1.    Board investigated a claim against a medical director for unprofessional conduct in denying coverage under ERISA.
2.    Medical director held that the family who wanted nursing care fell under the idea of “custodial care” which was not included under the ERISA plan.
3.    Board said that doctor Doe did not interpret the K correctly b/c more benefits were available to the family than Doe indicated.  The board concluded that medical services went beyond the definition of custodial care.
4.    The insurance company sued the board, seeking a judgment that the Board was trying to regulate ERISA by conducting its own determination of benefits and that such conduct was preempted by ERISA.
5.    Court said the board was evaluating the quantity of care.  The state can force an ERISA plan to adopt a certain scheme of substantive coverage or effectively restrict its choice of insurers but such laws may be preempted.
a)    The regulation of medical decision-making is within the state’s authority to regulate matters relating to health care.  The boards’s action is mandating employee benefits b/c it is determining what is custodial care and thus reviews benefit coverage determinations.
b)    The state/board can only look at the quality/delivery of benefits and the quantity is left with ERISA to determine.