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Vol. 15, Nos. 1- 25, pp. 1-756 Jan. 7 - June 24, 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
MA
State-subsidized Dirigo health plan, tax assessments revised to fund, 715
Treatment authorization denied, ERISA preempts stroke patient's state law claims against plan (N.J. Super. Ct. App. Div.), 293
HMOs
Autism
Coverage required under new Colo. law, 679
Tex., bill passed requiring coverage, 716; new law, 744 Children's health care, hearing aids covered under N.J. law, 43 Employer health coverage, large job losses would result, study, 132 Health insurance coverage, federal requirements
See generally HEALTH CARE REFORM, FEDERAL
High-deductible plans, 17 percent with private insurance in 2007, report, 297
LSCs
See MEDICAL TOURISM
Small group carriers, largest increased median market share in 2008, GAO study, 391
Deceptive
Fair market value sales agent compensation rates also set for Part D, 7; rule may discourage independent agent assistance, 64
Guidance, CMS revises, 609 Strict guidelines needed to protect beneficiaries, advocacy groups say, 737 WellCare, CMS orders suspension, 211
Data mining
Part D, CMS revises guidance, 609
Antitrust, proposed self-insured employer joint contracting with physician-hospital organization allowed, FTC advisory opinion, 456
Electronic health records, provider incentives bill passed, 502; new law, 625 Health insurance, lawmakers pass bill to tighten individual market regulation, 463; new law, 625 Telemedicine, Price Frederick hospital links to Wilmington, Del., tertiary care facility, 682
Health reform law
Catholic hospital affiliation, agency approves subsidized plan affording family planning services, 315
Initial success, affordability gains eroded, study, 651 Insurance coverage mandate, tax penalties schedule for noncompliance issued, 294 Over 97 percent of residents insured, report, 15 Reliance on private plans hinders spending control, report, 350 Single-payer advocates criticize potential use as model, report, 222 Spending distribution unchanged, BCBS report, 437 Subsidized care, $794 million in 2008, report, 417
Gifts, network implements rules restricting drug and device company ties, 439
Medical errors, rule adopted barring providers from billing for care, 592 Overtime, network pays millions to settle failure to pay claims (D. Mass.), 535
Cost of health care, officials probe link between increase and insurer payments to providers, 43
Panel recommends end to fee-for-service method, 594
See also specific states
Coding
See generally CODING
See DISCOUNTS
Information technology, meaningful use payment incentives
Capitated, not all states report encounter data to national database, IG report, 672
Drug rebates
See DISCOUNTS
Hearing aids, N.J. law mandates coverage for children, 43
Hospital gainsharing, industry concerns expressed in letter to CMS, 212 Industry gifts for health care providers
See generally GIFTS
Hospitals
Colo. Medicaid, executive order signed to deny payments for avoidable mistakes, In Brief, 417
Mass., rule adopted barring providers from billing for care, 592 Pa. senate to vote on bill to deny payment, 416
ICD-10 coding conversion
See generally CODING
BNA audio conference, In Brief, 187
Growth industry, possible risks and legal issues discussed, Special Reports, 354
Anthem BCBS, class action alleges regular payment denial (Cal. Super. Ct.), 292; treatment approved in coverage reversal, 314
Autism, Cal. group seeks changes to policy allowing plans to deny treatment, 265; state regulatory clarifies coverage requirements, 316 Fraud, guilty plea entered by recruiter of healthy patients for unnecessary surgeries (Cal. Super. Ct.), 264 Idaho, lawmakers pass bill creating external review system for denied claims, 384 Neurofeedback therapy, plan administrator properly denied coverage (5th Cir.), 216 Out-of-network care, denial proper where Medicare beneficiary did not prove surgery was superior to procedure plan covered (9th Cir.), 261
Bariatric surgery, covered for some obese diabetics, 181
Chronic illness disease management pilot, limited impact of interventions, report, 33; AMA study confirms, 178 Coding
See generally CODING
Compliance, CMS recommends voluntary self-reporting of suspected issues, 581 Delivery system reform
