Letter of the Law - Managed Healthcare Executive
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Letter of the Law
  • Understand Public Information Act to protect records



    When companies interact with governmental bodies, issues related to the Public Information Act frequently arise. It is imperative for those companies to understand the Public Information Act as well as the internal procedures that may be developed to handle open records issues.

    Captive insurance arrangements more common



    Many healthcare entities have explored certain alternative risk transfer arrangements as a means for insuring, or perhaps self-insuring, various exposures. The use of captive insurance arrangements has been a common approach, and thus, "protected cell companies" have become popular vehicles.

    States face ERISA hurdle on employer-funded universal care



    Across the country, state and local lawmakers are discussing various mechanisms to provide healthcare coverage to uninsured residents, and some states have recently enacted such legislation. Some of these laws include the requirement to make employers fund at least part of the states' health insurance programs.

    Proposed HIPSA Legislation Intends to Tighten Privacy Rules



    Sens. Leahy and Kennedy have introduced the Health Information Privacy and Security Act of 2007 (HIPSA), which if enacted into law, would require HHS to revise HIPAA.

    Understand choice, implications of law principles



    Choice of law issues arising from coverage disputes of both individual and group insurance policies many times determine which party will prevail on the merits of a particular case. Also, in today's mobile economy, insurance transactions frequently cross state boundaries.

    Monitor discrimination laws for wellness programs


    As employers search for ways to reduce rising healthcare costs and improve employee productivity, more companies are implementing wellness programs in an attempt to improve employees' health and reduce their own insurance costs. There are a number of different options employers may consider when deciding to institute a wellness program, including offering smoking cessation and weight loss programs, fitness classes, and in some cases, penalizing certain behavior. Employers must be careful, however, to ensure that these programs do not violate certain federal and state laws as they carry certain inherent legal risks.

    Prepare for inevitable underwriting challenges



    There are as many as 75 million Americans who are either uninsured or underinsured, and the rate will continue to grow. Access to healthcare for all Americans was a hot topic during the early years of the Clinton administration, and has resurfaced recently in anticipation of the 2008 presidential election.

    Corrective action plans play integral role in Medicaid suit


    Ahearing before a federal district court this summer will most likely conclude the 14-year Texas class action case of Frew v. Hawkins. This class action suit was filed in 1993 by a group of mothers who were dissatisfied with the medical treatment that their children received—children who qualified for, but allegedly did not receive, full preventive care and treatment under Medicaid laws. As states enact changes to ensure full compliance with these laws, MCOs will see the effects on Medicaid provider networks, reimbursement rates and reporting requirements.

    Rescission practices can protect against misrepresentation


    The practices of some California insurers have recently come under attack in lawsuits brought by private litigants and in administrative actions brought by state regulators. The practice involves the rescission of health insurance policies due to misrepresentations made in the policy application form.

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