Health Plan & Provider Report Index Summary

P4P PROGRAMS

See PAY-FOR-PERFORMANCE PROGRAMS

PARITY, MENTAL HEALTH

See MENTAL HEALTH

PART B DRUG BENEFIT

See MEDICARE DRUG COVERAGE; PREMIUMS AND RATES

PART D DRUG BENEFIT

See MEDICARE DRUG COVERAGE; PREMIUMS AND RATES

PAY-FOR-PERFORMANCE PROGRAMS

– Bonuses

See BONUSES

– Demonstration projects

– – Diabetes, Medicare pilot assessed, report, 201
– – Implementation of models, problems predicted, forum, 15
– – Minn. health system reform, among task force recommendations, 203
– – Timely CMS feedback lacking, GAO report, 233

PAYMENT DELAYS

See PROMPT PAYMENT

PBM

See PHARMACY BENEFITS MANAGEMENT (PBM)

PENNSYLVANIA

– Generic drugs, Independence BC waives copayments, 706
– Health insurance, small businesses

– – Premium subsidies, house bill passed, 345
– – Standard plan, house passes bill, 402

– HMOs, employer lacks standing to sue over participant's self-pay request where insurers denied coverage (E.D. Pa.), 504
– Hospitals, serious preventable errors

– – Medicaid will not reimburse, 120
– – Reduced payment, house passes bill, 402

– Mental health, Medicaid reimbursement properly denied where inpatient psychiatric treatment was inadequate (Pa. Commw. Ct.), 126
– MEWAs, trust's claim for benefit surplus refund from Capital BC proceeds (M.D. Pa.), 408
– Specialty pharmacy, no breach of fiduciary duty claim against BC of Northeastern Pa. over termination of linked group health plan (M.D. Pa.), 244

PERSONAL ELECTRONIC HEALTH RECORDS

See ELECTRONIC HEALTH RECORDS

PERSONALIZED MEDICINE

– Privacy, concerns over genetic and historical data misuse, report, 144

PHARMACEUTICALS

See DRUGS AND PHARMACEUTICALS

PHARMACISTS AND PHARMACIES

– Antitrust, independent pharmacies negotiating prices

See LEGISLATION, FEDERAL, HR 971

– CVS Minute Clinics, Mass. regulatory structure approved to allow, 60
– Fraud conspiracy, 2-year sentence for employee who filed $18 million in false private insurance prescription claims (S.D. Fla.), 557
– LSCs, numbers grow to meet consumer demands, Special Reports, 218
– Miss. Medicaid, state sued over generic drugs reimbursement cuts (Miss. Ch. Ct.), 533
– Online

See INTERNET PHARMACIES

– Part D

– – Arbitration, award upheld for chain that would not charges prohibited copayment as PBM ordered (D. Minn.), 619
– – Benefit success, patients and physicians more pleased than pharmacists, study, 547
– – Long-term care, groups seeking payment information lack standing to sue HHS (D.D.C.), 98
– – Medicare payments 18 percent over costs, IG report, 88

– PBM

See PHARMACY BENEFITS MANAGEMENT (PBM)

– Specialty, no breach of fiduciary duty claim against BC of Northeastern Pa. over termination of linked group health plan (M.D. Pa.), 244
– Wal-Mart, $4 prescription program expanded as Kroger and Target cut prices, 530

PHARMACY BENEFITS MANAGEMENT (PBM)

– Antitrust, online prescription vendor's suit against Medco and Caremark dismissed (E.D. Tex.), 333
– Chronic diseases, annual drug license fee payment proposed to cut out-of-pocket costs, study, 124
– Conflicts of interest, collateral estoppel doctrine no bar to D.C. disclosure law challenge (D.C. Cir.), 451
– E-prescriptions, trade group campaigns to mandate for Medicare, 494
– Employer management strategies cutting costs effectively, survey, 349
– Formulary submissions format, impact described, report, 449
– Fraud

– – Express Scripts, states' charges over switching patients to more expensive brand-name drugs settled, 607
– – Medco, former worker sentenced to prison for attempted destruction of network data system (D.N.J.), 69

– Generics

– – Copayments, Independence BC of Pa. waives, 706
– – Use increase saved billions in 2007, Express Scripts report, 297

– Md. registration requirement bill approved, 424; new law, 469
– N.Y. patient notification law on unilateral drug changes, 580
– Part D, arbitration award upheld for pharmacy chain that would not charge prohibited copayment as PBM ordered (D. Minn.), 619
– Physicians urged to change patients' brand-name drugs, CVS Caremark settles state fraud probes, 211
– TennCare, Ill. firm awarded contract, In Brief, 500
– Underpayment, class of drug stores suing insurer and PBM certified (M.D. Ala.), 710
– URAC

