www.bna.com Health Plan & Provider Report
HomeIndexTable of CasesFeedbackwww.bna.com

Printable version (PDF) 

INDEX
Vol. 15, Nos. 1- 39, pp. 1-2046
Jan. 7 - Oct. 21, 2009

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

    HAWAII
      – Contract denial, plan has no claim against state for alleged violation of Medicaid Act (9th Cir.), 862
      – Mandated enrollment in Medicaid managed care organizations, suit proceeds against CMS and state over (D. Haw.), 622; request for temporary restraining order denied, 1031; contractors eligibility certified question, 1190
      – Medicare coverage for liver resection surgery performed out of plan without prior authorization, denial affirmed (D. Haw.), 1099
    HEALTH AND HUMAN SERVICES DEPARTMENT (HHS)
      – Centers for Medicare & Medicaid Services
      – Comparative effectiveness research, data infrastructure is greatest need for $400 million allocated for funding, report, 796
      – Federal Coordinating Council on Comparative Effectiveness Research, members named, 335
      – Natl. Coordinator for Health Info. Tech.
        – – ARRA implementation plans released, 611
        – – Physician Blumenthal named, 336
        – – Success, 2009 government decisions key, chief says, 562
      – Natl. eHealth Collaborative
      – Nominations, Senate Republican leaders warn of delays unless CMS rescinds order on Humana mailings, 1124; Sebelius defends CMS action, 1181; mailings allowable only with enrollee opt-in prior authorization, CMS says, 2011
      – Office of Civil Rights, HIPAA
        – – Privacy rules modification re GINA, regulatory agenda, 589; proposed rules issued, 1152
        – – Security rule enforcement responsibility, 916
        – – Website revised, 181
      – Office of Health Reform created and key members appointed, 560
      – Office of Recovery Act Coordination, created to manage economic stimulus law funds, In Brief, 311
      – Secretary
        – – Sebelius nominated, 252; confirmation vote delayed, 407; MA plans may get less than fee-for-service providers, nominee says, hearing, 429
        – – Senate panel sets Jan. 8 hearing on nominee Daschle, In Brief, 8; bipartisan cooperation promised, 33; Daschle withdrawal may delay reform efforts, 149
    HEALTH CARE QUALITY
    HEALTH CARE REFORM, FEDERAL
      – Accountable Care Promotion Act, bill introduced to create voluntary shared savings program with Medicare provider incentives, 740
      – Advertising, public policy advocacy campaign launched, 965
      – American Recovery and Reinvestment Act
      – Antitrust, market regulation essential, hearing, 859
      – Attorneys at conference suggest employers be ready to understand and implement changes, 2013
      – Bipartisan Affordable Health Choices Act, proposed draft bill imposes major employer requirements, Special Report, 984
      – Children and older adults, needs critical, hearing, 699
      – Chronic illness
        – – Care management and disease prevention key to delivery system revision, BCBS guide, 506
        – – Treatment and prevention key focus, stakeholders meeting, 432; White House Office for Health Reform Director DeParle optimistic, 432
      – Company premiums, efforts should focus on equalization, reports, 917
      – Comparative effectiveness research, efforts will include, seminar, 1036
      – Congressional action required after recess, Pallone (D-NJ) says, 182
      – Consensus, Baucus (D-Mont) promises effort during recess, 942
      – Consumer-directed plans
      – Controversial proposals
        – – Baucus (D-Mont) urges restraint, briefing, 484
        – – Industry and business groups express concerns, hearing, 698
      – Cooperatives as possible solution to rising costs, critics and supporters continue debate, Special Report, 1163
      – Cost reduction unlikely, CBO official says, hearing, 857
      – Delivery system, Baucus (D-Mont) and Grassley (R-Iowa) find consensus on goals but strategies differ, paper, 521; policy options to be released, 521; report issued, 554
      – Economic stimulus package
        – – Baucus (D-Mont) plan outlined, 94
        – – House package includes information technology and Medicaid funding boosts, 61
        – – Information technology funding and COBRA assistance
          See LEGISLATION, FEDERAL, HR 598
        – – Medicaid boost for states
          See LEGISLATION, FEDERAL, HR 1, S 1
        – – N.Y., COBRA eligibility extended, 349
      – Employer-based system
        – – Favored basis, report, 75
        – – Mandates
