Health Plan & Provider Report Index Summary

MALPRACTICE

– Antitrust exemption for insurers, limiting McCarran-Ferguson Act, CRS report, 116

MANAGED CARE

– Assignment of benefits, plans direct reimbursement of out-of-network providers, N.J. law, 122
– Cal., timely access rules adoption, 107
– HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– MA

See MEDICARE ADVANTAGE (MA)

– Medicaid

See MEDICAID MANAGED CARE

– State issues

See specific states

MARKETING

– MA plan sponsors, inappropriate actions, GAO report, 115
– Off-label uses of Neurontin, Pfizer misrepresentations affect on insurance companies claims payments (D. Mass.), 84

MASSACHUSETTS

– Off-label uses of Neurontin, Pfizer misrepresentations affect on insurance companies claims payments (D. Mass.), 84

MCCARRAN-FERGUSON ACT

– Antitrust exemption for health and medical malpractice insurers, limiting, CRS report, 116

MEDICAID

See also specific states
– Comparison chart of health care reform bills provisions, CRS memorandum, 82

MEDICAID MANAGED CARE

– Haw. program, mandatory enrollment, CMS contract approval and waiver of freedom of choice provision issues and claims against state (D. Haw.), 83
– Outlook 2010, potential impact of health care reform, Special Report, 126

MEDICAL RECORDS

– Personal electronic

See ELECTRONIC HEALTH RECORDS

– Privacy

See generally PRIVACY AND CONFIDENTIALITY

MEDICALLY NECESSARY SERVICES

– External review, Idaho system allows appeal of denied claims, 18

MEDICARE

– Comparison chart of health care reform bills provisions, CRS memorandum, 82
– Cost plans conversion to MA plans, concerns and issues, GAO report, 11
– Drug coverage

See MEDICARE DRUG COVERAGE

– Part C

See MEDICARE ADVANTAGE (MA)

– Part D

See MEDICARE DRUG COVERAGE

– Payment advisory board, Senate health care reform bill, 80; hospitals' reform priorities, 81
– Prompt billing, preemption of state law, hospital's right to set lien against liability insurance settlement (Tex. Ct. App.), 18

MEDICARE ADVANTAGE (MA)

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Health Plan Mgmt. Sys. memoranda, CMS issuances, list, 82
– Marketing by plan sponsors, inappropriate actions, GAO report, 115
– Medicare cost plans conversion to MA plans, concerns and issues, GAO report, 11
– Outlook 2010, potential impact of health care reform, Special Report, 126
– Policy and technical changes to plan program, comments on CMS proposed rule, Special Report, 47; finalizing continues, 111
– Private fee-for-service plans in 2011, CMS delists counties requiring networks, 115

MEDICARE+CHOICE

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.

MEDICARE DRUG COVERAGE

– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Drugs approved and listed with FDA, enrollees purchase advice, CMS fact sheet, 12
– Formularies

– – Changes, notification of beneficiaries, HHS Inspector Gen. Office report, 12
– – Utilization management, drugs subject to, researcher findings, 118

– Health Plan Mgmt. Sys. memoranda, CMS issuances, list, 82
– Outlook 2010, potential impact of health care reform, Special Report, 126
– Policy and technical changes to plan program, comments on CMS proposed rule, Special Report, 47; finalizing continues, 111
– Tax deduction for companies, potential repeal in health care reform bills, accounting issue, 79

MERGERS AND ACQUISITIONS

– PacificSource Health Plans and Clear One Health Plans, 46

MISREPRESENTATION

– Aetna plan coverage for lung transplant, ERISA no bar to former NewMarket employee claims (S.D. Miss.), 41
– Off-label uses of Neurontin, Pfizer actions affect on insurance companies claims payments (D. Mass.), 84

MISSISSIPPI

– Misrepresentation of Aetna plan coverage for lung transplant alleged, ERISA no bar to former NewMarket employee claims (S.D. Miss.), 41