CMS requires increased resources and greater flexibility, hearing, 493
Payment structure lacks incentives, MedPAC report, 702 Exhaustion of remedies, federal law preempts cancer patient's fraud and breach of contract claims against Humana (S.D. Fla.), 288 FY2010 budget, billions in cuts proposed over 10 years, 249; final proposal would cut program spending by $309 billion to fund health reform, 557; President defends program spending reductions in address to AMA, meeting, 692; Obama proposes $313 more program cuts, 694 Funding increase, Baucus (D-Mont) economic stimulus plan includes, 94 Health care reform, program key to legislative efforts, Leavitt says, 66 Hospital gainsharing, medical device makers express concerns in letter to CMS, 212 HRAs, payment errors source, conference, 306 Information technology, meaningful use payment incentives Out-of-network care, denial proper where beneficiary did not prove medical necessity or superiority of surgery plan covered (9th Cir.), 261 Physicians Provider incentives, Accountable Care Promotion Act bill introduced to create voluntary shared savings program, 740 Secondary Payer Act
BCBS, statute not violated by reimbursement for non-network dialysis at lower rates (N.D. Ga.), 261
Hospital reimbursement, federal program had superior claim and first right before facility's claim to policy covering patient hit by uninsured motorist (N.D. Ind.), 100 Plan reporting requirements, implementation deadline extended, 614 Sanctions imposed on individual who did not receive benefits and therefore lacked standing to bring qui tam suits (U.S., rev sought), 70 Virtual colonoscopy, bipartisan House members urge coverage, 340 Wrongful death, federal program has right to reimbursement from family's insurance settlement for medical costs of deceased beneficiary (8th Cir.), 156
Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
Bidding
Budget, MedPAC debates pros and cons of competitive process included in proposal, 255
Enrollment, competitive bids might reduce, MedPAC report, 739 Former CMS chief predicts competitive program, meeting, 373 Payments based on average submitted, industry leaders object to White House proposal, 250; OMB director defends, forum and hearing, 306; MedPAC deems long-term impact of lower pay hard to predict, 309 Preparation, draft 2010 call letter for plans released, 31; withdrawn, 95; oversight focus in revision, 253 Spending, CBO estimates competitive process would reduce by $159 billion, 609 Coding
See generally CODING
Compliance, CMS recommends voluntary self-reporting of suspected issues, 581 Consumer satisfaction, CMS seeks to raise quality ratings, forum, 151 Coverage denial, Kaiser dismissed as improper defendant but leave to amend granted to sue HHS (S.D. Cal.), 676 Enforcement
CMS actions updated, In Brief, 674
Revised rules, CMS to propose, 584 Fraud and abuse, 2 charged in 5-state billing scheme for bogus treatments (S.D. Fla.), 590 Hospitalization, shorter less costly stays than Medicare patients, study, 67 International economic crisis, compliance programs critical, BNA Analysis, 470 Marketing
See MARKETING
Outlook 2009, among top health issues to be addressed, Special Reports, 18 Plan types, 3-limit requirement to avoid 2010 duplication, CMS call letter, 368; more definitive, Kaiser brief, 563; CMS telephone campaign to drop duplicative plans, 607 Rates
Alternative payment system, MedPAC says Congress should focus first on program goals, 431
CMS estimates 0.5 percent increase in 2010, 208; physician pay may be considered in rate calculations, BCBSA says, 337; 0.81 percent is actual rate, 403 Cuts will result in fewer plans and options, MedPAC says, 65 Fee-for-service providers
MA plans to be paid $11.4 billion more in 2009, report, 528
Payments may be less, Sebelius says, hearing, 429 Private MA plans should receive same pay, briefing, 615 Wellcare to withdraw from private market in 2010, 571 Payment policy changes, House leaders and Baucus (D-Mont) support proposal, 282 Private-sector insurer payments, CMS and Treasury Dep't officials consider timing changes, GAO report, 282
CMS posts, 209
Private plan monitoring will improve, forum, 117
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.
