delegation of responsibility for payments to providers disallowed (Cal. Super. Ct.), 1070
– Texas

– – Free-standing clinics, new law regulates, 744
– – Standing, physicians' challenge to contracts barred (Tex. Ct. App.), 162

EMPLOYEE BENEFITS

– Ed. Note: This heading covers employer-provided health insurance unless otherwise indicated.
– Cafeteria plans

– – Attorneys at conference suggest employers be ready to understand and implement reform changes, 2013
– – Tax code Section 125 discussed, CRS report, 947

– Chronic illness, company costs increased 30 percent in 2008, survey, 318
– COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Consumer-directed plans

See generally CONSUMER-DIRECTED PLANS

– Cost increases

– – 6 percent for employers in 2009, survey, 226
– – 10 percent predicted for employers in 2010, survey, 748

– Deductibles

See generally COPAYMENTS AND DEDUCTIBLES

– Domestic partners

See generally DOMESTIC PARTNERS

– Eligibility audits expanding to cut costs, report, 225
– Employee Retirement Income Security Act

See generally ERISA

– Employer-based system

– – Bipartisan Affordable Health Choices Act, proposed draft bill imposes major employer requirements, Special Report, 984
– – Family coverage, average cost exceeds $12,000 annually, HHS data, 901
– – Federal reform legislation would increase regulation and hinder cost control efforts, webcast, 884
– – Protection and improvement, health insurer alliance, 859
– – Recommended basis of health care reform, report, 75

– Employer health coverage mandate

– – Efficacy challenged, study, 351
– – Job losses would result, study, 132
– – Wal-Mart and SEIU, support expressed in letter to White House, 804

– Federal Long Term Care Insurance Program with automatic compound inflation option, Senate hearing told enrollees face premium rate increases, 2017
– FEHBP

See FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP)

– Health care reform

– – Employers will reduce benefits and workforce and raise customer prices if reform increases their costs, survey finds, 1135
– – Proposals, most large companies oppose, survey, 322

– High-deductible plans, patients more involved in care decisions, survey, 507
– HSAs

See HEALTH SAVINGS ACCOUNTS (HSAs)

– Phased-in reform approach favored by most firms, survey, 835
– Rates

See generally PREMIUMS AND RATES

– Recession, cost control methods including eligibility audits explored, letter, 465
– Retirees

See generally RETIREE BENEFITS

– San Francisco fair share ordinance requiring employer-paid coverage

See CALIFORNIA

– Scaled back in 2007, study, 390
– Shifting costs to employees by employers expected in 2010, Mercer says, 1075
– Size of businesses and workers' coverage under employer plan, Bureau of Labor Statistics detailed 2009 data, 1156
– Small businesses

See generally SMALL BUSINESSES

– State and local workers, 75 percent considering changes, survey, 723
– Taxation

See TAXATION

– Uninsured persons, options for addressing health coverage loss examined, CRS reports, 124
– Utah contractors must provide, In Brief, 317
– Wellness programs

See PREVENTIVE CARE

EMPLOYEE BENEFITS SECURITY ADMINISTRATION (EBSA)

– GINA implementation, regulatory agenda, 589; interim final rules released, 1152
– MHPAEA implementation, agency seeks public comment in advance of future rulemaking, 488; business groups seek clarification, 644; industry representatives cite enforcement concerns, 671; senators call for prompt release of rules, 943

EMPLOYEE RETIREMENT INCOME SECURITY ACT

See ERISA

END-STAGE RENAL DISEASE (ESRD)

– Medicare Secondary Payer Act

– – BCBS, not violated by reimbursement for non-network dialysis at lower rates (N.D. Ga.), 261
– – Plan violated law by terminating coverage upon learning of now deceased beneficiary's Medicare eligibility (E.D. Tenn.), 975

– Medigap, new Fla. coverage law, 711

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION (EEOC)

– GINA implementation, agency releases proposed rules, 256; final rules expected May 21, 589

ERISA

– Administrator failed to provide claim denial documentation, penalty imposed (W.D. Ark.), 185
– Arbitration, provision enforceable in medical benefits denial dispute despite statutory violations in agreement (8th Cir.), 184; (U.S., rev den), 1186
– Class action certification issues arise from growing number of complex lawsuits, BNA audio conference, 1126
– COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Congenital jaw deformity, corrective surgery may be mandated by state law despite lack of coverage under plan (D. Or.), 1029
– Derivative standing, provider receiving assignment of benefits from participant entitled to copies of plan documents (E.D. La.), 99
– Disclosure, plan administrator violated statute by failing to provide participant with internal coverage guidelines for speech therapy (7th Cir.), 287; (U.S., rev den), 1186
– Employer did not pay premiums, former employees' claims for medical costs reimbursement denied but money submitted to BCBS by workers recoverable (W.D. Ark.), 1030
– Fiduciary duty breach