          – – – Critics and supporters continue debate re reform proposals, Special Report, 1196
          – – – Efficacy challenged, study, 351
        – – Preservation, Am. Benefits Council recommends, In Brief, 411
        – – Retaining employer support, congressional leaders challenged, 787
        – – Retention favored with cost shifting addressed, hearing, 308; Andrews (D-NJ) deems debate incomplete absent discussion of how to pay, hearing, 492
        – – Tax exclusions for health benefits, Obama supports retention, 792
      – Enactment in 2009
        – – Consumer protections, President urges public support, 916
        – – 4-year delay absent success now, Grassley (R-Iowa) predicts, 333
        – – Imperative, Obama says, forum, 279; follow-up forums set in 5 states, 279; stakeholders deem congressional flexibility key, 279
        – – President pushes for completion as Medicare payment council is proposed, 852; Democratic senators ask insurers for billions to fund reform, 852
        – – Senate will not pass bill by August break, 884
        – – Timetable, Senate panel aides predict August passage, 310
      – Episode-based payment system, RAND releases study, 1162
      – Financing alternatives, Senate Finance Comm. considers elimination of medical deductions and flexible spending curb, 618; proposal defended, report, 643; panel considering options outside health sector to fund reform, 765; CBO financing options outlined, MedPAC report, 769; options analyzed, CRS reports, 773; markup delayed beyond August recess, 914; Schumer (D-NY) says reconciliation is possible, 915; Center on Budget and Policy Priorities supports tax on high-end plans, report, 949
      – Hospitals, $155 billion in Medicare and Medicaid cuts over 10 years under White House accord, 819
      – House Comm. on Education and Labor, insurance reforms and public plan emphasized in comprehensive legislation, 815
      – House Democrats release legislative framework, 697; business groups to halt negotiations absent affordable proposals, 804
      – Impact, HHS state-by-state analysis, 945
      – Individual mandate
        – – Constitutionality concerns raised by critics, BNA Analysis, 1165
        – – Employer mandates also included in House Democrats' drafts, 668
        – – Enforcement issues explored, BNA Analysis, 836
        – – Exemptions, Obama wants waivers in legislation based on affordability, 667; increased MedPAC authority possible, 667
      – Insurance myths explored, BNA Analysis, 1037
      – Kaiser integrated care, model should be part of national effort, AFL-CIO chief says, forum, 930
      – Kennedy (D-Mass) plan, draft legislation includes comprehensive coverage and employer mandates, briefing paper, 641; Medicaid expansion and play-or-play mandates detailed, 665
      – Key principles, Rockefeller (D-WVa) outlines, 564
      – Large employers, most oppose current proposals, survey, 322
      – Legal issues project, Georgetown Univ. papers present possible solutions, In Brief, 414
      – Lobbying expenditures of insurance companies, AFL-CIO seeks state investigations, 1133
      – McConnell (R-Ky) chooses Senate GOP team leaders, In Brief, 67
      – Medicare key to legislative efforts, Leavitt says, 66
      – Medicare payment inequities, House Democrats release plan, 886; reimbursement formulas recalibration, agreement near, 1155
      – Obama Council of Economic Advisers, deficit would be lowered and spending reduced, report, 642
      – Out-of-network care, debate should address high fees, report, 968
      – Physicians can better care for patients with health care reform, Obama says, 1183
      – “Play-or-pay” option, House panel draft legislation includes employer requirement, 583
      – Policy options for coverage expansion, Senate Finance Comm. explores, 583
      – Post-claims underwriting, elimination recommended, hearing, 736
      – Preexisting conditions, legislation addresses unfair practices of denying and rescinding policies, HHS report, 968
      – Premium increases during the last decade, White House issues report, 1125
      – Private insurance lobby rebuts criticism as support for federal efforts is expressed, 942
      – Public plan
        – – Accountability ensured, Senate report, 644
        – – Administrative savings predicted, report, 888
        – – AMA House of Delegates, resolution to support President's plan without reference to option, meeting, 749
        – – Baucus (D-Mont) urges continued discussion of all options, meeting, 371; consensus principles outlined, 371
