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Vol. 14, Nos. 1-44, pp. 1-1214 Jan. 2 - Nov. 5, 2008 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
MA
– Colorectal cancer screening, new coverage law, 400
– Hospitals
– – Charity care, state regulators did not violate 14th Am. by imposing requirement on facilities and providers (D. Me.), 1115
– – Medical errors, new law bans charges for corrective treatment, 522
– Arbitration, HMO cannot compel because language was not obvious on Kaiser enrollment form (Cal. Ct. App.), 301
– Colo. awards, bill defeated, 523
– Antitrust, specialty hospital's contract interference suit against acute care facilities and PPOs settled (D. Kan.), 355
– Cal. Office of Admin. Law, timely patient access rules rejected for lack of uniformity, 294 – Criminal prosecution, WellCare Tampa office replaces CEOs, 150 – Health care provider tax, final CMS rule cuts rate states can impose, 229 – HMOs – MA – Medicaid
See specific states
– AIDS and HIV testing, Cal. bill passed, 966
– Autism diagnosis and treatment, new Pa. law, 775 – Bariatric surgery for morbid obesity, new N.J. law, 838 – Colorectal cancer screening
– – Me., new law, 400
– – Pa., new law, 775
– – Anesthesia for colonoscopies, new law, 837
– – Hair prostheses, new law, 808 – N.J. post-enactment costs, lawmakers approve bill requiring analysis, 347 – Uninsured persons, increases linked, report, 752
– Bad debt, most incurred by insured, study, 1029
– Consumer-directed plans
– – Greater health care choice and access sought, report, 241
– – Plan details, educating members increases ratings, study, 501 – Health care system efficiency, improved payment and benefit structure key, meeting, 705 – LSCs – Out-of-pocket expenses, Medical Mutual of Ohio offers credit cards, 1061 – Physician ranking programs, consumers demand, teleconference, 63 – Safety net providers, private sector strategies used to attract higher paying patients, study, 915 – Walk-in health insurance information office, Aetna opens in Fla., 299 – Women's health insurance, young online shoppers, report, 1155
– Health insurance
– – HealthMarkets and affiliates, 29-state $20 million settlement, 839
– – Unapproved policies, La. firm to halt sales to Mass. residents, 10 – Medicare Advantage plans
– – AHIP, industry agrees to focus on reform, report, 283
– – Comprehensive rule, CMS to publish, 440; progress described, conference, 857 – – Fraud problematic, hearing, 167 – – Geographic service areas, CMS extends, 439 – – Improper sales practices, proposed CMS rules protect enrollees, 517; association urges more active state role, 522; CMS reforms inadequate, report, 576; groups praise proposals, 829; final rule released, 991; private fee-for-service plans cease to be enforcement focus, conference, 1046; Natl. Ass'n of Ins. Commissioners adopts similar enforcement policy, 1050; one-week implementation delay, 1081; new requirements for agents, 1083; CMS guidance clarifies agent responsibilities, 1108; guidance rescinded, 1167 – – Investigations, House panel leaders probe fraud charges, 1143 – – Practices, increased regulation probable, conference, 170 – – Regulatory action to curb abuses considered, hearing, 196 – – Wis., Humana settlement agreement, 998 – Oncology clinic, excluded providers' antitrust action proceeds against BCBS (W.D.N.C.), 1064 – Prescription drugs
– – Data mining
– – – Federal guidelines, most plans do not meet, IG report, 959
– – – Proposed CMS rules protect enrollees from improper sales practices, 517; association urges more active state role, 522; CMS reforms inadequate, report, 576; groups praise proposals, 829; final rule released, 991; private fee-for-service plans cease to be enforcement focus, conference, 1046; Natl. Ass'n of Ins. Commissioners adopts similar enforcement policy, 1050; one-week implementation delay, 1081; new requirements for agents, 1083; CMS guidance clarifies agent responsibilities, 1108; guidance rescinded, 1167 – – – Standing, beneficiaries cannot challenge private entity regulatory policies (D.D.C.), 982 – – – Wis., Humana settlement agreement, 998
– Anesthesiologist, prison term and $5 million payment for improper Medicare, Medicaid, and private insurer billing (D.D.C.), 783
