Health Plan & Provider Report Index Summary

MAINE

– Annual or lifetime caps on health insurance benefits, insurers prohibition, new law, 434
– Autism coverage and treatment for children up to age 5, new law, 496
– Uninsured persons, improving access to and affordability of health care, report, 251

MALPRACTICE

– Antitrust exemption for insurers, limiting McCarran-Ferguson Act, CRS report, 116
– Costs incurred by policyholder in settlements, insurer must pay pro rata share (Fla. Dist. Ct. App.), 563

MAMMOGRAPHY

– Breast cancer screenings, health plans coverage, Colo. lawmakers consider bill, 226; governor signs bill, 624

MANAGED CARE

– Assignment of benefits, plans direct reimbursement of out-of-network providers, N.J. law, 122
– Cal., timely access rules adoption, 107
– HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– MA

See MEDICARE ADVANTAGE (MA)

– Medicaid

See MEDICAID MANAGED CARE

– Physicians contracts, AMA website, 324
– State issues

See specific states

MANDATED BENEFITS

– Autism treatment

See AUTISM

– Hearing aids for children up to age 21, new N.C. law, 706
– Oral chemotherapy drugs, insurer coverage requirement, new Colo. law, 465

MARKET TRENDS

– Competition in health insurance, AMA study, 253
– Consumer-directed plans

See CONSUMER-DIRECTED PLANS

– Revenues of health insurers shifting from commercial sources to government programs, report, 628
– Top 10 health care issues for 2010, Managed Care Executive Group list, 439

MARKETING

– Billing fraud re vitamins, Regence BCBS investigates in 4 western states, 593
– Medicare Advantage

– – CMS policies, comments sought on proposed revisions, 240
– – Inappropriate actions by plan sponsors, GAO report, 115
– – Independent sales agents use by plan sponsors, HHS Inspector General Office report, 265
– – Quality Health Plans, CMS intermediate sanction, 614

– Medicare Part D

– – Aetna, CMS intermediate sanction, 424
– – CMS policies, comments sought on proposed revisions, 240
– – Fox Ins., CMS suspension, 266; contract termination, 286
– – Quality Health Plans, CMS intermediate sanction, 614

– Off-label uses of Neurontin, Pfizer misrepresentations affect on insurance companies claims payments (D. Mass.), 84; Kaiser plaintiffs, verdict, 349

MARYLAND

– Assignment of benefits to out-of-network provider, new law requires preferred provider health benefit policies to honor insured individual's choice, 625
– Cost containment practices of insurers, medical society chief seeks review, 625
– High-risk pools

– – National temporary program administration, new law, 466
– – Plan option for members whose premiums are paid for by other government units, new law, 466

– Nurse practitioners treating patients, approved attestation, new law, 466
– Patient-centered medical home program creation, new law, 466
– Senior Prescription Drug Assistance Program

– – Continuing education requirements for insurance producers, new law, 466
– – Termination date extension, new law, 466

MASSACHUSETTS

– Contracting practices of Partners HealthCare, DOJ probe, 531
– Costs of health care, price variations tied to market leverage of hospital or provider group, report, 154
– Employer offers of health insurance coverage, state survey findings, 172
– Employer-subsidized health insurance requirement, Commonwealth Care program eligibility determination, waiver denial (Mass.), 499
– ERISA preemption of insurance commissioner show cause order, self-funded plans HIPAA nondiscrimination provision violation, abstention (D. Mass.), 222
– Hospitals one-time payment to reduce small businesses and individuals insurance costs, Senate passes bill, 625
– Lessons learned from health care reform law implementation, applicability to national reform, article, 382
– Mental health and substance abuse treatment, medical necessity requirement, BCBS of Mass. refusal to pay (D. Mass.), 220
– Off-label uses of Neurontin, Pfizer misrepresentations affect on insurance companies claims payments (D. Mass.), 84; Kaiser plaintiffs, verdict, 349
– Personal injury protection benefits fraud scheme alleged, insurer documents protective order denied (D. Mass.), 646
– Racial or ethnic disparity in insurance coverage eliminated under state health reform law, report, 707
– Small businesses health insurance rate increases, governor's plan for regulating, 195; Div. of Ins. rejects proposed rate hikes, 388; preliminary injunction denied (Mass. Super. Ct.), 433

