Volume 7 (1998)
Annals of Health Law
The Health Policy and Law Review of Loyola University Chicago School of Law
Volume 7 (1998)
Editor-in-Chief: John D. Blum, M.H.S., J.D.
Executive Editor: M.J. Harris, J.D., M.S.
Senior Editor: Naomi Ono, J.D., LL.M.
John D. Blum, J.D., M.H.S.
Mark Hall, J.D.
Jean A. Hellman, J.D., LL.M.
Edward B. Hirshfeld, J.D., M.B.A (deceased)
John Jacobsen, Jr., J.D., M.A.
Jeffrey G. Kraft, J.D., M.P.H.
Lauren McNulty-Mack, J.D.
Phillip H. Mitchell, J.D.
Anne M. Murphy, J.D.
Lawrence E. Singer, J.D., M.H.S.A.
Senior Articles Editors:
Jeffrey Bennett, J.D., LL.M.
Ellen Luepke, J.D., LL.M.
Heather O'Shea, J.D., LL.M.
Dawn Carman, J.D.
Andrew Fischer, J.D.
Julie Vlaming, J.D.
Regulating Managed Care Coverage: A New Direction for Health-Planning Agencies
Author: Thaddeus J. Nodzenski
The article focuses on the role of health planning agencies in the context of managed care. The author argues that health planning agencies can be directed toward assessment of managed care plans. Planning entities can be used to evaluate the viability of managed care markets taking into account social, financial and medical considerations.
Managed Care at the Crossroads: Can Managed Care Organizations Survive Government Regulation?
Author: Vickie Yates Brown & Barbara Reid Hartung
Attorneys Brown and Hartung provide a comprehensive overview of the development and structural components of managed health care plans. The article discusses the state regulatory controls affecting managed care, including Patient Protection Acts, Mandated benefit provisions, any willing provider laws, and consumer access provisions. The article considers liability problems facing managed care organizations, in particular liabilities which arise from utilization and medical review discussions, as well as gag clauses and financial incentive arrangements. The authors also review relevant federal regulatory initiatives.
The States, Congress, or the Courts: Who Will Be First To Reform ERISA Remedies?
Author: Curtis D. Rooney
Curtis Rooney's article reviews the ERISA law and its relationship to managed care. The piece continues with a review of the relevant preemption provisions and an extensive discussion of related U.S. Supreme Court decisions. The author discusses malpractice and design liabilities. The article concludes with a discussion of reform initiatives directed toward the ERISA preemption and damage provisions.
Boards of Directors Under Fire: An Examination of Nonprofit Board Duties in the Health Care Environment
Author: Naomi Ono
Attorney Ono presents a detailed discussion of fiduciary duty principles as applied to the directors of nonprofit health care corporations in the current health care environment. The article reviews general corporate responsibilities, the implication of the taxpayer's Bill of Rights 2, the care of In re Caremark International Inc., derivative Litigation and particular issues faced by boards in nonprofit conversions.
Responsibilities of Directors of Not-for-Profit Corporations Faced with Sharing Control with Other Nonprofit Organizations in Health Industry Affiliations: A Commentary on Legal and Practical Realities
Author: L. Edward Bryant, Jr.
This article concerns the legal responsibilities of not-for-profit corporation directors in merges and affiliations with other not-for-profits. The article considers three sets of legal duties board members have, ancillary contractual obligations, mandatory statutes and procedural laws, and contextual legal duties.
Recent Changes to the Internal Revenue Code May Require Tax-Exempt Hospitals to Restructure Ownership of Certain Activities
Author: Joseph C. Mandarino
This article by attorney Mandarino explores the implications of a 1997 change in the Internal Revenue Code affecting tax-exempt hospitals which run or operate for-profit ventures and continues on to review the implications of the 1997 amendment, particularly on existing structures. The article concludes with suggestion to avoid applications of the amended section.
Federal Regulation Comes to Private Health Care Financing: The Group Health Insurance Provisions of the Health Insurance Portability and Accountability Act of 1996
Author: Jack A. Rovner
Attorney Rovner presents a very detailed account of the impacts of the Health Insurance Portability and Accountability Act as it relates to group health insurance. including provisions that concern preexisting conditions, special enrollment rights, premium discrimination, maternity length of stay, parity for mental health benefits, and small groups coverage. The article concludes with a discussion of the federalism question as it relates to regulation of private market health financing.
A Look Back at the Year in Health Law
Author: Jeffrey R. Bennett
The Bennett article takes us back to 1997 and reviews key legislators, regulations and judicial developments in Medicare, antitrust, tax, and ERISA, all of which greatly impact the practice of health law.
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