– Commercial HMOs, annual state quality report adds PPO data, 1093 – Hospitals, eCare remote monitoring program for off-site critical care physician support, 503 – Insurance carriers, new laws, 586 – Part D, new law authorizes subsidies from CareFirst BCBS, 586 – PBM, registration requirement bill approved, 424; new law, 469 – Provider contracting, bill passed, 426 – SCHIP, outreach bill passed, 426; new law, 469 – Stop-loss insurance, bill passed, 426; new law, 469
– Electronic health records
– – BCBS, Google Health platform, 679
– – Promoting use, new law, In Brief, 934 – Health insurance
– – Assessments, governor proposes increase to cover state costs, 807; omitted from final reform package, 864; new law, 911; proposed rules would increase number of employers funding state pool, 912; state employer groups criticize, 1000; revised rule cuts number of affected small businesses, 1093
– – Coverage mandate, higher tax penalties for noncompliance, 36; over 2 percent of filers paid, 649 – – La. firm to stop marketing unapproved policies to Mass. residents, 10 – – Minimum coverage standards, employers evaluating, 1119 – – Subsidized plans, state spending projected to double, 173 – – Working poor, reform law coverage expansion considered, 526
– – Emergency services, physicians sue Aetna over reimbursement rates (Mass. Super. Ct.), 329
– – Free care seekers declined, report, 238 – – Medication errors, 10 percent of patients admitted to 6 community facilities, study, 238 – – Trustees, quality improvement training course recommended, 375 – Medicaid waiver, 3-year extension granted as CMS authorizes $4.3 billion more for plan, 1092 – Medical errors, state will not pay associated costs, 698 – Mental health
– – BCBS, medically unnecessary residential treatment for emotional problems properly denied (D. Mass.), 42
– – Expanded coverage requirement bill sent to governor, 864; new law, 911 – Pharmacies, regulatory structure approved allowing CVS Minute Clinics, 60 – Physician rankings, medical society sues to halt state plan (Mass. Super. Ct.), 590 – Reform law implementation
– – Continued viability, rising costs threaten, Senate panel hearing, 1052
– – Cost management, major challenge, briefing, 583 – – Minimum coverage levels, panel approves revised standards, 1149 – – Problems, consumer group says Cal. should consider Mass. experience, 35 – – Uninsured persons
– – – Coverage up 439,000 since 2006, report, 969
– – – Percent dropped, study, 648
See also specific states
– Budget, FY2009
See BUDGET, U.S.
– CMS rules delay – Drug rebates
See DISCOUNTS
See DUAL ELIGIBLES
– Funding boost – Long-term care spending increasing rapidly, report, 1084 – Medical errors, CMS urges coordination with Medicare policies to ensure payment denial for preventable hospital events, 880 – Part D, costs would be cut by Medicaid pricing levels, study, 57 – Payment errors, top federal program in 2007, GAO letter, 113 – Provider taxes and school-based services, CMS rules impact
See QUALITY OF CARE
– Waivers
See WAIVERS
See also specific states
– Drug rebates
See DISCOUNTS
– Performance improvement, most states use external quality reviews, IG report, 641
– Antitrust, coding designation for incontinence equipment proper (11th Cir.), 380
– Artificial hearts, CMS seeks comments on proposed reversal of Medicare noncoverage policy, 170 – Clinical policy bulletins, Aetna CEO urges providers to check for reimbursement questions, meeting, 267 – Comparative effectiveness research, future role of national entity unclear, conference, 613 – Industry gifts, health care providers
See generally GIFTS
See also ADVERSE EVENTS
– BCBS
– – Additional treatment costs, no Tex. reimbursement, 865
– – Complications, no Kan. City Blues reimbursement for hospitals, 864 – – Mich., no payment for hospital mistakes, 809 – Me. hospitals, new law bans charges for corrective treatment, 522 – Mass., no payment for associated costs, 698 – Medicaid, CMS urges coordination with Medicare policies to ensure payment denial for preventable hospital events, 880 – Serious preventable
– – BCBS of Ill., no hospital payments, 887