See UTILIZATION REVIEW ACCREDITATION COMMISSION (URAC)

– Vytorin for cholesterol, multiple fraud suits filed over Zetia-Zocor combination product payments by federal government and private insurers (M.D. Fla.), 183

PHYSICAL THERAPY

– Physicians, claim over clinic reimbursement interference by plan employee reinstated (8th Cir.), 130

PHYSICIANS

See also SPECIALISTS
– Aetna network agreements, guidelines released, 612
– Bonuses

See BONUSES

– Consumer satisfaction

– – Profiles, Ill. Web site allows comparison, 427
– – Ranking programs in demand, teleconference, 63

– Electronic health records, use increasing, survey, 703
– Electronic prescriptions

See generally E-PRESCRIPTIONS

– Emergency services, Aetna sued over reimbursement rates (Mass. Super. Ct.), 329
– Firing, no violation of HMO contract or state unfair trade practices law (Conn.), 68
– Fraud

See generally FRAUD AND ABUSE

– Gifts

See GIFTS

– Hospital arrangements monitoring, BNA audio conference, In Brief, 587
– Information technology

– – Security concerns addressed

See LEGISLATION, FEDERAL, HR 6357

– – Virtual house calls, Aetna and CIGNA messaging system expansions allow, 17

– Medicare Physician Quality Reporting Initiative, 16 percent of eligible providers participating, CMS says, 260; payments to be sent mid-July, 695
– Medicare providers

– – Cuts cancellation

See LEGISLATION, FEDERAL, S 2785

– – FY2009 budget resolutions, payment fix

See LEGISLATION, FEDERAL, HConRes 312, SConRes 70

– – Managed care funding, physician pay cut

See LEGISLATION, FEDERAL, S 3118

– – Part D benefit success, patients and physicians more pleased than pharmacists, study, 547
– – Payment increase, Baucus (D-Mont) says June action possible on $15-$18 billion legislation, 519; Feinstein (D-Cal) urges provision to expand Part D off-label coverage, 605
– – Primary care

See PRIMARY CARE PHYSICIANS

– – Reimbursement legislation, managed care cuts predicted, meeting, 195
– – 6-month pay increase

See LEGISLATION, FEDERAL, S 2499

– Ohio contracts, new insurer negotiations law, 374
– Pay-for-performance programs

See PAY-FOR-PERFORMANCE PROGRAMS

– Physical therapy clinic reimbursement, claim over interference by plan employee reinstated (8th Cir.), 130
– Prescription data mining

– – State laws surpass federal protection, Special Reports, 185
– – Wash. ban on sales passed, 234

– Primary care

See PRIMARY CARE PHYSICIANS

– Quality of care

See QUALITY OF CARE

– Reimbursement

– – BCBS

– – – Class action settlement approved (S.D. Fla.), 477
– – – Reconstructive plastic surgeon, ERISA preempts state reimbursement claims for participant's child (D. Conn.), 534

– – Bonuses

See BONUSES

– – Medicare providers

See Medicare providers, this heading

– – Pay-for-performance programs

See PAY-FOR-PERFORMANCE PROGRAMS

– – Price fixing, FTC finding of illegal contract negotiation by Tex. association upheld (5th Cir.), 556

– Tex. medical board misconduct, doctors sue (E.D. Tex.), 61
– Transparency, new Ky rules on insurer contract negotiation, 549
– UnitedHealth/Sierra Health Services merger, divestiture of Las Vegas MA plans required, 243; doctors file objections to approval (D.D.C.), 544

PILOT PROJECTS

See DEMONSTRATION PROJECTS

PIP (PERSONAL INJURY PROTECTION)

See AUTOMOBILE INSURANCE

PLAN LIABILITY

– Administrator misrepresented participant coverage, ERISA does not preempt hospital's state detrimental reliance claims (E.D. La.), 557
– Claims processing

See CLAIMS PROCESSING

POLITICAL ACTIVITIES

– Employee benefits, most voters support play or pay coverage fund, survey, 95
– 2008 presidential candidates, health care reform proposals, Special Reports, 44

POOLS, INSURANCE

See HIGH-RISK POOLS; PURCHASING POOLS

PPOs

See PREFERRED PROVIDER ORGANIZATIONS (PPOs)

PREEMPTION

– Employee Retirement Income Security Act

See ERISA

PREEXISTING CONDITIONS

– Mich., senate panel considers bill BCBS supports, 119
– Notice, plan forfeited discount where administrator did not advise hospital of exclusion (S.D. Tex.), 330
– Short-term policy coverage denial, Assurant Health settles regulator charges (Conn. Ins. Dep't), 589