        – – Bipartisan support, Baucus (D-Mont) says inclusion likely, 608; talks on compromise bill continue, 733
        – – Cong. Progressive Caucus supports, 998
        – – Cost reduction and coverage expansion, best method, report, 773
        – – 5 of 6 witnesses recommend but Republicans seek greater diversity, hearing, 490
        – – House Democrats release 852-page draft bill, 734; ERISA-based plan concerns discussed, hearing, 761; insurers and hospitals criticize, hearing, 766; must be comprehensive to be successful, panel hearing, 771; provider payments and public plan option detailed, 790
        – – House majority leader Hoyer (D-Md) supports, 998
        – – Insurers oppose stating more regulation would stabilize market, Senate roundtable, 558
        – – Key to keeping private insurers honest, Senate Democrats say, 527
        – – Legislation, White House Office of Health Reform Director DeParle outlines effective construction, 457
        – – Necessary choice, conference, 123
        – – Obama supports inclusion, conference, 122
        – – Option not essential element, HHS chief says, 967
        – – Popular support but cost and quality key factors, panel discussion, 821
        – – Private plan administrative costs compared, BNA Analysis, 509
        – – Quality improvement and lower costs, study, 196
        – – Rate structure, House Democrats continue discussions, 1155; multiple versions of rate structure in bill sent to CBO, 1178
        – – U.S. Chamber of Commerce opposes and as campaign is launched to preserve ERISA, 887
      – Senate Finance Comm. to release bill soon, draft framework addresses employer mandate requirement and uninsured patients hospital rates, 1051; excise tax on high-value plans and health insurance cooperatives part of framework, 1053; cap on high-value plans subject to excise tax and health insurance cooperatives discussed further, 1089; bill released, markup to begin with numerous amendments considered, 1091; small business cafeteria plans, markup includes safe harbor from nondiscrimination rules, 1097; public plan option debate postponed, action on health care czar and pharmacy benefits information amendments, 1117; Medicare prescription drug coverage doughnut hole amendment defeated, Medicare Advantage spending cuts debated, 1119; excise tax on persons who do not buy insurance, Republican efforts to scrap defeated, 1120; Medicare spending cuts, Republican efforts to remove defeated and independent Medicare Commission amendment defeated, 1121; markup completed, final vote imminent, 1147; states negotiation with insurers amendment approved, 1150; public plan option, 2 amendments defeated, 1151; bill approved, CBO analysis and Pricewaterhouse Coopers report available, 1175; excise tax on uninsured individuals clarification, technical correction to markup, 1180; further action, see LEGISLATION, FEDERAL, S 1796
      – Senate Health, Education, Labor, and Pensions Comm., 615-page draft bill released, 696; panel delays markup, 764; Democrats estimate coverage costs at $611 billion, 789; August deadline approval unlikely, analysts say, 791; GOP efforts to limit subsidies and eliminate public plan option fail, 817; panel revises coverage provisions as markup continues, 817; committee votes to report out, 855; employer mandates unlikely, 885; “play-or-pay” mandates impact on small businesses, CRS report, 1179; public plan, Harkin (D-Iowa) pushes for inclusion in merged bill, 2008; Am. Benefits Council lists priorities for reform in letter, 2015
      – Small businesses
      – Spending
        – – Budget panel chairman says efforts cannot add significant system costs, hearing, 182
        – – Industry stakeholders pledge $2 trillion in savings over next 10 years but impact on legislation unclear, 553; savings and system streamlining detailed, letter, 639; CBO unable to confirm proposed savings, 736
      – State and local initiatives examined as nationwide reform efforts proceed, Senate panel hearing, 96
      – Subsidies key, Kaiser Found. says, report, 1027
      – Tax issues
      – Underinsured persons, House subcommittee hearing, 2010
      – Uninsured
      – Value-based purchasing, House Democrats' health reform bill
        See LEGISLATION, FEDERAL, HR 3200
      – Windfall profits tax on insurers, House Democrats consider to pay for bill, 1178
    HEALTH CARE REFORM, STATE
      See also specific states
      – Federal reform impact, HHS state-by-state analysis, 945