– – BNA audio conference, In Brief, 615 – – Employer costs, $1.5 billion annually for hospital surgeries, study, 867 – – Hospital readmission rates, Fla. Web site, 730 – – N.Y. Medicaid, no hospital reimbursement, 651 – – Pa. Medicaid, no hospital reimbursement for related adverse events, 120
– Disclosure
– – Cal. provider protection requirement, new law, 1091
– – Wis., new law, 345 – Personal electronic
– Cost of health care
– – Half of spending increase attributable, report, 142
– – Increases, major contributing factor, report, 1154
See generally CODING
– Anesthesia for colonoscopies, Del. mandated benefit law, 837
– Disabled persons, Ga. Medicaid must pay for skilled in-home nursing care for child (N.D. Ga.), 683 – Excess skin removal after gastric bypass surgery, coverage denial upheld (S.D. Ohio), 377 – HMOs, employer lacks standing to sue over participant's self-pay request where insurers denied coverage (E.D. Pa.), 504 – Independent review, commissioner need not follow recommendation to cover out-of-network multiple myeloma treatment (Mich.), 482 – Medicare determination prior to treatment, final CMS rule allows, 231 – Mental health, insurer properly denied coverage for unnecessary residential treatment for emotional problems (D. Mass.), 42 – Obesity, coverage denial arbitrary where evidence established morbid condition (S.D. Ohio), 919 – Prosthetic arm, plan properly denied coverage for backup equipment (8th Cir.), 376 – Self-funded plans, contractual duty satisfied by medical reviews despite contradictory results (Ind. App. Ct.), 157 – Single-source drugs, lawmaker criticizes N.Y. plan restrictions, 584 – Wheelchair accessory, BCBS coverage denial proper (D. Vt.), 1065
– ADEA
– – Coordinating retiree and Medicare benefits, federal statute not violated (U.S., rev den), 354
– – Retiree health benefits link, EEOC issues rule, 8 – Artificial hearts, CMS seeks comments on proposed reversal of noncoverage policy, 170 – Budget, FY2009
See BUDGET, U.S.
– Chartered value exchanges, 14 public-private partnerships designated to access provider data, 143; 11 additions, 964 – Chronic illness, pilot project ends, 143 – Claims processing, CMS awards contract for combined administration of Part A and Part B payments, 343 – Cost shifting to private payers to compensate for low public program reimbursement rates, panel hearing, 1028 – Coverage restrictions based on age unwarranted, groups advises CMS, 1200 – Diabetes, pay-for-performance pilot assessed, report, 201 – Drug coverage
See DUAL ELIGIBLES
– False claims, Mo. health care system pays millions to settle improper billing charges, 844 – FEHBP retirees, OPM seeks wraparound option and better hearing benefits, 370 – Gainsharing, CMS proposes self-referral exception, 747; physicians support, 993 – Growth halt – Incentive arrangements, payments linked to quality favored over rewards for quantity, hearing, 994 – Integrated system would cut costs and improve care, hearing, 1022 – Medically necessary services, final CMS rule allows determination prior to treatment, 231 – Medigap policy holders, increased use of Medicare services disputed, AHIP study, 320 – MMA – Overpayments, CMS extends provider payment schedule, 747 – Part A fiscal intermediaries, 4.6 on 6.0 performance approval scale, survey, 963 – Pay-for-performance pilots, timely CMS feedback lacking, GAO report, 233 – Payment Advisory Comm'n, new members, 576 – Physicians
See generally PHYSICIANS
– Recovery Audit Contractor Program, small business providers report negative experiences, hearing, 545 – Secondary Payer Act
– – Program reporting, CMS to issue 2009 coverage coordination guidance, 113
– – Qui tam suits, individual who does not receive benefits lacks standing sue (6th Cir.), 270; sanctions imposed, 895 – System efficiency, HHS urges stakeholders to develop quality and cost comparison measures, meeting, 464 – Universal coverage, proposed plan combines private insurance and federal program elements, 208
– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Access and choices, HHS chief says Bush would veto bill causing loss, 569 – Benchmarks, payment method change recommended, article, 292 – Beneficiary funding cuts opposed, survey, 695 – Budget, FY2009
See BUDGET, U.S.
