Health Plan & Provider Report Index Summary

E-HEALTH

– Personal electronic medical records

– Prescriptions, electronic

E-PRESCRIPTIONS

– Demonstration projects, BCBS of N.C. expands initiative, 841
– First step toward electronic health records system, seminar, 327
– Incentive arrangements

– – Federal endorsement of payments, BNA Analysis, 820
– – 5-year physician program, final CMS rule issued, 1199
– – Implementation, CMS efforts include fall conference for physicians, 797
– – Key to physician adoption, meeting, 575

– Medicare drug coverage

– – Computer faxes ban, CMS reconsiders, 287
– – Financial incentives, CMS urges plans to work with network pharmacies, 1050
– – Guidance for 2009 benefit year, CMS issues draft call letter, 85; deadline delayed for plan reporting, 343; released with minor changes from 2008, 464; update also addresses disenrollment, 829
– – PBM, trade group campaigns to require use, 494
– – Standards, final CMS rule, 394
– – Technology investment, provider reimbursement

See LEGISLATION, FEDERAL, HR 4296, S 2408

– Minn. omnibus law requires, In Brief, 652
– Natl. Gov. Ass'n

– – Federal use urged, meeting, 834
– – Privacy safeguards, panel recommends immediate focus, report, 1056

– Patient safety improved, study, In Brief, 678
– Physician incentives, CMS to issue final rule in Nov., conference, 1107
– SureScripts/RXHub merger, 751

ELECTRONIC HEALTH RECORDS

– Adoption, Cal. groups lead but national progress minimal, reports, 122
– Customized health features and benefits, consumers would prefer, survey, 704
– Data exchanges, effective cost cutting strategy, study, 1002
– Definitions, medical record and health record distinguished, report for HHS, 573
– Demonstration projects

– – Ariz. and Utah, Medicare personal health records pilot, 908
– – Medicare primary care physicians pilot, over 30 applicants, 574
– – Microsoft Health Vault, Kaiser employees pilot, 655
– – National network, live HHS demonstration, meeting, 1051

– Destruction, felony under N.Y. law, 1119
– E-prescriptions, first step toward system, seminar, 327
– Google Health

– – BCBS of Mass., insurer to use platform, 679
– – Public Web site launched, 587

– Grants, N.Y. awards for community-based projects, 401
– Health information technology terms, clarification progress, 96
– HIPAA security rule, vulnerabilities remain due to ineffective enforcement, IG report, 1197
– HMOs, all Kaiser outpatients, 529
– Horizon BCBS, N.J. and federal probe of member data security breach, 176
– Internet

– – Google

See Google Health, this heading

– – Personal, 9 percent of provider institutions offer Web-based service, 914
– – Wal-Mart Web-based worker option in 2009, 1121

– Legislation passage, unlikely before mid-2009, forum, 1198
– Massachusetts

– – BCBS, insurer to use Google Health platform, 679
– – Promoting use, new law, In Brief, 934

– Mich., secure network for sharing patient data, 1180
– Minnesota

– – Insurance eligibility inquiries, rules adopted requiring electronic responses, 118
– – Personal portfolios, governor proposes 2011 goal, 865
– – Provider use requirement, bill sent to governor, 581

– N.J. law creates panel and statewide plan development mandate, 90
– NYC Medicaid providers, system launched, 264
– Physician use increasing, survey, 703
– Portable, Aetna teams with Microsoft, 1181
– Privacy

See PRIVACY AND CONFIDENTIALITY

– Private sector data banks, potential negative impact on biomedical research, article, 448
– Quality of care, group promotes adoption, 976
– Tenn., AT&T and state launch provider-to-provider data exchange network, 263
– Unique patient ID numbers, errors cut and adoption expedited, study, 1184

EMERGENCY SERVICES

– Balance billing, California

– – Agency issues new rules, 398; more rules proposed, 525; physicians criticize proposed ban, 552; adopted, 885
– – Legislative ban, draft underway, 885; approved, 966
– – Prime Healthcare Services, state agency sues (Cal. Super. Ct.), 755

– Ga. Medicaid HMOs, coverage bill approved, 424
– Out-of-network care

– – Air transportation, ERISA does not preempt state law reimbursement claims against HMO (M.D. Fla.), 943
– – Billing limits, Cal. lawmakers approve measure, 1001
– – Kaiser sued over reimbursement rates (Cal. Super. Ct.), 247
– – Medicaid managed care, plan can pay providers state-set rate (Ill. App. Ct.), 588

– Reimbursement rates, physicians sue Aetna (Mass. Super. Ct.), 329
– Remote monitoring, Md. eCare program for off-site critical care physician support, 503
– Trauma care, plan reimbursement of hospitals recurring arbitration issue, BNA Analysis, 381

EMPLOYEE BENEFITS

– Ed. Note: This heading covers employer-provided health insurance unless otherwise indicated.
– Actuarial equivalence, plan comparison tool, briefing, 773
– Consumer-directed plans