      – Initiatives examined as nationwide reform efforts proceed, Senate panel hearing, 96
    HEALTH INFORMATION TECHNOLOGY (HIT)
    HEALTH INSURANCE
      – AARP indemnity health plans, Grassley (R-Iowa) calls for limits disclosures to policyholders, 486
      – Adults, most ages 55-64 have coverage, survey, 932
      – Aetna underpricing to gain market share, class securities action alleging misrepresentation dismissed (E.D. Pa.), 742
      – AMA
        – – Code of conduct for insurers, group pushed to create, 899
        – – Insurer improvements noted, but efficiency challenges remain, report card, 900
        – – Markets dominated by 1 or 2 insurers, AMA report, 175
      – Antitrust, long-term care pharmacy's claims against merged insurance companies dismissed for insufficient evidence (N.D. Ill.), 89; Omnicare to appeal, 89
      – BCBS
      – Cancer, affordable post-diagnosis coverage problematic, report, 164
      – Children's health care, affordable coverage options
        See LEGISLATION, FEDERAL, HR 193, HR 194
      – COBRA
      – Consumer protection
        – – Policy benefits labeling system recommended, report, 570
        – – President urges public support, 916
        – – Profits valued over members, Senate panel hearing, 767; Rockefeller (D-WVa) calls for CIGNA clarification of small businesses policy purging, 941
        – – Purging of small business policies, House panel investigates, 1056
      – Coverage types and impact of uninsured explored, CRS reports, 341; 456
      – Deceptive practices, Senate panel releases report on database creation, 768
      – Discount cards and programs
      – Eligibility misrepresentation, former plan participant's claims proceed (S.D.N.Y.), 376
      – Employee Retirement Income Security Act
      – Fraud
      – Health Net rescissions, class action settled with agreement to reimburse policyholder medical costs (Cal. Super. Ct.), 190; hospitals' settlement, 650
      – High-risk activities, coverage restrictions
        See LEGISLATION, FEDERAL, HR 1253
      – High-risk pools
      – HIPAA
      – HMOs
      – Individual mandates
      – Investigations, House panel probes CEO compensation, 995
      – Long-term care, tax benefit
        See LEGISLATION, FEDERAL, S 702
      – Loss of coverage
      – Mandated
      – Marketing
      – Medical loss ratio, Rockefeller (D-WVa) probes data on premiums collected compared with paid claim amounts, 1026
      – Medical underwriting, industry willing to phase out practice, hearing, 366
      – Mergers
      – National exchange program
        – – Coverage would be improved, report, 701
        – – Market would shift from risk-based competition, study, 700
      – N.C., new law requires notice of contract amendments, 927
      – Outlook 2009, reform among top issues to be addressed, Special Report, 18
      – Plan mergers
      – Policy options for coverage expansion, Senate Finance Comm. explores, 583
      – Policy rescission, industry CEOs defend practice, hearing, 911
      – Preexisting conditions
      – Prompt payment
      – Rates
      – Reform myths explored, BNA Analysis, 1037
      – Retirees
      – Small businesses
      – State issues
        See specific states
      – Subrogation
      – Taxation, incentives for state reform
        See LEGISLATION, FEDERAL, S 979
      – Transparency, policy purchasing
        See LEGISLATION, FEDERAL, HR 2427, S 1050
      – Unauthorized health insurance, Fla. regulators order 3 companies to stop sales, 1071
      – Wellness programs
      – Women's health, access barriers would be eased by reform efforts, report, 948
    HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
      – ARRA
        – – Attorneys at conference suggest employers be ready to understand and implement reform changes, 2013
        – – Enforcement increase and contract changes required, meeting, 439
        – – HHS guidance on information protection from unauthorized use, 454; groups say more specifics are required to ensure protection, 611
      – BNA audio conference, In Brief, 286
      – Disclosure, protected health information may be given to physician treating patient's family member, 66
      – Enforcement increase and contract changes, required under stimulus package, meeting, 439
      – Group health plan requirements
        – – Preexisting condition exclusions notice, Labor Dep't seeks comments on information collection requirements proposed extension, 1122