Access, no improvement for many beneficiaries, study, 284 Bid preparation
Draft 2010 call letter for plans released, 31; withdrawn, 95; oversight focus in revision, 253
Errors, no refunds for overcharged enrollees, 487 Choices, numerous options impede ability to select low-cost plan, study, 739 E-prescriptions, community pharmacists want federal incentives, 489 Enforcement
CMS actions updated, In Brief, 674
New regulations proposed, 584
Affected seniors cut prescriptions 14 percent, study, 152
Closing, AARP campaign fact sheet, 616 Cost cuts, drug industry pledges, 731 7 percent total of 2006 beneficiaries, report, 283 Low-income persons, health reform would help most, briefing, 615 Marketing guidance, CMS revises, 609 Outpatients, spending up in first program year, brief, 433 Oversight challenges loom, IG report, 34 Payment policy changes, House leaders and Baucus (D-Mont) support proposal, 282 Plan marketing, fair market value sales agent compensation rates set, 7; rule may discourage independent agent assistance, 64 Premiums Protected classes, comments sought on proposed CMS rule requiring coverage, 61; managers' group opposes expansion, 371 Reporting requirements, CMS posts, 209 Stand-alone plans, over 40 percent of beneficiaries purchased, study, 284
Ambiguous policy provision, plan must pay hospital's standard rate rather than lower Medicare charges reimbursement (Wis.), 590
Consumer satisfaction, 88 percent of policyholders pleased, study, 701 Deceptive practices, BCBS of Mich. plan warned, 16 ESRD, new Fla. coverage law, 711 Genetic Information Nondiscrimination Act, CMS to use Natl. Ass'n of Ins. Comm'n model for regulations, 486 Out-of-pocket expenses, MA affords less protection, studies, 339 Policy sales increasing, study, 750
Dependents
Disabled, medical and denial plan acted arbitrarily to deny 23-year-old son's enrollment (N.D. Ill.), 387
Eating disorders, Horizon BCBS of N.J. settlement of coverage claims approved (D.N.J.), 494 Out-of-network care, claim over denial of residential treatment for eating disorder barred (S.D.N.Y.), 347 Parity
Act, business groups seek agency clarification, 644; industry representatives cite enforcement concerns, 671
Federal agencies seek public comment on regulations, 488 Outlook 2009, among top health issues to be addressed, Special Reports, 18
Dependents, medical and dental plan acted arbitrarily to deny disabled 23-year-old son's enrollment (N.D. Ill.), 387
Antitrust
CVS/Caremark, FTC probe sought, 561
FTC to focus on hospital quality improvement potential, meeting, 177 Justice Dep't review, hospital association urges, letter and report, 585 Long-term care pharmacy's claims against merged insurance companies dismissed for insufficient evidence (N.D. Ill.), 89; Omnicare to appeal, 89
Highmark and Independence, Pa. plans halt effort, 103
Transferring funds to subsidiary, suit alleging state law violation dismissed (Mich. Cir. Ct.), 72 Preferred Care Partners/Humana, claims over alleged breach of confidentiality agreement proceed (S.D. Fla.), 495 Sales, binding arbitration hearing set in suit over sale of 3 hospitals (Colo. Dist. Ct.), 73; 2 sales disallowed for violation of state nonprofit law but third proceeds, 712
BCBS
Individual health insurance market rates, lawmakers adjourn without action, 16; insurer to cut jobs and seek increases to offset losses, 106; commissioner sets hearing, 681
Medigap policies, insurer warned about deceptive business practices, 16 Mergers and acquisitions, suit alleging state law violation for transferring funds to subsidiary dismissed (Mich. Cir. Ct.), 72 Omega Hosp., trial over plan reimbursement proceeds (E.D. La.), 376 Health insurance, ERISA does not preempt state rules barring discretionary clauses in policies (6th Cir.), 343 No-fault automobile insurer bound by 2-year limitations period in ERISA plan contract (E.D. Mich.), 158
Antitrust, legislative exemption of health care cooperatives activities will reduce competition and increase costs, FTC letter, 384
Hospitals
Allina pays $1.1 million to settle patients' usury claims (Minn. Dist. Ct.), 460
Net income, many lost money on operations, report, 596
Aetna underpricing to gain market share, class securities action dismissed (E.D. Pa.), 742
Insurance eligibility, former plan participant's claims proceed (S.D.N.Y.), 376 Out-of-network care, ERISA no bar to negligent misrepresentation claim over physician statement that knee treatment would be covered by plan (S.D. Ohio), 675 Standing, spouse cannot sue insurer over terms of policy covering late wife (Cal. Ct. App.), 500
BCBS, ERISA preempts physician's state law prompt payment claims (S.D. Fla.), 158
HMOs, state regulation violated by charging copayment and percentage fee for same single service (W.D. Mo.), 706 Contact the Webmaster at webmaster@bna.com Copyright © The Bureau of National Affairs, Inc. All Rights Reserved. |