See generally CONSUMER-DIRECTED PLANS

– Continuing coverage, most large firms likely to offer, study, 529
– Cornerstone of health system reform, Chamber of Commerce CEO says, 703
– Cost sharing, 2009 increase expected for workers, report, 973
– Deductibles

See generally COPAYMENTS AND DEDUCTIBLES

– Dependents, eligibility audits can cut costs, Special Reports, 1011
– Employee Retirement Income Security Act

See generally ERISA

– Fair share laws, San Francisco ordinance requiring employer-paid coverage

See CALIFORNIA

– Health insurance costs up for employers, Kaiser report, 328
– HSAs

See HEALTH SAVINGS ACCOUNTS (HSAs)

– Job-based health options declining, report, 474
– Make-whole doctrine, no bar to Wal-Mart health plan's recovery of full reimbursement from participant's personal injury settlement (U.S., rev den), 352
– Managing worker health, employer trend, survey, 405
– Ohio HMO enrollees, group plans dropped as Medicaid rose, report, 610
– Participation, percent covered steady in 2007, study, 1003
– Payroll costs, 10 percent for insurance, report, 801
– PBM

– – Management strategies cutting costs effectively, survey, 349
– – Performance, employers using multiple strategies to optimize, report, 1183

– Personal health records, Wal-Mart Web-based worker option in 2009, 1121
– Play-or-pay mandates

– – Coverage fund, most voters support, survey, 95
– – Employer support, half of those surveyed, 1183

– Political activities, employers criticize McCain and Obama health reform plans, survey, 1030
– Premiums

See generally PREMIUMS AND RATES

– Private sector, over 50 percent enrolled in 2007 employer health plans, report, 882
– Reform

– – National health insurance connector plan would save trillions, researchers say, reports, 554
– – Natl. Business Group on Health, employer mandates rejected in favor of requirements for individuals, 153

– Retirees

See generally RETIREE BENEFITS

– Same-sex domestic partners of federal workers should be covered, witnesses tell Senate panel, 1053
– Self-funded plans

See SELF-FUNDED PLANS

– Stability of employer plans explored, conference, 150
– Taxation

See generally TAXATION

– Uninsured persons, immigrants without coverage constitute 55 percent of recent increase, report, 916
– Wages, health care costs impact, report, In Brief, 208
– Wellness programs

See PREVENTIVE CARE

– Wrongful discharge, ERISA does not preempt state claims over heart attack treatment costs (W.D. Mo.), 303

EMPLOYEE RETIREMENT INCOME SECURITY ACT

See ERISA

END-STAGE RENAL DISEASE (ESRD)

– Standing, anti-assignment provisions bar provider recovery of dialysis treatment costs under ERISA (M.D.N.C.), 332

ERISA

– ADA, discrimination claims of couple fired during son's cancer treatments proceed (10th Cir.), 531
– Advisory Council, members named, 420
– Benefit plan modification must be in writing (7th Cir.), 1173
– Claims processing requirements, widower challenging wife's breast cancer treatment approval denied injunctive relief against BS (N.D. Cal.), 481
– COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Conflicts of interest, case-by-case analysis required where health plan both determines eligibility and pays benefits (U.S.), 707; ruling signals shift in favor of plaintiffs, attorneys say, audio Webcast, 845
– Discretionary clauses, insurance commissioner may bar without violating federal law (D. Mont.), 304
– Fiduciary duty breach

– – AWP, PBM is not a fiduciary absent discretionary authority to set drug and rebate prices (E.D. Mo.), 894
– – FSAs, employer provided misleading documents (D.N.J.), 407
– – Retiree benefits, no breach where broker chose retiree health insurance policy (S.D.N.Y.), 782
– – Specialty pharmacy, no claim against BC of Northeastern Pa. over termination of linked group health plan (M.D. Pa.), 244
– – State claim proceeds against human resources worker who disclosed sensitive health information (E.D. Mo.), 181
– – Third-party plan administrator, claim over coverage denial for quadriplegic son fails (W.D.N.Y.), 1087

– Inapplicable for 2-employee health plan, (5th Cir.), In Brief, 159
– Jurisdiction, plan sponsor's suit for benefits reimbursement from wrongful death award proceeds (D.N.J.), 379
– Make-whole doctrine, no bar to Wal-Mart plan's recovery of full reimbursement from participant's personal injury settlement (U.S., rev den), 352
– Misconduct, no claim for worker who was fired before surgery (W.D. Ark.), 978
– Nonfiduciaries, third party benefit denial decision entitled to deference (U.S., rev den), 759
– Notice inadequate, plan beneficiary's claim for penalties proceeds in suit over accident coverage denial (D. Idaho), 504
– Out-of-network services

See generally OUT-OF-NETWORK CARE

– Personal injury settlement, health plan sponsor entitled to reimbursement (D. Neb.), 1176
– Preemption

– – ASCs, claims over reimbursement levels proceed (S.D. Tex.), 1205
– – COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– – Dependents, plan can recover medical expenses paid for woman who was not participant's legal spouse (W.D. Wash.), 130
– – Eating disorders