PREFERRED PROVIDER ORGANIZATIONS (PPOs)

– Antitrust

– – DME, network agreement with suppliers legal (6th Cir.), 535
– – Radiology services, excluded providers' monopolization claim properly dismissed (9th Cir.), 588
– – Specialty hospitals, managed care contract interference suit settled (D. Kan.), 355

– CalPERS premiums, small drop in 2009, 584
– Discounts, acute care facility's rate suit proceeds against insurer that withdrew from PPO network without notice (S.D. Fla.), 355
– Physicians, appropriation of identity claims over use of names and practice information on medical discount cards proceed (11th Cir.), 377

PREGNANCY AND CHILDBIRTH

– Maternity health insurance, state attorney general sues firm over fraudulent policy sales (Tex. Dist. Ct.), 505
– OB/GYN provider, ERISA does not preempt reimbursement claims against Aetna (W.D. Tex.), 618

PREMIUMS AND RATES

– BCBS of N.C., online cost estimator for procedures, 95
– CalPERS

– – HMOs, 2009 lowest rate of increase in years, 701
– – Small drop for PPOs in 2009, 584

– Colo. increases, senate panel approves bill requiring insurer justification, 496; passed, 523
– Disability leave, no health benefits for worker laid off upon return where payments were not made (D.N.J.), 127
– Discounts

See generally DISCOUNTS

– Emergency services, physicians sue Aetna over reimbursement (Mass. Super. Ct.), 329
– Families, cost increases exceed income gains, study, 502
– Health insurance subsidies, Pa. house passes bill, 345
– Hospitals

– – Ill. Consumer Fraud Act, no violation for charging uninsured patients higher rates (Ill. App. Ct.), 480
– – Insurer lacking contract with facility, full rate payment due (Ariz., rev den), 68

– Individual health insurance plans

– – Mich. senate passes reform bill, 498; BCBS should use surplus to modify rates, hearing officer says, 582
– – Wash. senate-approved bill would allow commissioner to review rates, 147; passed, 324; new law, 423

– Medicare Advantage

– – Growth percentage, over 4 percent to be used for 2009 private plan rate calculation, 391
– – Part A Trust Fund, cutting rates would extend life, hearing, 393
– – 2009 projected payment rate, 4.8 percent increase, CMS advance notice, 229

– Out-of-network emergency room care, Kaiser sued over reimbursement rates (Cal. Super. Ct.), 247
– Part B, clinical laboratories competition pilot enjoined (S.D. Cal.), 429
– Part D

– – CareFirst BCBS of Md. subsidies, new law, 586
– – Due process, beneficiaries' claims over withholding errors proceed against HHS (D. Mass.), 444
– – Low-income persons, plans may reduce, 31

– Physician-specific data, BCBS of Tenn. provides for members, 205; release delayed, 300
– Small businesses

– – Oxford Health issues refunds to NYC firms, 649
– – Wash. subsidies bill passed, 234; amended bill sent to governor, 324; new law, 372

PRESCRIPTION DATA MINING

– State laws surpass federal protection, Special Reports, 185
– Wash. ban on sales passed, 234

PRESCRIPTION DRUG BENEFIT UNDER MEDICARE

– Reform law

See MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT (MMA)

PRESCRIPTION DRUG PRICES

– Antitrust, independent pharmacies negotiating prices

See LEGISLATION, FEDERAL, HR 971

– AWP

See AVERAGE WHOLESALE PRICE (AWP)

– Brand name outpace inflation, AARP report, 299
– Copayments

See COPAYMENTS AND DEDUCTIBLES

– Discount cards and programs

See generally DISCOUNTS

– Generics

See GENERIC DRUGS

– Internet

– – N.Y. comparative Web site created, 204
– – Web site data gaps limit usefulness, study, 206

– Medicaid level would cut Part D costs, study, 57
– Medicare

See generally MEDICARE DRUG COVERAGE

– Online purchases

See INTERNET PHARMACIES

– PBM

See generally PHARMACY BENEFITS MANAGEMENT (PBM)

– State bills pending, reports, In Brief, 177
– Vytorin for cholesterol, multiple fraud suits filed over Zetia-Zocor combination product payments by federal government and private insurers (M.D. Fla.), 183

PRESCRIPTION DRUGS

– Copayments

See COPAYMENTS AND DEDUCTIBLES

– Discount cards and programs

See generally DISCOUNTS

– Electronic prescribing

See E-PRESCRIPTIONS

– Fraud

See FRAUD AND ABUSE

– Generics

See GENERIC DRUGS

– Off-label use

See OFF-LABEL USE

– Online

See INTERNET PHARMACIES

– Patient safety

See SAFETY OF PATIENTS

– PBM

See PHARMACY BENEFITS MANAGEMENT (PBM)

