Health Plan & Provider Report Index Summary

NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

– Board of directors, MedPAC chairman Hackbarth named, In Brief, 32
– Health promotion program standards, NCQA releases, 654
– Medicare Advantage plans, deeming authority renewed, In Brief, 201
– Physicians and Hospital Quality Program, proposed standards released for public comment, 297

NCQA

See NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

NEGLIGENCE

– Medical errors

See MEDICAL ERRORS

– Medical malpractice

See MALPRACTICE

– Skilled in-home care for amputated leg, ERISA preempts widow's claims against CIGNA over denial (D. Me.), 353

NEVADA

– UnitedHealth/Sierra Health Services merger, divestiture of Las Vegas MA plans required, 243; physicians file objections to merger approval (D.D.C.), 544

NEW HAMPSHIRE

– Small businesses, low-cost required health insurance coverage bill passed, 550

NEW JERSEY

– Dental coverage decisions, new law, 91
– Eating disorders, ERISA preempts state claims over Aetna coverage denial for daughters (D.N.J.), 269; settlement, 659
– Electronic health records, new law creates panel and statewide plan development mandate, 90
– Horizon BCBS

– – Anti-assignment provision, no bar to out-of-network ASC's ERISA claims for payment (D.N.J.), 302
– – Privacy, state and federal probe of member data security breach, 176

– Hospitals charged uninsured higher rates, dismissal of proposed class action upheld (3d Cir.), 735
– Mandated benefits, lawmakers approve bill requiring analysis of post-enactment costs, 347
– Network-based plans, proposed rule on excessive cost sharing, 148
– Neurologist, fine and 5-year probation term for submitting fraudulent claims to private insurers (N.J. Super. Ct.), 682
– Orthotic and prosthetic devices, new law requires insurer coverage, 90
– Prompt payment, arbitration decisions posted on Web site, 234
– State subsidized health benefits, bill approved to strengthen income verification procedures, 700
– Universal coverage, subsidized care bill approved, 726

NEW MEXICO

– Universal coverage, governor calls on lawmakers to pass requirement, 93; lawmakers reject plan, 202

NEW YORK

– Health insurance

– – ASCs, Long Island facility overcharged public employee plan, audit, 499
– – Group Health/Health Ins. Plan merger, NYC officials urge state to reject conversion to for-profit firm, 524
– – Outpatient consultant services and facility fees, state worker plan overpaid, audit, 37
– – Reform, universal coverage project and policy changes to expand access, 202
– – Single-source drugs, lawmaker criticizes plan restrictions, 584
– – Small businesses, Oxford Health issues premium refunds to NYC firms, 649

– Information technology, grants awarded for community-based projects including electronic health records, 401
– Medicaid

– – Children's health care, governor proposes using state funds for coverage expansion, 61; spending cuts, SCHIP growth, and HMO tax increase outlined, 118
– – Electronic health records, NYC provider system launched, 264
– – Funding increase, 2008-2009 budget, 400
– – Managed care, enrollment drops and goals unmet, reports, 347
– – Newborns, improper overpayments for fee-for-service claims, 648
– – Serious preventable medical errors, no hospital reimbursement, 651

– Part D, assets tests for low-income subsidies qualification eliminated from budget bill, 425
– Prescription drugs

– – PBMs, new patient notification bill would impose requirements for unilaterally changing medications, 580
– – Physician gifts from industry, governor proposes bill to limit, 580
– – Prices, comparative Web site created, 204
– – Single source, lawmaker criticizes plan restrictions, 584

– Provider reimbursement, systematic underpayment based on faulty methodology, attorney general says, 215; subpoenas issued, 294
– SCHIP expansion, 2008-2009 budget includes, 400
– Sexual orientation discrimination, community college violated state law by denying same-sex marriage partner health coverage (N.Y. App. Div.), 216

NONPROFIT ORGANIZATIONS

– Am. Health Info. Community, HHS policy group conversion problematic, 643
– Colo. Medicaid, health partnership program for high-risk adults, Special Reports, 626
– Hospitals, attorney general approves sale of nonprofit Denver facilities to Catholic system, 34; suit to block transfer filed (Colo. Dist. Ct.), 101; suit dropped, 327; arbitration ordered, 736
– Information technology groups, grantees' joint effort, 115
– Insurance reform, Natl. Business Group on Health rejects employer mandates but favors requirements for individuals, 153

NORTH CAROLINA

– BCBS

– – Generic drug copayments, waived for chronic illness, 38
– – Rates, online cost estimator for procedures, 95

– Chronic conditions, standardized care and coverage agreement for 5, 400
– Prescription drugs, free through clinic pilot program, 527

NOTICE

– Discounts, rate suit proceeds against insurer that withdrew from PPO network without advising acute care hospital (S.D. Fla.), 355
– Fla. Medicaid pilot, patients not informed they could change plans for cause (S.D. Fla.), 127
– Hospital discounts, plan forfeited reduction where administrator did not advise facility of preexisting condition exclusion (S.D. Tex.), 330
– Inadequate, ERISA plan beneficiary's claim for penalties proceeds in suit over accident coverage denial (D. Idaho), 504
– PBMs, new N.Y. patient notification bill would impose requirements for unilaterally changing drugs, 580
– SNFs, proposed class action over glucose test claim denial based on invalid local coverage determination dismissed (D.D.C.), 214

NURSING HOMES

– False claims, no insurer duty to defend charges over submission of improper Medicare and Colo. Medicaid claims (10th Cir.), 708
– Part D, residents need more assistance, IG report, 672