– – Autism experimental treatments, no claim against BCBS over therapy denial (E.D. Mich.), 312; class action status denied, 413
– – Emergency services, no equitable relief for GM participants over BCBS of Mich. coverage denials (E.D. Mich.), 413
– – Humana employees allege failure to divest pension plan of company stock during price drop, dismissed (W.D. Ky.), 1191
– – “Named” fiduciary, third party administrator status unresolved re liability for alleged claims processing errors (D. Mass.), 2020
– – Premiums, employer did not forward deducted from paychecks (S.D. W.Va.), 37
– – Sponsor's claim against disability plan administrator denied (7th Cir.), 1001
– – Terminated ill employee's health coverage canceled, no claim against employer absent plan administrator status (N.D. Tex.), 435
– – Vytorin clinical study results delay caused plan losses Merck employees allege, motion to dismiss denied (D.N.J.), 1064

– Former plan participant did not convert policy to individual coverage, sponsor not required to pay deceased's medical costs (W.D. Va.), 10
– Full and fair review, BCBS of La. did not afford where new grounds were raised for denying benefits for bypass patient (5th Cir.), 379
– Hospitals, state law claims alleging insurer's processor intentionally interfered with contractual relations proceed (E.D. Cal.), 156
– Illegal acts exclusion, health plan administrator use to deny benefits to hospital treating unlicensed and uninsured driver improper (6th Cir.), 1129
– Informal complaints about health plan administration, fired worker has no retaliation claim under Section 510 (E.D. Pa.), 924
– Long-term disability, plan participant may conduct discovery of conflicts related to history of medical reviewers who denied benefits claim (E.D. Ky.), 99
– No-fault automobile insurer bound by 2-year limitations period in plan contract (E.D. Mich.), 158
– Out-of-network services

See generally OUT-OF-NETWORK CARE

– Preemption

– – Acute rehabilitative care decision delay by health plan alleged cause of injury, state law claims denied (D.N.J.), 1066
– – Breach of contract

– – – Claims processing errors by third party administrator alleged, ERISA does not preempt (D. Mass.), 2020
– – – Employer's state law claim alleging improper health coverage termination barred (N.D.N.Y.), 621
– – – Hospital state law claims for benefits against health plan administrator not barred (9th Cir.), 1062
– – – Physician shareholder's claims against practice group proceed (W.D. Tenn.), 708

– – Eating disorders, Horizon BCBS of N.J. settlement of coverage claims for dependents approved (D.N.J.), 494
– – Emergency services, no bar to state law requiring plans to reimburse providers for member care (Cal. Ct. App.), 593
– – Federal court lacks jurisdiction over disabled participant's wrongful discharge claim but complaint amendment allowed for remand to state court (N.D. Va.), 10
– – Group health care policy covering sole owner of real estate business and family members is ERISA plan (N.D.N.Y.), 101
– – Malpractice, patient's state law claims against plan over treatment denial barred (N.J. Super. Ct. App. Div.), 293
– – Mich. insurance, state rules barring discretionary clauses in policies not preempted (6th Cir.), 343
– – Negligence, state claim against Aetna for releasing address to ex-husband who harassed insured proceeds (C.D. Cal.), 621
– – OB/GYN group reimbursement, state law claims challenging pay rate proceed (5th Cir.), 1002

– Prescription drug Plavix prices, Independence BC did not violate benefit plan terms by assigning medication without generic version to highest tier (E.D. Pa.), 706
– Retroactive reinstatement of health benefits, equitable remedy under Section 502(a)(3), 920
– San Francisco fair share ordinance requiring employer-paid health coverage

See CALIFORNIA

– Small businesses, eligibility rules not established when insurer withdrew specific health policy from market (S.D.N.Y.), 891
– Stock benefits not deferred until retirement, plan not governed by Act (D. Idaho), 826
– Subrogation

See generally SUBROGATION

– Summary plan description does not supersede plan language omitting provisions on administrator's discretionary authority to deny autism coverage (D. Or.), 313
– Supreme Court nominee Sotomayor, Second Circuit ERISA decisions scrutinized, 646

ESRD

See END-STAGE RENAL DISEASE (ESRD)

EVIDENCE

– Discovery

See DISCOVERY

EXCLUSIONS AND TERMINATIONS

– Chiropractic services, exclusion of providers from network upheld (Tenn. Ct. App.), 383

EXHAUSTION OF REMEDIES

– Cancer, Medicare law preempts patient's fraud and breach of contract claims against Humana (S.D. Fla.), 288
– Premiums and rates, provider challenge to health care management services method of determining customary charges barred (D.N.J.), 460

EXPERIMENTAL TREATMENTS

– Autism, no ERISA breach of fiduciary duty claim against BCBS over therapy denial (E.D. Mich.), 312; class action status denied, 413
– Leukemia, ERISA plan must pay for medically necessary bone marrow transplant where coverage denial was arbitrary (N.D. Ohio), 260; order to pay reversed and remanded (6th Cir.), 1063
– Negligence, member claim against plan administrator over denial of radio frequency ablation for lung cancer reinstated (Cal. Ct. App.), 498; right to independent medical review important to patients, 499

EXTERNAL REVIEW OF COVERAGE DECISIONS

See UTILIZATION REVIEW (UR)

EYE CARE

– FEHBP, OPM proposes amended benefit rules, 671