– Records, Google Health public Web site launched, 587
– Schizophrenia, Me. Medicaid prior authorization requirement raises widespread treatment concerns, study, 395
– Single source, lawmaker criticizes N.Y. health plan restrictions, 584
– Spending growth rate, cancer and diabetes leading causes of increase, report, 680
– State bills pending, reports, In Brief, 177

PREVENTIVE CARE

– Grants, Medicare beneficiary study, 31
– Minn., Allina Hosp. & Clinics to develop center focusing on heart attacks, 681
– Wellness programs

– – BCBS of Ariz., 87 percent surveyed say health needs improvement, report, 120
– – Growth, employer costs cut and productivity increased, study, 678
– – Health promotion program standards, NCQA releases, 654
– – HIPAA, sponsors should determine applicability, bulletin, 88; Labor Dep't releases compliance checklist, 210
– – Onsite centers, employers seek to cut health care costs, Special Reports, 360

PRIMARY CARE PHYSICIANS

– Health services coordination, problems predicted, forum, 15
– Medical home

See MEDICAL HOME

– Medicare electronic health records pilot, over 30 applicants, 574

PRIVACY AND CONFIDENTIALITY

– CMS Boston regional office, computer stolen from third-party vendor, 143
– Electronic health records

– – Federal protection, state laws surpass, Special Reports, 185
– – Information technology progress, security rules improvement key, forum, 467
– – Legislation, stalled as information technology and privacy advocates fail to compromise, AARP says, 287
– – Patient data breaches, health care facilities respond improperly, report, 428
– – Recommended practices, providers and technology firms endorse framework, 733
– – Safeguards, key to passing legislation, hearing, 642
– – Security rules adequacy discussed, BNA Analysis, 621
– – State teams also describe progress regarding security concerns, report, 207
– – Verification, CEOs say health care industry must develop uniform method, survey, 326
– – Wellpoint, online member data compromised, 428

– Fiduciary duty breach, ERISA no bar to state claim against human resources worker who disclosed sensitive health information (E.D. Mo.), 181
– HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Information technology legislation, security concerns addressed

See LEGISLATION, FEDERAL, HR 6357

– N.J. and federal probe of Horizon BCBS member data security breach, 176
– Part D claims data release, concerns addressed, MedPAC report, 369
– Personalized medicine, concerns over genetic and historical data misuse, report, 144

PROMPT PAYMENT

– Colo., house bill increasing penalties for delay passed, 497; lawmakers approve, 523; new law, 651
– MA private fee-for-service plans, reimbursement delays and problems for patients, hearing, 140
– N.J. arbitration decisions, Web site posting, 234
– Part D, law would increase costs billions, PBM study, 370

PROVIDER REIMBURSEMENT

See also specific providers
– Medicaid

See specific states

– N.Y. insurers, systematic underpayment based on faulty methodology, attorney general says, 215; subpoenas issued, 294
– Out-of-network care, benefits assignee provider lacks standing to sue plan to recover treatment costs (W.D. Mich.), 212
– Plans

See generally SUBROGATION

– Prompt payment

See PROMPT PAYMENT

– RICO, class action conspiracy claims against 20 BCBS plans dismissed (S.D. Fla.), 658
– Standing, anti-assignment provisions bar recovery of dialysis treatment costs under ERISA (M.D.N.C.), 332

PROVIDERS

See also specific providers
– Aetna network agreements, guidelines released, 612
– Excluded from network, damages suit against affiliated insurers proceeds under AWP statute (E.D. Ark.), 22
– Fla. contracts, new law, 729
– Health care tax, final CMS rule cuts rate states can impose for managed care, 229
– Information technology use

– – Health care system savings unlikely without incentives revision, CBO report, 570
– – House panel releases draft bipartisan bill to promote, 571
– – Penalties greater incentive than subsidies, CBO says, 697

– Medicare chartered value exchanges, 14 public-private partnerships designated to access data, 143
– Medicare Recovery Audit Contractor Program, small businesses report negative experiences, hearing, 545
– PPOs

See PREFERRED PROVIDER ORGANIZATIONS (PPOs)

– TennCare, request for medical and behavioral services proposals, In Brief, 62; contracts awarded, 471

PUBLICATIONS

– Ed. Note: For information on publications, reports, studies, and surveys, see specific subject headings.

PURCHASING POOLS

– Conn., law to create would not affect state's pending insurance contracts, attorney general opinion, 647
– Small businesses

– – Bipartisan bill

See LEGISLATION, FEDERAL, S 2795

– – S.C., new law, 235
– – Tenn. senate approves bill, 372; lawmakers pass, 550; new law, 608