Health Plan & Provider Report Index Summary

SAFETY OF PATIENTS

– Hospitals, medical errors

See MEDICAL ERRORS

– Medication errors

See MEDICATION ERRORS

– Prescription drugs, WellPoint developing post-FDA approval monitoring system, 449

SCREENING

See TESTS AND SCREENING

SECONDARY PAYER PROGRAM

– Qui tam suits, individual who does not receive benefits lacks standing sue (6th Cir.), 270
– Reporting, CMS to issue 2009 coverage coordination guidance, 113

SELF-FUNDED PLANS

– BCBS HMO hospital rates, plan did not act as fiduciary when negotiating (E.D. Mich., recon den), 39
– Medically necessary services, contractual duty satisfied by medical reviews despite contradictory results (Ind. App. Ct.), 157

SEXUAL ORIENTATION DISCRIMINATION

– Employee benefits, community college violated state law by denying same-sex marriage partner health coverage (N.Y. App. Div.), 216

SKILLED NURSING FACILITIES (SNFs)

– Jurisdiction, proposed class action over glucose test claim denial based on invalid local coverage determination dismissed (D.D.C.), 214

SMALL BUSINESSES

– Health insurance

– – Pennsylvania

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

– – Purchasing pools

See PURCHASING POOLS

– – Tenn. expands program eligibility, 121
– – Wash. premium subsidies bill passed, 234; amended bill sent to governor, 324; new law, 372

– Mental health parity, coverage requirement

See LEGISLATION, FEDERAL, S 558

SMOKING

– Wrongful discharge, ERISA claim over firing for violating no-smoking policy proceeds (D. Mass.), 158

SNFs

See SKILLED NURSING FACILITIES (SNFs)

SOLVENCY

– MA, cutting rates would extend Part A Trust Fund life, hearing, 393

SOUTH CAROLINA

– Hospitals, uninsured patients not entitled to discounts for insured (S.C.), 329
– Small businesses, new health insurance purchasing pool law, 235

SOUTH DAKOTA

– Health insurance filings, new standard document law, 264

SPECIAL REPORTS

– LSCs, numbers grow to meet consumer demands, 218
– Medical data privacy, state laws surpass federal protection, 185
– Mental health parity compromise

See LEGISLATION, FEDERAL, HR 1424, S 558

– Onsite wellness centers, employers seek to cut health care costs, 360
– Outlook 2008, top health insurer and provider issues discussed, 71
– San Francisco fair share ordinance requiring employer-paid health coverage, implementation implications discussed, 102
– 2008 presidential candidates, health care reform proposals, 44

SPECIALISTS

– Pathologists

– – Clinical services, damages award for practice upheld where BCBS HMO withheld payments from hospital-based practice (Fla. Dist. Ct.), 478
– – Reimbursement, class action against United Healthcare certified (Am. Arbitration Ass'n), 380

– Surgeon profiles, Ill. Web site allows consumer comparisons, 427

SPECIALTY HOSPITALS

– Antitrust, managed care contract interference suit against acute care hospitals and PPOs settled (D. Kan.), 355

STANDING

– Anti-assignment provisions, provider cannot recover dialysis treatment costs under ERISA (M.D.N.C.), 332
– HMOs, employer cannot sue over participant's self-pay request where insurers denied coverage as not medically necessary (E.D. Pa.), 504
– Hospitals, individual who does not receive benefit cannot bring qui tam suit under Medicare Secondary Payer Act (6th Cir.), 270
– Long-term care pharmacies, groups seeking Part D payment information cannot sue HHS (D.D.C.), 98
– Out-of-network care, benefits assignee provider may not sue plan to recover treatment costs (W.D. Mich.), 212

STATE AND LOCAL GOVERNMENT

See also HEALTH CARE REFORM, STATE; specific states
– Cost of health care, sustained fiscal challenges examined, GAO report, 114
– Electronic health records, state teams describe progress regarding security and privacy concerns, report, 207
– Health care provider tax, final CMS rule cuts rate states can impose for managed care, 229
– Medical data privacy, state laws surpass federal protection, Special Reports, 185
– Prescription drug bills pending, reports, In Brief, 177

STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP)

See also specific states
– Limiting enrollment, Rockefeller (D-WVa) says CMS lacked authority, hearing, 418

SUBPOENAS

– N.Y. insurers, systematic provider underpayment based on faulty methodology, attorney general says, 215; subpoenas issued, 294

SUBROGATION

– Agreement, Wal-Mart can require signature before paying benefits (E.D. Ark.), 156
– Make whole doctrine application, ERISA no bar to La. insurance commissioner directive (5th Cir.), 330
– Third-party settlement proceeds

– – Plan entitled to lien on accident victim member's award (E.D. Wis.), 100
– – Special needs trust, employer-sponsored plan can seek medical expenses from conservator mother (11th Cir.), 98

SUBSTANCE ABUSE

– Drug addiction, BCBS properly denied coverage for medically unnecessary residential treatment for emotional problems (D. Mass.), 42

SUPREME COURT, U.S.

– ADEA, retiree and Medicare benefits may be coordinated (rev den), 354
– Dependent son not enrolled, self-funded plan administrator did not abuse discretion by denying heart defects treatment coverage (rev den), 247
– Employee benefits, make-whole doctrine no bar to Wal-Mart health plan's recovery of full reimbursement from participant's personal injury settlement (rev den), 352
– San Francisco fair share ordinance requiring employer-paid health coverage, ERISA preempts (N.D. Cal.), 21; injunction barring ordinance implementation stayed (9th Cir.), 66; implementation implications discussed, Special Reports, 102; en banc review will not be sought, 126; employer group asks Justice Kennedy to vacate stay (application filed), 211; (denied), 243

SURGICAL SERVICES

– ASCs, anti-assignment provision no bar to out-of-network provider's ERISA claims (D.N.J.), 302
– Experimental knee procedure, BCBS of Tenn. coverage denial upheld (6th Cir.), In Brief, 70
– Gastric bypass, coverage denial upheld for medically unnecessary excess skin removal (S.D. Ohio), 377

SURVEYS

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