MCCARRAN-FERGUSON ACT

– Antitrust exemption for health and medical malpractice insurers, limiting, CRS report, 116
– Prompt pay dispute, RICO claims of providers preempted (6th Cir.), 431
– Repeal of antitrust exemption for health insurers

– – Financial regulatory reform bill, Leahy amendment

See LEGISLATION, FEDERAL, S 3217

– – 2 House Democrats to offer legislation, 165; further action, see LEGISLATION, FEDERAL, HR 4626

MEDICAID

See also specific states
– Benchmark or benchmark-equivalent benefit packages for certain populations, CMS final rule, 519
– Comparison chart of health care reform bills provisions, CRS memorandum, 82
– Dual eligibles

See DUAL ELIGIBLES

– FY2011 budget proposal, includes average of spending cuts in House and Senate health care reform bills, 140
– Funding increase extension

See LEGISLATION, FEDERAL, HR 4213

– Modernization efforts could save federal government and states hundreds of billions, report, 456
– Pharmacy reimbursement rate cuts, industry groups sue 4 states despite legal setbacks, 462
– PPACA impact

– – CMS guidance to states

– – – Drug rebate policies, implementation, 482
– – – Expansion under new law, 426

– – Expansion, federal and state coordination needed to ensure smooth implementation, 698

MEDICAID MANAGED CARE

– Drug rebate program, plans inclusion, PPACA provision, 380
– Florida

– – Fraud prevention and enforcement efforts coordination, bill, 294
– – Reforms, House and Senate to reconcile bills, 499

– Haw. program, mandatory enrollment, CMS contract approval and waiver of freedom of choice provision issues and claims against state (D. Haw.), 83
– Outlook 2010, potential impact of health care reform, Special Report, 126

MEDICAL DEVICES

– Hearing aids for children up to age 21, insurers coverage requirement, new N.C. law, 706
– Webinars, May 19-June 17, BNA Legal and Business Edge, 558; May 25-June 17, 620; June 9-17, 644; June 9-July 13, 672; June 17-July 13, 699

MEDICAL HOME

– Direct primary care medical homes in state-run exchanges, BNA Insight, 566
– Patient-centered medical home program creation, new Md. law, 466

MEDICAL LOSS RATIOS

– Anti-fraud expenses should be included, letter to NAIC, 639
– Appropriate use of and definitions for, Analysis & Perspective, 95
– Definitions, NAIC delays recommendations to HHS, 639; market exit concerns of working group, 663; information technology costs issue, 668; quality improvement activities, AHA comments, 680
– Medicaid overpayments, Wellcare Health Plans to repay Ill., 533
– PPACA requirement

– – Disruption to individual insurance market possible, NAIC says, 584
– – Many insurers falling short, Senate committee report, 452
– – Rates and reimbursements under scrutiny, insurers attempts to thwart, 638
– – Weakening rule, Rockefeller (D-WVa) urges regulators to guard against insurers efforts, 583

– Request for information, Obama administration moves quickly to implement insurance industry reforms, 421; AHIP and BCBSA comments, 613

MEDICAL NECESSITY

See MEDICALLY NECESSARY SERVICES

MEDICAL RECORDS

– HIPAA rules

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Personal electronic

See ELECTRONIC HEALTH RECORDS

– Privacy

See generally PRIVACY AND CONFIDENTIALITY

MEDICALLY NECESSARY SERVICES

– External review, Idaho system allows appeal of denied claims, 18
– Mental health and substance abuse treatment, BCBS of Mass. refusal to pay (D. Mass.), 220

MEDICARE

– Breach of contract claim, 2003 class action settlement no bar to bankrupt physician group suit against Aetna subsidiary (11th Cir.), 591
– Comparison chart of health care reform bills provisions, CRS memorandum, 82
– Copayments increase for ambulatory care and effects on elderly outpatient and inpatient care, study results, 144
– Cost plans conversion to MA plans, concerns and issues, GAO report, 11
– Drug coverage