– Chronic care special needs plans, HHS advisory panel members chosen, 1023 – Data collection and analysis, CMS seeks improvement to Part D level, meeting, 574; risk adjustment data requirements increased, 905; sponsor responsibilities outlined, 958 – Dual eligibles
See DUAL ELIGIBLES
– Enhancements, final CMS rule bars midyear benefit changes, 831 – Enrollment
– – Increasing generally but local coordinated care slows, report, 654
– – Up in 2008, CMS report, 89 – Guidance for 2009 benefit year, CMS issues draft call letter, 85; deadline delayed for plan reporting on e-prescribing, 343; released with minor changes from 2008, 464; update also addresses disenrollment, 829 – HMOs, receivership ordered for insolvent plan (Fla. Cir. Ct.), 1083 – Humana/Carlten Healthcare merger, Tenn. expansion, 890 – Jurisdiction, judicial review denied for Kaiser enrollee seeking damages for alleged improper stroke treatment termination (6th Cir.), 479 – Low-income coverage, study, In Brief, 1085 – Marketing of plans
– – Comprehensive rules, CMS to publish, 440; progress described, conference, 857
– – Fraud problematic, hearing, 167 – – Geographic service areas, CMS extends, 439 – – Improper sales practices, proposed CMS rules protect enrollees, 517; association urges more active state role, 522; CMS reforms inadequate, report, 576; groups praise proposals, 829; final rule released, 991; private fee-for-service plans cease to be enforcement focus, conference, 1046; Natl. Ass'n of Ins. Commissioners adopts similar enforcement policy, 1050; one-week implementation delay, 1081; new requirements for agents, 1083; CMS guidance clarifies agent responsibilities, 1108; guidance rescinded, 1167 – – Industry agrees to focus on reform, AHIP report, 283 – – Investigations, House panel leaders probe fraud charges, 1143 – – Practices, increased regulation probable, conference, 170 – – Regulatory action to curb abuses considered, hearing, 196
– – Impact on plans discussed, conference, 862
– – PPOs, expansion predicted, 810 – – Program changes described, 815 – NCQA, deeming authority renewed, In Brief, 201 – Out-of-network care, plan guide updated, In Brief, 1202 – Outlook 2008, among top health issues to be addressed, Special Reports, 71 – Payment cuts – Private fee-for-service plans, payment delays and problems for patients, hearing, 140 – Profits, high in 2005 due to overestimated expenses, GAO report, 723 – Rates – Reimbursement
– – $8.5 billion more in 2008 than for fee-for-service plans, report, 959
– – Private plans, 16.6 percent more than traditional providers in 2008, report, 1140 – Special needs plans
– – Congress should lift moratorium, AHIP report, 473
– – Performance measures, CMS proposes, 7 – – Product improvement, CMS assisting, conference, 442 – – Quality data, first year to publish, 1047 – – Value debated, report, 145 – Supplemental coverage, majority of beneficiaries enrolled, Kaiser report, 880 – Toll-free customer service line, 2009 plan details also available on Web site, 1144 – UnitedHealth/Sierra Health Services merger, divestiture of Las Vegas plans required, 243; physicians file objections to merger approval (D.D.C.), 544 – Wis. marketing, Humana settlement agreement, 998
– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Adverse events
– – CMS protocol guidance for researchers, 931
– – Final rule permits claims data sharing to identify key issues, 572
– – Coverage requirements revision recommended, GAO report, 231
– – Procedures, proposed CMS rule clarifies, 322
– – Best tool for price reporting data oversight, GAO letter, 1198
– – Program compliance, CMS begins, 1140 – CalPERS, retiree drug subsidy funds distributed to cities, 471 – Centers for Beneficiary Choices, renamed CMS office to coordinate Part D and MA contracts, 638 – Cholesterol treatment, patients stop brand name prescriptions upon reaching coverage gap, report, 1052 – Claims data
– – Release, privacy concerns addressed, MedPAC report, 369
