Managed care and ERISA: synopsis and case law review.
Managed care organizations (MCOs) have become the predominant health care model in the United States. Through cost containment arrangements with providers, incentives for patients to pursue less costly care and reductions in the provision of unnecessary care, MCOs are more intimately involved in the delivery of health care than their former fee-for-service insurance company counterparts. However, this new role has not implied increased liability, largely because of The Employee Retirement Income Security Act of 1974 (ERISA). This article provides an overview of ERISA and a review of the important legal cases in this area, including the three most recent Supreme Court cases. Courts have struggled with interpreting ERISA, and decisions have been difficult to reconcile. Frustration with this statute and the failure of the U.S. Congress to amend it, has led to more liberal interpretations of ERISA in recent years.
Gerbasi
Joan B
JB
Department of Psychiatry, University of California, Davis, Sacramento, CA 95817, USA. joan.gerbasi@ucdmc.ucdavis.edu
D019461:Employee Retirement Income Security Act / Q000331:legislation & jurisprudence*; D006801:Humans; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D013219:State Government; D035521:Supreme Court Decisions; D014481:United States