Health Plan & Provider Report Index Summary

HEALTH AND HUMAN SERVICES DEPARTMENT (HHS)

– Advancing health information technology adoption, new approach required, forum, 321
– Am. Health Info. Community, conversion to nonprofit entity problematic, 643
– FY2008 budget, omnibus funding bill

See LEGISLATION, FEDERAL, HR 2764

– Office for Civil Rights, percentage of HIPAA complaints requiring corrective action increasing, 545
– Office of Natl. Coordinator for Health Info. Tech., 5-year plan to focus on privacy and interoperability, 639

HEALTH CARE QUALITY

See QUALITY OF CARE

HEALTH CARE REFORM, FEDERAL

– Bipartisan agreement realistic, hearing, 519
– Budget neutrality

See LEGISLATION, FEDERAL, S 334

– Bush proposals, Congress unlikely to adopt, 145
– Employer-based system cornerstone, Chamber of Commerce CEO says, 703
– Long-term care benefit

See generally LONG-TERM CARE

– Medically underserved populations, proposed rule consolidates criteria and designation process, 261
– National health insurance connector plan would save trillions, researchers say, reports, 554
– Passage predicted regardless of White House winner, meeting, 696
– Private-public sector efforts, coalition recommends, report, 554
– Recommendations development, former Senate majority leaders' project, 448
– Tax code and policy

See generally TAXATION

– 2008 presidential candidates' proposals, Special Reports, 44
– Universal coverage, trillions in savings possible with concurrent policies revision, study, 16
– Value-based reimbursement and comparative effectiveness institute key elements of AHIP cost reduction proposal, report, 614

HEALTH CARE REFORM, STATE

See also specific states
– BCBSA, access expansion efforts hampered by budget shortfalls, report, 205
– ERISA preemption problematic, issue brief, 168
– Part D and MA plan marketing practices, proposed CMS rules protect enrollees, 517; association urges more active state role, 522
– Quality of care, Commonwealth Fund performance improvement program selects 9 states, 447

HEALTH INFORMATION TECHNOLOGY

See INFORMATION NETWORKS AND TECHNOLOGY

HEALTH INSURANCE

– Aetna network provider agreements, guidelines released, 612
– BCBS

See BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Breast cancer treatment coverage

See BREAST CANCER

– Claims processing

See CLAIMS PROCESSING

– Discount cards and programs

See generally DISCOUNTS

– Employee Retirement Income Security Act

See ERISA

– Fraud

See generally FRAUD AND ABUSE

– Guaranteed individual coverage, AHIP proposes plan for states, 11
– High-risk pools

See HIGH-RISK POOLS

– HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Individual market, most lacking group coverage do not buy, study, 179
– Mandated

See MANDATED BENEFITS

– Market trends, Aetna opens walk-in Fla. office to provide information informally, 299
– Mergers

See generally MERGERS AND ACQUISITIONS

– Outlook 2008, reform among top issues to be addressed, Special Reports, 71
– Physicians, new Ohio contract negotiations law, 374
– Preexisting conditions

See COVERAGE AND REIMBURSEMENT POLICIES; PREEXISTING CONDITIONS

– Prompt payment

See PROMPT PAYMENT

– Purchasing alliances

See PURCHASING POOLS

– Rates

See PREMIUMS AND RATES

– Reform, national connector plan would save trillions, researchers say, reports, 554
– Retirees

See generally RETIREE BENEFITS

– Self-funded plans

See SELF-FUNDED PLANS

– Small businesses

See PURCHASING POOLS; SMALL BUSINESSES

– State issues

See specific states

– Subrogation

See generally SUBROGATION

– Tax credits and policies

See TAXATION

– Universal coverage

See ACCESS TO CARE

– Wellness programs

See PREVENTIVE CARE

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Preventive care, wellness programs sponsors should determine applicability, bulletin, 88; Labor Dep't releases compliance checklist, 210
– Privacy

– – Disclosure, counseling center worker indicted for illegal release of patient information (W.D. Okla.), 270
– – Electronic health records, security rules adequacy discussed, BNA Analysis, 621
– – HHS Office for Civil Rights, percentage of complaints requiring corrective action increasing, 545
– – Patient data breaches, health care facilities respond improperly, report, 428
– – Transactions of Code Sets standards and Privacy Rule, patient benefits not realized, BNA Analysis, 507

– Voluntary compliance key to HHS privacy rule enforcement, conference, 369

HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– BCBS

See BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Brain cancer, plan must cover child's treatment costs (Wis.), 616
– Cal. health insurance policy rescission, Kaiser and regulators reach agreement on 1,000 members, 549; PacifiCare third plan to settle, 698
– CalPERS premiums, 2009 lowest rate of increase in years, 701
– Colo., Kaiser pays millions to customers under agreement with state, 727
– Copayments