        – – Prior creditable coverage written certificate, Labor Dep't seeks comments on information collection requirements proposed extension, 1122
        – – Special enrollment notice, Labor Dep't seeks comments on information collection requirements proposed extension, 1122
      – Guide for patients, public interest group publishes, In Brief, 414
      – HHS Office of Civil Rights
        – – Privacy rules modification re GINA, proposed rules issued, 1152
        – – Security rule enforcement responsibility, 916
        – – Website revised, 181
      – Legal framework for information protection and state regulation explored, BNA Analysis, 442
      – Pharmacists and pharmacies
        – – CVS Caremark pays millions to settle privacy rights violations (FTC), 207
        – – Professional group urges continued probe of CVS Caremark privacy rights violations despite FTC settlement, 339
      – State attorneys general suits, economic stimulus package provision
        See LEGISLATION, FEDERAL, HR 1
    HEALTH MAINTENANCE ORGANIZATIONS (HMOs)
      – BCBS
      – CalPERS, plan offering greater transparency sought, 160
      – Class action alleges underpayment for services, sanction order vacated (3d Cir.), 1061
      – Colorado
        – – Enrollment drops as profits increase, report, 223
        – – Limited benefit plans, new law allows, 498
      – Copayment and percentage fee coinsurance charged for same single service, state regulation violated (W.D. Mo.), 706
      – Credit for copayment discrepancy, plan beneficiary must exhaust administrative remedies before filing suit (N.D. Cal.), 1067
      – Databases and data banks
        – – Computer theft of private information, 30,000 Kaiser workers affected, 191
        – – Management, agreement with IBM cuts hundreds of Kaiser jobs, 352
      – Fla. policyholders, new law requires identification cards, 44
      – Kaiser Permanente, Cal. job cuts, 982
      – Market conduct violations, Kaiser fined, In Brief, 955
      – Physician reimbursement, suit dismissed where capitation agreement between unlicensed firm and HMO was illegal and unenforceable (Cal. Ct. App.), 104
      – Projected premium increase of 12 percent in 2010, Hewitt analysis, 871
      – Tenn., proposed budget includes premium tax increase, 388
      – Top 3 insurers dominate business in 48 states, GAO analysis, 1054
      – Wis., enrollment increases as hospital patients and revenues decline, report, 193
    HEALTH REIMBURSEMENT ARRANGEMENTS (HRAs)
      – Medicare payment errors source, conference, 306
    HEALTH SAVINGS ACCOUNTS (HSAs)
      – Coverage, 8 million in 2009 in large and small group markets, 598
      – Employer comparable contributions, IRS final rule also provides excise tax guidance, 1057
      – Employer contributions, $1,680 average in 2007, report, 195
      – IRAs, slower growth, report, 225
      – Reform financing alternatives, Senate Finance Comm. considers elimination of medical deductions and flexible spending curb, 618; proposal defended, report, 643; panel considering options outside health sector to fund reform, 765; CBO financing options outlined, MedPAC report, 769; options analyzed, CRS reports, 773; markup delayed beyond August recess, 914; Schumer (D-NY) says reconciliation is possible, 915; Center on Budget and Policy Priorities supports tax on high-end plans, report, 949
    HEARING AIDS
      – N.J. law mandates coverage for children, 43
      – Or. children, mandated benefit, In Brief, 803
      – Wis., new law also requires cochlear implant coverage for children, 653
    HEART DISEASES AND DISORDERS
    HEMODIALYSIS
    HHS
    HIGH-RISK POOLS
      – Children with preexisting conditions, coverage eligibility under new S.D. law, 680
      – Mishandling by insurer alleged caused of rise in premiums, N.J. claim allowed and Cal. claims dismissed (D.N.J.), 1100
      – Proposal to expand role examined, GAO report, 996
      – Small businesses, competitive markets would also cut costs, Senate leaders say, 917
      – Wyo., new law expands coverage, 292
    HIPAA
    HIV
    HMOs
    HOME HEALTH CARE
      – Ariz. Medicaid, order upheld requiring state to improve home and community services for disabled recipients (D. Ariz.), 531
      – Telemedicine, new Wash. law allows Medicaid reimbursement, 594
    HOSPICE CARE
      – Fla., website data comparison tool, In Brief, 505
    HOSPITALS
      – Administrative services automation, initiative announced at AHIP teleconference, 1195
      – Antitrust