See MEDICARE DRUG COVERAGE

– Dual eligibles

See DUAL ELIGIBLES

– Educating beneficiaries on health insurance options, CMS state grant funds available, 429
– Fee-for-service payments to providers

– – Comparison with MA special needs plan, study, 308
– – HCERA, study findings, 376

– FY2011 budget proposal, includes average of spending cuts in House and Senate health care reform bills, 140
– Fraud, billing for cancer drugs not provided, doctor pleads guilty (C.D. Cal.), 463
– Health care reform bill HR 4872

– – Response to House passage, 306
– – Tax higher on high-income households, 307

– Independent Payment Advisory Bd.

– – Senate health care reform bill provision opposed, 80; hospitals' reform priorities, 81
– – Spending reduction methods, report examines, 554

– Inpatient psychiatric facilities, payment rates in 2011, CMS notice, 520
– Low-income persons enrollment in savings programs, state assistance efforts, report, 243
– MA

See MEDICARE ADVANTAGE (MA)

– Medigap Plan N, revised guidance, 553
– Out-of-pocket spending, outpatient and inpatient services, analysis findings, 166
– Part C

See MEDICARE ADVANTAGE (MA)

– Part D

See MEDICARE DRUG COVERAGE

– Payment Advisory Comm'n, new members and reappointments, 588
– PPACA impact

– – Challenge lies in implementation, CMS official says, 552
– – CRS report details changes, 671
– – Misinformation, Sebelius seeks to dispel in online discussion, 425
– – Part A Trust Fund, CMS analysis, 483
– – Payment innovations promising, success not guaranteed, policy briefing speakers say, 587
– – Reimbursement rate cuts and effect on employers' costs, webinar speaker, 488; impact on large employers, webcast speaker, 661
– – Spending cut over next decade, CRS report, 522

– Prompt billing, preemption of state law, hospital's right to set lien against liability insurance settlement (Tex. Ct. App.), 18
– Secondary payer

– – Collection practices of HHS, class action discovery requests (D. Ariz.), 493
– – Reporting requirements for insurers, deadline extension, 213

– Taxes under HCERA, CRS report, 347

MEDICARE ADVANTAGE (MA)

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Bids for 2011, Sebelius tells plans to compete on prices and quality, 662; CMS should fully review, lawmakers say, 662
– Cal. HMOs patient care standards, preemption, review denied (Cal.), 352
– Data validation audits of Medicare Advantage organizations, OMB reviewing process, 489
– Enrollment higher among plans with lower quality ratings, Avalere Health analysis, 521; top-rated plans, analysis shows wide state variation, 697
– Health Care and Education Reconciliation Act

– – Payment provisions, study findings, 376
– – Plans changes, BNA Insight, 602
– – Response to House passage, 306

– Health Plan Mgmt. Sys. memoranda Jan. 1-12, CMS issuances, list, 82; memos, Jan. 12-27, 146; memos, Jan. 28-Feb. 5, 190; memos, Feb. 11-20, 245; memos, Feb. 19-March 8, 287; memos, March 9-24, 347; memos, March 24-April 6, 430; memos, April 8-16, 523; memos, April 21-30, 559; memos, April 30-May 14, 619; memos, May 19-June 2, 699
– Hospital readmissions reduction, AHIP study, 696
– Marketing of plans

– – CMS policies, comments sought on proposed revisions, 240
– – Facebook and Twitter use permitted, 697
– – Inappropriate actions by plan sponsors, GAO report, 115
– – Independent sales agents use by plan sponsors, HHS Inspector General Office report, 265
– – Quality Health Plans, CMS intermediate sanction, 614

– Medicare cost plans conversion to MA plans, concerns and issues, GAO report, 11
– Out-of-pocket spending

– – Mandatory maximum limit, CMS memo, 453
– – Outpatient and inpatient services, analysis findings, 166