– – Researcher availability, year end likely, CMS forum, 674 – Compendium, management strategies for conflicts of interest outlined, draft paper, 1171 – Complaints and grievances, resolution issues continue, GAO report, 858 – Cost-sharing structure, financial hardship for uninformed, study, 466 – Coverage gap for one-quarter of enrollees, report, 932 – Customer service, CMS data indicate most plans meet standards, 288 – Due process, beneficiaries' claims over premium withholding errors proceed against HHS (D. Mass.), 444 – E-prescriptions
– – Computer faxes ban, CMS reconsiders, 287
– – Financial incentives for providers, 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 – Enrollment, increase noted as projected costs drop, 139 – FEHBP, millions wasted due to lack of benefits coordination, letter, 518 – Formularies
See FORMULARIES
– Generic drug prices, 10 percent drop, report, 546 – Improper enrollment alleged, dismissal of claim against plan upheld (9th Cir.), 979 – Jurisdiction, claim against insurer not arising under Medicare Act remanded to state court (M.D. Ala.), 182 – Low-income persons
– – Allowable eligibility assets doubled
– – Plan choices, fewer in 2009, study, 1111 – – Plan reassignment, final CMS rule bars, 371 – – Premiums, plans may cut, 31 – – Subsidies qualification
– – – Assets test eliminated from N.Y. budget bill, 425
– – – Denial basis, income not assets, GAO report, 993 – Managed care funding
– – Federal guidelines, most plans do not meet, IG report, 959
– – Proposed CMS rules protect enrollees from improper sales practices, 517; association urges more active state role, 522; CMS reforms inadequate, report, 576; groups praise proposals, 829; final rule released, 991; private fee-for-service plans cease to be enforcement focus, conference, 1046; Natl. Ass'n of Ins. Commissioners adopts similar enforcement policy, 1050; one-week implementation delay, 1081; new requirements for agents, 1083; CMS guidance clarifies agent responsibilities, 1108; guidance rescinded, 1167 – – Standing, beneficiaries cannot challenge private entity regulatory policies (D.D.C.), 982 – Medicare Improvements for Patients and Providers Act, program changes described, 815 – Medicare Prescription Drug, Improvement, and Modernization Act of 2003, provision triggering spending reductions nullified, 835 – Medication therapy management programs, midyear changes flexibility for plans, 931 – MEWAs, many funds accept retiree subsidies, survey, 772 – Monitoring, CMS focusing on plan compliance, forum, 292 – Nursing homes, residents need more assistance, IG report, 672 – Out-of-pocket expenses, 2006 tracking faulted, IG report, 9 – Part B
– – Claims processing, CMS awards contract for combined administration of Part A payments, 343
– – Whistleblower's FCA claims proceed against carrier (S.D. Miss.), 213 – Pharmacists and pharmacies
– – Arbitration, award upheld for chain that would not charge prohibited copayment as PBM ordered (D. Minn.), 619
– – Benefit success, patients and physicians more pleased than pharmacists, study, 547 – – Community stores, contract negotiation issues, IG report, 879 – – Long-term care, groups seeking payment information lack standing to sue HHS (D.D.C.), 98 – – Payments are 18 percent over costs, IG report, 88
See PREMIUMS AND RATES, subheading: Part D
– Program spending, up over 18 percent in 2006 due to benefit, article, 55 – Prompt payment, costs would increase billions, study, 370 – Quality assurance checklist, tool for plans submitting data to CMS, 495 – Reconciliation payments, plan sponsors returns millions to CMS, 1108 – Reporting requirements, technical specifications, In Brief, 646 – Retiree subsidy program
– – Attestation guidance, In Brief, 646
– – Qualifications guidance, In Brief, 646 – Specialty medications, increase greater than other categories, report, 1053 – Standardization, enrollee choices would be improved, report, 639 – Technical corrections, 2005 rules clarification finalized, 417 – Toll-free customer service line, 2009 plan details also available on Web site, 1144 – Training requirements, CMS issues compliance guidance for plans, 1082 – Wis. marketing, Humana settlement agreement, 998