      – Arbitration, hearing set in suit over sale of 3 facilities (Colo. Dist. Ct.), 73; 2 sales disallowed for violation of state nonprofit law but third proceeds, 712; agreement to transfer 2 Exempla properties to Catholic system, 1007
      – Breach of contract, ERISA no bar to state law claims for benefits against health plan administrator (9th Cir.), 1062
      – Charity care
      – Claims processing, state law claims alleging insurer's processor intentionally interfered with contractual relations proceed (E.D. Cal.), 156
      – Class action certification denied, uninsured patients allege overcharges violate state law (Ala.), 1131
      – COBRA, early retirees entitled to notice although afforded other health benefits in retirement packages (W.D. Va.), 11
      – Colo. provider fee, governor proposes to cover expanded SCHIP and Medicaid, 107; house approves, 385; senate approves bill, 438; new law, 504
      – Discounts
      – Electronic health records, 1 in 10 only, survey, 389
      – Emergency room care
      – Employee pay, Mass. facilities to pay overtime back wages (D. Mass.), 926
      – Fla. profits up in 2007 but sustained growth questionable, report, 316
      – Gainsharing, medical device makers express concerns in letter to CMS, 212
      – Gifts
      – Group purchasing organizations, system saves billions, study, 832
      – ICD-10 coding conversion
      – Illegal acts exclusion, health plan administrator use to deny benefits for treating unlicensed and uninsured driver improper (6th Cir.), 1129
      – Information technology, implementation obstacles described, webinar, 465
      – Kidney transplant patients, Kaiser settles for $1 million, 494
      – Massachusetts health reform law
        – – Agency approves subsidized Catholic-affiliated plan affording family services, 315; facility ends affiliation with insurer subsidizing coverage, 779
        – – Diversion of funds to finance, facility sues state (Mass. Super. Ct.), 865
      – Medical errors
      – Medical transcription company billing, Kaiser Found. fraud claim proceeds (D.N.J.), 461
      – Medigap, HHS IG approves proposal to create preferred provider networks, 944
      – Mergers
      – NCQA
      – Nonprofits
      – Offshore captive insurer owned by hospital group, insurance premiums paid to insurer not reimbursable by Medicare (D.D.C.), 1188
      – Quality
      – Referral practices, facility sues Scripps Health (Cal. Super Ct.), 712
      – Reimbursement
        – – External review organization and plan administrator, facility's claims alleging underpayment proceed (E.D. Cal.), 1002
        – – Federal reform, $155 billion in Medicare and Medicaid cuts over 10 years under White House accord, 819
        – – Medi-Cal rates increase, governor signs bill, 2023
        – – Medicare Secondary Payer Act
          – – – State Farm's motion to dismiss qui tam suit properly granted where insurer did not avoid legal obligation to repay after accident (D. Idaho), 1005
          – – – Superior claim and first right before facility's claim to policy covering patient hit by uninsured motorist (N.D. Ind.), 100
        – – Medigap policy provision ambiguous, plan must pay standard rate rather than lower Medicare Part A charges (Wis.), 590
        – – Minn. net income, many lost money on operations, report, 596
        – – Out-of-network care
          – – – Anthem BCBS, suit filed over use of manipulated information to underpay (Cal. Super. Ct., C.D. Cal.), 921
          – – – BCBS sues over waiver of patient costs (N.J. Super. Ct.), 677
          – – – ERISA plan participant not entitled to full coverage (N.D. Cal.), 126
        – – Overpayment, BCBS of Mich. and Omega Hosp. trial proceeds (E.D. La.), 376
        – – Pay-for-performance programs
        – – Usury, Allina pays $1.1 million to settle patients' claims (Minn. Dist. Ct.), 460
      – Taxation
      – Telemedicine, Prince Frederick, Md., facility and Wilmington, Del., tertiary care facility linked, 682
      – Uninsured patients
      – Value-based purchasing, House Democrats' health reform bill
        See LEGISLATION, FEDERAL, HR 3200
      – Wis., patients and revenues decline as HMO enrollment increases, report, 193
    HPV
    HRAs
    HSAs
    HUMAN PAPILLOMA VIRUS (HPV)
      – Cal. passes health insurance coverage mandate bill for vaccinations, 1102
      – Vaccine for young women, Or. mandated benefit, In Brief, 803

Contact the Webmaster at webmaster@bna.com
1801 S. Bell Street, Arlington, VA 22202 - Phone: 1-800-372-1033

Copyright © The Bureau of National Affairs, Inc. All Rights Reserved.