All the latest developments in health care lawBy W. Eugene BasantaDecember 2000A decision from the Seventh Circuit Court of Appeals concludes that provisions of the Illinois Health Maintenance Organization Act, 215 ILCS 125/4-10 which require health maintenance organizations (HMOs) to provide a mechanism for review by an independent physician when the patient's primary care physician and the HMO disagree about the medical necessity of a particular treatment and further require the HMO to cover the treatment if deemed by the reviewing physician to be necessary, are mandated contract terms and part of the insurance plan, thereby avoiding preemption under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et. seq.
All the latest developments in health care lawBy W. Eugene Basanta & Michele MillerSeptember 2000Justice David Souter, writing for a unanimous Supreme Court, ruled in June that the Seventh Circuit Court of Appeals was wrong when it held that a health maintenance organization (HMO) was acting as a fiduciary when one of its physicians made an adverse treatment decision regarding a patient.
All the latest developments in health care lawBy W. Eugene BasantaApril 2000On February 29, in a five to four decision, the United States Supreme Court ruled that an Illinois nursing home trade association could not bypass administration review of regulations it objected to and seek immediate judicial review before any enforcement action.
Legislation and regulationsApril 2000The Health Care Section Council has, during the last several months, had the opportunity to review numerous health care-related bills introduced during the current session of the Illinois General Assembly.