– Part D
– Hospitals, 10 percent of patients admitted to 6 Mass. community facilities, study, 238
– Discounts, no penalties for assisting hospitals, advisory opinion, 1111
– Hospital reimbursement, insurer that issued supplemental policy liable for covered patient's charges (D. Minn.), 1203 – Low-income persons, coverage essential, study, 1061 – Minimum plan standards updated, 1051 – Part A benefits exhausted, hospital must be paid for patient's kidney transplant (Wis. Ct. App.), 356 – Policy holders, increased use of Medicare services disputed, AHIP study, 320 – RICO, class action alleging insurer told agents to deny supplemental coverage for ill seniors dismissed in part (W.D. Ky.), 477 – Supplemental coverage, majority of beneficiaries enrolled, Kaiser report, 880
– Bulimia, claim against HMO over daughter's out-of-network treatment coverage reinstated (9th Cir.), 213
– Colo. programs, new law requires actuarially sound payment rates, 427 – Disabled son, educational and psychiatric coverage arbitrarily denied due to treatment center's billing codes (D. Colo.), 156 – Eating disorders
– – Aetna coverage denial for daughters, ERISA preempts state claims (D.N.J.), 269; settlement, 659
– – Depression, ERISA does not preempt participant's state law claims for daughter's residential treatment coverage (D. Utah), 130 – – Horizon BCBS of N.J., coverage claims for daughters barred (D.N.J.), 896 – Fla. Medicaid providers, reform pilot problematic, report, 607 – Generic drugs, damages for insurers where maker retained anxiety medication supplies to raise prices (D.D.C.), 155 – HIPAA, counseling center worker indicted for illegal disclosure of patient information (W.D. Okla.), 270 – Inpatient psychiatric treatment inadequate, Medicaid reimbursement denial proper (Pa. Commw. Ct.), 126 – Insomnia and depression, Aetna tests HealthMedia online behavior-change programs, 705 – Mass., expanded coverage requirement bill sent to governor, 864; new law, 911 – Parity
– – Act expansion, impact on plans explored, BNA Analysis, 1187
– – Cal. comprehensive coverage bill, 608; lawmakers approve, 966 – – Extension of current law – – Past and current bills traced, report, 32 – – Small businesses, coverage requirement – Spending, behavioral health care and substance abuse treatment cost increase anticipated, study, 1110 – TennCare, request for medical and behavioral provider proposals, In Brief, 62; contracts awarded, 471
– Autism
– – Care and coverage, new Fla. law, 580
– – Diagnosis and treatment, new Pa. coverage mandate, 775
– BCBS, state law violated by transferring funds to subsidiary (Mich. Cir. Ct.), 756; suit proceeds, 1118
– CIGNA/Great-West Healthcare completed, 403 – Group Health/Health Ins. Plan, NYC officials urge state to reject conversion to for-profit firm, 524 – Hospitals
– – Community Health Sys./Empire Health Serv. approved, 977
– – Evanston Northwestern Healthcare, Sherman and Clayton Act claims by injured individuals proceed (N.D. Ill.), 657 – – Inova Health Sys. Found./Prince William Health Sys. merger challenged for antitrust violations (FTC), 532; plan abandoned (E.D. Va.), 645 – – Nonprofits, attorney general approves sale of Denver facilities to Catholic system, 34; suit to block transfer filed (Colo. Dist. Ct.), 101; suit dropped, 327; arbitration ordered, 736 – Humana/UnitedHealth Medicare HMO approved, 502 – Independence BC/Highmark, plans and providers disagree about Pa. impact, hearing, 857 – SureScripts/RXHub combine, 751 – UnitedHealth/Sierra Health Services, divestiture of Las Vegas MA plans required, 243; physicians file objections to merger approval (D.D.C.), 544 – Wellpoint/Resolution Health, 475
– BCBS
– – Antitrust, PPO network agreement with DME suppliers legal (6th Cir.), 535