– Outlook 2010, potential impact of health care reform, Special Report, 126
– Pay-for-performance star rating bonus system, CMS seeks comments, 479
– Payment policy, impact of physician cut highlighted, MedPAC report to Congress, 265
– Payment rates to plans in 2011

– – CMS advance notice, 216; final rate announcement, 375
– – Wall Street analyst prediction, 144

– Physician Quality Reporting Initiative payment policy, CMS official outlines, 585
– Policy and technical changes to plan program, comments on CMS proposed rule, Special Report, 47; finalizing continues, 111; final rule released, 423
– PPACA impact

– – AARP fact sheet, 558
– – Briefing paper available, 523
– – Changes to rates and policies, consultant comments during teleconference, 342
– – Efficient plans will remain in market, consultant prediction, 378
– – Plans changes, BNA Insight, 602

– Private fee-for-service plans in 2011, CMS delists counties requiring networks, 115
– Relationship between plan designs and beneficiary health status, report, 666
– Sales agent licensing and prompt payment violations, N.Y. HMO to pay fine, 531
– Special needs plan payments to providers, comparison with Medicare fee-for-service, study, 308

MEDICARE+CHOICE

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.

MEDICARE DRUG COVERAGE

– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Benefit parameters annual update, CMS advance notice, 216; final rate announcement, 375
– Coverage gap

– – Brand name drugs, prices, policy brief, 309
– – Discount program, CMS preliminary guidance discusses sponsor payments, 520; drugmakers without contracts, options considered, 586; fines for failure to sign agreement, comments sought on draft model agreement, 617; concerns voiced, 664
– – Generic drugs covered by enhanced alternative plans, CMS memo, 618
– – HCERA impact, MA 2011 final rate announcement, 375
– – Rising prices and effect on, Senate committee hearing and testimony, 309

– Data validation audits of prescription drug plans, OMB reviewing process, 489
– Drugs approved and listed with FDA, enrollees purchase advice, CMS fact sheet, 12
– Dual eligibles prescription drug costs, states clawback payments reduction, HHS announcement, 217
– Enrollment of new members

– – Aetna, CMS intermediate sanction, 424
– – Fox Ins., CMS suspension, 266; contract termination, 286
– – Quality Health Plans, CMS intermediate sanction, 614

– Formularies

– – Changes, notification of beneficiaries, HHS Inspector Gen. Office report, 12
– – Utilization management, drugs subject to, researcher findings, 118

– Fraud

– – HHS response to private insurers' allegations, Grassley (R-Iowa) questions, 424
– – Safeguards, Senate subcommittee hearing and testimony, 266

– HCERA impact, plans changes, BNA Insight, 602
– Health care reform bill HR 4872, response to House passage, 306
– Health Plan Mgmt. Sys. memoranda Jan. 1-12, CMS issuances, list, 82; memos, Jan. 12-27, 146; memos, Jan. 28-Feb. 5, 190; memos, Feb. 11-20, 245; memos, Feb. 19-March 8, 287; memos, March 9-24, 347; memos, March 24-April 6, 430; memos, April 8-16, 523; memos, April 21-30, 559; memos, April 30-May 14, 619; memos, May 19-June 2, 699
– Low-income persons enrollment, state assistance efforts, report, 243
– Marketing

– Outlook 2010, potential impact of health care reform, Special Report, 126
– Policy and technical changes to plan program, comments on CMS proposed rule, Special Report, 47; finalizing continues, 111; final rule released, 423
– PPACA impact

– – AARP fact sheet, 523
– – Briefing paper available, 523
– – Plans changes, BNA Insight, 602
– – Retiree benefits, companies may have changed to avoid one-time accounting charge, 598

– Tax deduction for companies, potential repeal in health care reform bills, accounting issue, 79

MEDIGAP

– Financial arrangements between policy providers and hospital networks, anti-kickback law, advisory opinions, 242
– Plan N, revised guidance, 553

