Document Type
Article
Publication Date
12-2002
ISSN
0028-4793
Publisher
Massachusetts Medical Society
Language
en-US
Abstract
States may have more freedom to regulate the practices of managed-care organizations than many observers previously believed. In the absence of congressional action on the federal Bipartisan Patient Protection Act, the primary source of patient-protection legislation remains at the state level. Nevertheless, the federal Employee Retirement Income Security Act (ERISA) of 19742restricts state regulation of health maintenance organizations (HMOs) that serve private employee group health plans. On June 20, 2002, the U.S. Supreme Court, in Rush Prudential HMO, Inc. v. Moran, upheld an Illinois state law that requires binding independent external review when an HMO disagrees with the decision of a patient's physician that a treatment is medically necessary. The Moran decision clarifies the states' authority, and may allow physicians a larger say in decisions about managed-care coverage.
Recommended Citation
Wendy K. Mariner,
Independent External Review of Health Maintenance Organizations' Medical-Necessity Decisions
,
in
347
The New England Journal of Medicine
2178
(2002).
Available at:
https://scholarship.law.bu.edu/faculty_scholarship/845
Comments
From The New England Journal of Medicine, Wendy K. Mariner, Independent External Review of Health Maintenance Organizations' Medical-Necessity Decisions, Volume 347, Page 2178 Copyright ©(2002) Massachusetts Medical Society. Reprinted with permission.