– – HMO hospital rates, plan did not act as fiduciary when negotiating (E.D. Mich., recon den), 39 – – Independent review, commissioner need not follow recommendation to cover out-of-network multiple myeloma treatment (Mich.), 482 – – Individual health insurance market, senate reform bill passed, 498; plan should use surplus to modify rates, hearing officer says, 582; commissioner approves increase, 838; subscriber challenges rate increase approval (Mich. Cir. Ct.), 1009 – – Medical errors, no payment for hospital mistakes, 809 – – Mergers and acquisitions, state law violated by transferring funds to subsidiary (Mich. Cir. Ct.), 756; suit proceeds, 1118 – – Out-of-network care, coverage denial proper for Mich. member's treatment at Miss. medical center (N.D. Miss.), 892 – – Over-the-counter Zyrtec covered, 177 – – Preexisting conditions, senate panel considers bill insurer supports, 119 – Electronic health records, secure network for sharing patient data, 1180 – HMO profits drop in 2007, report, 888 – Information technology, grants for statewide health system, 971 – No-fault automobile insurance, ERISA preempts state coordination of benefits law (E.D. Mich.), 352
– E-prescriptions, new omnibus law requires, In Brief, 652
– Electronic health records
– – Health insurance eligibility inquiries, rules adopted requiring electronic responses, 118
– – Personal portfolios, governor proposes 2011 goal, 865 – – Provider use requirement, bill sent to governor, 581 – HMOs, enrollment decline levels, report, 806 – Insurance tax credits for employers, new law, In Brief, 653 – Premiums and rates, BCBS SureBlue offers rate stability for small and mid-sized businesses, 1055 – Preventive care, Allina Hosp. & Clinics to develop center focusing on heart attacks, 681 – Price transparency, bill passed, 581 – System reform, pay-for-performance programs and evidence-based medicine, task force recommendations, 203 – Uninsured persons
– – Ages 50 to 64, Medica offers plan, 999
– – Approved bill also addresses underinsured, 581
– Businesses/HHS alliance, disparities reduction, In Brief, 201
– Employer quality improvement initiatives, legal issues related to information collection by race and ethnicity, BNA Analysis, 760 – NCQA, 8 successful programs recognized, 1031 – Nonmedical improvement strategies, commission created to study, 266
– ASCs, ERISA no bar to claims over reimbursement levels (S.D. Tex.), 1205
– COBRA, ERISA no bar to provider claims against plan administrator over negligent coverage communications (E.D. Mo.), 1008 – Health insurance policy rescission, state law requires plans to show enrollee deception (Cal. Ct. App.), 19; (pet for reh'g filed), 66; denied (Cal., rev sought), 173; (rev den), 378; new law codifies key holdings, 967 – Hospitals
– – BCBS, facility's suit over coverage proceeds (E.D. La.), 734
– – Coverage, ERISA no bar to state claims against insurer (S.D. Tex.), 812 – – Plan administrator verification of participant coverage, facility's 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
– Generic drugs, pharmacists sue over Medicaid reimbursement cuts (Miss. Ch. Ct.), 533
– Out-of-network care, BCBS coverage denial proper for Mich. member's treatment at Miss. medical center (N.D. Miss.), 892
– Antitrust
– – Price fixing, arbitration clauses in insurer contracts with physicians enforceable (Mo. Ct. App.), 812; correction, 897
– – Specialty hospitals, managed care contract interference suit against acute care facilities and PPOs settled (D. Kan.), 355 – Fiduciary duty breach, ERISA no bar to state claim against human resources worker who disclosed sensitive health information (E.D. Mo.), 181 – Hospital errors, no BCBS of Kan. City reimbursement for complications, 864 – Prescription drugs, state regulation capping copayments at 50 percent applicable (E.D. Mo.), 1064 – Wrongful discharge, ERISA does not preempt state claims over firing due to heart attack treatment costs (W.D. Mo.), 303
– Health insurance, commissioner may bar discretionary clauses without violating ERISA (D. Mont.), 304
– Benefit surplus, trust's claim for refund from Capital BC proceeds (M.D. Pa.), 408
– Coverage misrepresentation, ERISA does not preempt provider claims (7th Cir.), 869 – Part D, many funds accept retiree drug subsidies, survey, 772 Contact the Webmaster at webmaster@bna.com Copyright © The Bureau of National Affairs, Inc. All Rights Reserved. |
