Smarter Health Care Partnership for American Families: Making Federal and State Roles in Managed Care Regulation and Liability Work for Accountable and Affordable Health Care Coverage : Hearing Before the Subcommittee on Health of the Committee on Energy and Commerce, House of Representatives, One Hundred Seventh Congress, First Session, March 15, 2001, Volume 4 |
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alleged BILIRAKIS Bill of Rights BURR cause of action Chairman TAUZIN claims committee Congress consumer protections cost coverage decisions DEMONTMOLLIN denial denied disputes doctor eligibility decisions employers enacted enforce ensure ERISA fiduciary ERISA plans ERISA preemption expanding health plan external appeals process external review process federal courts Federal floor federal law federal remedy GANSKE Ganske-Dingell bill GREENMAN Greg Ganske health insurance health plan liability hearing Herdrich HIPAA independent medical review infrastructure internal and external issue LARSEN lawsuits liability system litigation managed care medical decisions medical injury medical judgment medical liability medical malpractice medical necessity mixed eligibility Model Act NCSL PALMISANO patient protection patient protection bill patient protection laws Pegram POLLACK preempted procedures question recognize regulation require ROSENBAUM SHADEGG statement statute STEVE BUYER subcommittee substantially equivalent sumers Supreme Court testimony Thank tient tion tort reform treatment decisions trial lawyers
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Page 25 - The NAIC, founded in 1871, is the organization of the chief insurance regulators from the 50 states, the District of Columbia, and four of the US territories. The NAIC's objective is to serve the public by assisting state insurance regulators in fulfilling their regulatory responsibilities. Protection of consumers is the fundamental purpose of insurance regulation.
Page 69 - Cir. 1995), the Court of Appeals held that claims for injuries arising from medical malpractice were not completely preempted by ERISA and therefore did not permit removal of the case from a state to a federal court: There is no allegation here that the HMOs denied anyone any benefits that they were due under the plan. In^^H. the plaintiffs here are *ttrmj*in^ to hold the HMOs liable for their role as the arrangers of their decedents
Page 22 - PREPARED STATEMENT OF HON. ELIOT ENGEL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW YORK Mr. Chairman, I would like to thank...
Page 121 - New York State Conference of Blue Cross & Blue Shield Plans v Travelers Ins. Co., 514 US 645...
Page 75 - ... have passed similar health plan accountability statutes. We strongly urge Congress therefore to recognize the legitimate authority of states and incorporate a bifurcated cause of action into a bipartisan patient protection bill. Such a bill would need to remove ERISA preemption in a targeted fashion, permitting states to pass or retain their own legislation which would protect the legitimate interests of their citizens. Additionally, removing ERISA preemption in this manner would preserve prior...
Page 25 - Accident and Health Insurance (B) Committee. I am testifying this morning on behalf of the NAIC's (EX) Special Committee on Health Insurance. I would like to thank you for providing the NAIC with the opportunity to testify today about the preemption issue surrounding the health information privacy legislation currently before Congress.
Page 108 - Please do not hesitate to contact me if I can be of further assistance in this matter. Sincerely, (S) ALFBED B. Fnr. JOINT PROJECTS Senator ELLENDER. The request includes $9.4 million for "Joint projects.
Page 61 - MCOs to obtain external validation from organizations such as the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). These organizations accredit health plans, hospitals, and other health care facilities — a "good housekeeping seal of approval" many clients and consumers look for when choosing a health plan.
Page 26 - Act relating to health insurance coverage offered by a health insurance issuer supersede any provision of State law which establishes, implements, or continues in effect a standard or requirement applicable to imposition of a preexisting condition exclusion specifically governed by section 701 which differs from the standards or requirements specified in such section. (2) Exceptions. Only in relation to health insurance coverage offered by a health insurance issuer...
Page 69 - Barrage, 59 F.3d 151, 155 (10th Cir. 1995) ("The present claim does not involve the administration of benefits or the level or quality of benefits promised by the plan; the claim alleges negligent care by the doctor and an agency relationship between the doctor and the HMO.. Just as ERISA does not preempt the malpractice claim against the doctor, it should not preempt the vicarious liability claim against...