– – – Aetna over coverage denial for daughters, state claims barred (D.N.J.), 269; settlement, 659
– – – Horizon BCBS of N.J., coverage claims for daughters barred (D.N.J.), 896
– – – Participant's state law claims for daughter's residential treatment coverage proceed (D. Utah), 130

– – Emergency services, out-of-network air transportation firms' state law reimbursement claims proceed against HMO (M.D. Fla.), 943
– – Fair share laws, San Francisco ordinance requiring employer-paid health coverage

See CALIFORNIA

– – Gastric bypass surgery, participant's state law claims for reimbursement barred (W.D.N.C.), 980
– – Health care injuries, Supreme Court rulings restrict state law remedies, 670
– – Hospitals

– – – Administrator agreed to pay, breach of contract, suit proceeds (E.D. Cal.), 978
– – – BCBS, suit over coverage misrepresentation proceeds (E.D. La.), 734
– – – Benefits assignment, breach of contract and fraud claims barred (N.D. Ind.), 99
– – – Organ transplants, suit alleging Kaiser's negligence caused treatment delay proceeds (E.D. Cal.), 1033
– – – Plan administrator misrepresented participant coverage, motion to remand granted (E.D. La.), 557; detrimental reliance claim proceeds, 868; remanded to state court, 980; state law claims proceed against plan administrator, 1204
– – – State claims over insurer coverage misrepresentation proceed (S.D. Tex.), 812

– – Iowa policies secondary to other insurance, state law controls (Iowa), 656
– – Medicaid payments for insured individuals, state agencies may sue to recover, advisory opinion, 417
– – MEWAs, ERISA does not preempt provider claims over coverage misrepresentation (7th Cir.), 869
– – Negligent dental provider referral, coverage denial claim against Humana administrator proceeds despite preemption finding (D.N.J.), 1063
– – No-fault automobile insurance, application of Mich. coordination of benefits law barred (E.D. Mich.), 352
– – OB/GYN provider, reimbursement claims proceed against Aetna (W.D. Tex.), 618
– – Pharmacists and pharmacies, claim alleging plans violated Tex. AWP law by denying out-of-network coverage barred (5th Cir.), 918
– – Reconstructive plastic surgeon, state reimbursement claims for BCBS participant's child barred (D. Conn.), 534
– – Skilled in-home care for amputated leg, widow's claims against CIGNA over denial barred (D. Me.), 353
– – State health care reform efforts, policy options limited, issue brief, 168
– – Substance abuse

– – – Inpatient treatment, claims barred (S.D. Tex.), 734
– – – Rehabilitation treatment, ERISA preempts state claim over reimbursement delay (E.D. Pa.), 848

– – Threshold, congressional discussions raise employer perception and statute modification concerns, conference, 289
– – Wrongful discharge, state claims over firing due to heart attack treatment costs proceed (W.D. Mo.), 303

– Preexisting conditions, plan forfeited discount where administrator did not notify hospital of exclusion (S.D. Tex.), 330
– Proposed amendments

– – Breast cancer benefit restrictions bar

See LEGISLATION, FEDERAL, HR 758, S 459

– – Cong. Research Serv. report, 996
– – Update, report, In Brief, 802

– Standing

See STANDING

– Subrogation

See generally SUBROGATION

– Substance abuse, no liability for third-party administrator who did not provide plan documents where dependent coverage exclusion applied for injuries sustained while engaging in criminal activities (N.D. Ind.), 1113
– Vioxx, plans' injunction request to delay settlement denied (E.D. La.), 946; health plans' class claims to settlement funds denied, 1203
– Wrongful discharge, claim over firing for violating no-smoking policy proceeds (D. Mass.), 158

ESRD

See END-STAGE RENAL DISEASE (ESRD)

EVIDENCE

– Discovery

See DISCOVERY

EVIDENCE-BASED MEDICINE

– Comparative effectiveness research

– – Cost-effectiveness information essential, position paper, 573
– – Organization, establishing and funding, MedPAC considers options, 290
– – Outcomes and costs would improve, CBO report, 14
– – Savings potential discussed, audio conference, 170

– Employer purchasing guide issued, 811
– Minn. health system reform, use among task force recommendations, 203
– National assessment of treatment effectiveness urged, IOM report, 115

EXCLUSIONS AND TERMINATIONS

– PPOs, provider challenge to insurer upheld (Cal.), 780

EXHAUSTION OF REMEDIES

– Accident injuries coverage denial, ERISA plan participant need not exhaust all administrative appeal issues before filing suit (9th Cir.), 1062
– Notice, benefits action proceeds where plan administrator did not advise former employee claim was denied (E.D. Wis.), 847

EXPERIMENTAL TREATMENTS

– Knee surgery, BCBS of Tenn. coverage denial upheld (6th Cir.), In Brief, 70

EYE CARE

– FEHBP, final OPM rule implements, 963