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Lawsuit seeks to block VHAE sale of Partners.
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Perspectives. Medigap market melee: next round.
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Delayed budget endangers Medicare payments--experts.
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The paradox of case management.
In attempting to contain costs, case management, as it is often conducted, negatively impacts the quality of patient care. In many instances this is because the clinical aspect of case management is performed by personnel lacking in clinical experience. Over the next few years federal and state legislators will be looking at the issue of case management and who provides it. Many groups will be putting in their bid. The home care community must be prepared to fight, support, or activate its own case management program.
Regulatory agency abuse: the need for protection of physicians' rights.
As a result of recently increased regulatory attention, the medical profession has become a heavily regulated "industry" and now must respond not only to the requirements of patients, but also to governmental agencies, insurance providers, and third-party payors. In this article, the author describes the ways in which agencies have abused their regulatory authority and what physicians should do to reverse this attack on their profession.
Medicaid program; modification of certain requirements for health insuring organizations--HCFA. Final rule.
This final rule implements statutory changes which expressly made certain Health Insuring Organizations (HIOs) subject to Medicaid Health Maintenance Organization (HMO) rules. The statute implemented in this rule requires that an HIO which became operational on or after January 1, 1986, and arranges for comprehensive health services for Medicaid recipients on a risk basis be subject to HMO requirements. The statute also provides that exemptions from certain HMO rules are permitted for HIOs which began operation on or after January 1, 1986, if the HIOs are operating under a section 1915(b) waiver obtained prior to that date, or if an HIO is otherwise identified in the law. The exemptions continue as long as the waiver under section 1915(b) of the Social Security Act remains in effect. The statutory provisions implemented in this rule were enacted in section 9517(c) of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended by section 9435(e) of the Omnibus Budget Reconciliation Act of 1986, and section 1895(c)(4) of the Tax Reform Act of 1986.
Pacific Standard gains board clout at National Heritage.
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Pittsburgh hospital sues partner in HMO venture.
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Bond insurer giving more issuers a chance.
Bond insurances firms generally provide credit enhancement only to A-rated hospitals. But a new player in the tax-exempt healthcare bond field is insuring a select number of hospitals with BBB ratings, saving those facilities millions of dollars in interest payments.
Medicaid program; modification of certain requirements for health insuring organizations--HCFA. Correction notice.
This notice corrects 42 CFR 434.20, Basic rules, to restore current text which was inadvertently deleted in the final rule, to make a conforming redesignation change, and to correct technical errors.
Insurance, business leaders fault state-mandated benefits.
As healthcare costs continue to soar, the cost of providing medical insurance is becoming unaffordable for many businesses, contributing to the growing number of uninsured. Business and insurance leaders say part of the blame rests with the growing number of state-mandated benefits, which they say should be rolled back.
VHAE shareholder suit hits hurdle.
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Looking for Mr. Good Care.
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On the road to reform.
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N.J. hospital annuities frozen following insurer's takeover.
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Insurance industry troubles put pension, annuity plans at risk; experts urge checkup.
Because of recent troubles in the insurance industry, most notably the state seizure of Newark, N.J.-based Mutual Benefit Life Insurance Co., it's a good time for hospitals and associations that sponsor pension and annuity plans to check up on the financial health of their investments, experts say. The rapid rise in "non-performing" mortgages held by insurance companies is among the maladies putting plans at risk.