MEETINGS

See CONFERENCES AND MEETINGS

MENTAL HEALTH

– Inpatient psychiatric facilities, Medicare payment rates in 2011, CMS notice, 520
– Medical necessity requirement for treatment, BCBS of Mass. refusal to pay (D. Mass.), 220
– Online support system, Aetna and social networking firm team up, 198
– Parity law revision

See PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT (MHPAEA)

– Residential care facility treatment, benefits denial (N.D. Cal.), 314
– Wisconsin Parity Act, governor signs bill, 535

MERGERS AND ACQUISITIONS

– Barriers to entry and expansion in insurance market, DOJ official says PPACA success depends partly on competition, 641
– BCBS of Mich. and Physicians Health Plan of Mid-Mich. call off merger, 273
– Cardinal Health purchase of Healthcare Solutions Holding, 711
– Care New England and Lifespan, application withdrawn, 274
– HIPAA privacy rule violation, UnitedHealthcare acquisition of certain Health Net assets, investigation sought, 152
– PacificSource Health Plans and Clear One Health Plans, proposed agreement, 46
– PeaceHealth and Southwest Washington Health System, discussions, 354

MHPAEA

See PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT (MHPAEA)

MICHIGAN

– BCBS

– – Hospital emergency room visits and readmissions reduction, collaboration, 155; Project BOOST touted, 708
– – Merger agreement with Physicians Health Plan of Mid-Mich. called off, 273
– – Premium increase proposed for under-65 individual plans, attorney general criticizes, 647

– ERISA, firing employee with colon cancer, medical claims files destruction, employer no interference with health benefits (E.D. Mich.), 170
– Health market review, report, 466
– Patient Protection and Affordable Care Act

– – Implementation, creation of entities, executive order, 391
– – Individual health insurance mandate, preliminary injunction to block and DOJ response to motion, status conference set (E.D. Mich.), 590

MINNESOTA

– General Assistance Medical Care program for poor, House passes bill to revive, 353; hospitals reluctant to become care coordinating delivery systems, 500
– Health care reform report, lessons learned could serve as guidance for other states, 464
– Medicaid reimbursement rate cuts, pharmacy groups sue despite legal setbacks, 462
– Oral chemotherapy drugs out-of-pocket expenses, governor signs cost parity bill, 595
– Profitability of hospitals and HMOs in 2008, market analysis report, 596; health market review 2010, 678
– Trends in health care, Minn. Council of Health Plans annual report, 535

MINORITY HEALTH CARE

– Disparity in insurance coverage eliminated under Mass. health reform law, report, 707

MISREPRESENTATION

– Aetna plan coverage for lung transplant, ERISA no bar to former NewMarket employee claims (S.D. Miss.), 41
– Off-label uses of Neurontin, Pfizer actions affect on insurance companies claims payments (D. Mass.), 84; Kaiser plaintiffs, verdict, 349
– Rescission of individual health insurance policy, policyholder omits back pain treatment information (Cal. Ct. App.), 151
– Settlement of hospital bill, insurer rescinds agreement based on insured's alleged misrepresentation (8th Cir.), 290
– Unlicensed chiropractor provides services, auto insurer claims payments recovery (W.D. Ky.), 148

MISSISSIPPI

– Misrepresentation of Aetna plan coverage for lung transplant alleged, ERISA no bar to former NewMarket employee claims (S.D. Miss.), 41

MISSOURI

– Autism, insurers coverage requirement, House passes bill, 275; Senate passes different version, 564; compromise version passed, 595
– Bogus health insurance plans, enforcement actions, 196
– ERISA, RICO, quasi contract, and unjust enrichment claims of out-of-network surgical group, disposition (E.D. Mo.), 269
– Individual mandate provision in PPACA, lawmakers pass bill allowing voters to weigh in on issue, 626
– National States Ins. placed into rehabilitation, court order (Mo. Cir. Ct.), 390
– Prompt payment of claims by insurers to providers, House and Senate pass bills, 251; governor signs House bill, 534

MONTANA

– Discretionary clauses in insurance products ban, Supreme Court review petition, webinar speakers prediction, 492; (U.S., rev den), 621