See COPAYMENTS AND DEDUCTIBLES

– Electronic health records, all Kaiser outpatients, 529
– Fla. policyholders, identification cards required, 676
– Ga. Medicaid, emergency services coverage bill approved, 424
– Humana/UnitedHealth Medicare acquisition approved, 502
– Malpractice, Kaiser cannot compel arbitration because language was not obvious on enrollment form (Cal. Ct. App.), 301
– N.Y. children's health care, governor proposes using state funds for coverage expansion, 61; Medicaid spending cuts, SCHIP growth, and HMO tax increase outlined, 118
– Ohio enrollees, employer group plans dropped as Medicaid rose, report, 610
– Out-of-network care, ERISA claim over daughter's bulimia treatment coverage reinstated (9th Cir.), 213
– Physicians

– – Firing, no violation of contract or state unfair trade practices law (Conn.), 68
– – Quality improvements, Cal. plans pay groups millions, 271

– Standing

– – Copayment overcharges

See COPAYMENTS AND DEDUCTIBLES

– – Medical necessity, employer cannot sue over participant's self-pay request where insurers denied coverage (E.D. Pa.), 504

HEALTH REIMBURSEMENT ARRANGEMENTS (HRAs)

– Cards, industry standards, In Brief, 38

HEALTH SAVINGS ACCOUNTS (HSAs)

– Appropriate care, participants may forgo, hearing, 543
– Community banks, more offer, In Brief, 241
– Coverage, 6 million in 2008, AHIP report, 493
– Eligibility, IRS releases detailed guidance, 722
– Inflation adjustments for 2009, IRS revenue procedure issued, 544
– Patient Empowerment Act, IRS contributions guidance, 640
– Taxation, final IRS rules on employer contributions, 465
– Uninsured persons, minimal impact, hearing, 543

HEARING AIDS

– FEHBP, OPM seeks better benefits and Medicare wraparound option for retirees, 370

HEART DISEASES AND DISORDERS

See CARDIOLOGY

HEMODIALYSIS

See END-STAGE RENAL DISEASE (ESRD)

HIGH-RISK POOLS

– Ages 55 to 64, one of many insurance options discussed, hearing, 395
– Cal., pending bill would boost, 346
– Effectiveness, House Democrats call for GAO probe, 288

HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

HOME HEALTH CARE

– Disabled child, Medicaid must pay for medically necessary skilled nursing care (N.D. Ga.), 683
– Skilled care for amputated leg, ERISA preempts widow's claims against CIGNA over denial (D. Me.), 353

HOSPITALS

– Adverse events

See generally ADVERSE EVENTS

– Antitrust

See ANTITRUST

– Arbitration, motion to compel granted in suit over sale of 3 facilities (Colo. Dist. Ct.), 736
– BCBS

– – Contract, Alvarado agreement valid despite ownership change (Cal. Super. Ct.), 590
– – Coverage misrepresentation, ERISA no bar to facility's suit (E.D. La.), 734

– Breach of contract, ERISA preempts claims based on benefits assignment (N.D. Ind.), 99
– Charity care

See CHARITY CARE

– Discounts

See DISCOUNTS

– Emergency room care

See EMERGENCY SERVICES

– Fraud

See FRAUD AND ABUSE

– Medical errors

See MEDICAL ERRORS

– Medication errors

See MEDICATION ERRORS

– Mental health, inpatient treatment

See generally MENTAL HEALTH

– Mergers

See MERGERS AND ACQUISITIONS

– Nonprofits

See NONPROFIT ORGANIZATIONS

– Patient data breaches, facilities respond improperly, report, 428
– Physician arrangements monitoring, BNA audio conference, In Brief, 587
– Quality

See QUALITY OF CARE

– Reimbursement

– – Cal. facilities, timely claims submission discussed, BNA Analysis, 308
– – Charges unrelated to actual costs, CalPERS study, 91
– – Copayments and deductibles, insurers would pay remaining uncollected under R.I. house-passed bill, 401
– – Mass. free care seekers declined, report, 238
– – Or. costs, 90 procedures on state Web site, 528
– – Part A benefits exhausted, Medigap must pay for policy holder's kidney transplant (Wis. Ct. App.), 356
– – Plan administrator misrepresented participant coverage, ERISA does not preempt state detrimental reliance claims (E.D. La.), 557
– – Rate, full payment due from insurer without contract (Ariz., rev den), 68
– – Trauma care, recurring arbitration issue, BNA Analysis, 381

– Remote monitoring, Md. eCare program for off-site critical care physician support, 503
– Reporting

See REPORTING REQUIREMENTS

– Self-funded plans

See generally SELF-FUNDED PLANS

– Specialty

See SPECIALTY HOSPITALS

– Uninsured patients

See UNINSURED PERSONS

– Value-based Medicare purchasing program, stakeholders discuss implementation concerns, 284

HRAs

See HEALTH REIMBURSEMENT ARRANGEMENTS (HRAs)

HSAs

See HEALTH SAVINGS ACCOUNTS (HSAs)