Science.gov

Sample records for state payer mandates

  1. The value of all-payer claims databases to states.

    PubMed

    Peters, Ashley; Sachs, Jane; Porter, Jo; Love, Denise; Costello, Amy

    2014-01-01

    All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs. PMID:24830498

  2. Mandated State-Level Open Government Training Programs

    ERIC Educational Resources Information Center

    Kimball, Michele Bush

    2011-01-01

    Although every state in the country has recognized the importance of government transparency by enacting open government provisions, few of those statutes require training programs to encourage records custodians to comply with the law. Ten states mandate training in how to legally respond to public records requests, and some mandates are stronger…

  3. THE EFFECT OF STATE INSURANCE MANDATES ON INFANT IMMUNIZATION RATES.

    PubMed

    Chang, Lenisa V

    2016-03-01

    While US infant immunization rates have been increasing in the last 20 years, the cost of fully immunizing a child with all recommended vaccines has almost tripled. This is partly not only due to new additions in the list of recommended vaccines but also due to the use of new, safer, but more expensive technologies in vaccine production and distribution. In recent years, many states have mandated that recommended childhood vaccines be covered by private health insurance companies. Currently, there are 33 states with such a mandate. In this paper, I examine whether the introduction of mandates on private insurers affected immunization rates. Using state and time variation, I find that mandates increased the immunization rate for three vaccines--the diphtheria-tetanus-pertussis, polio, and measles-mumps-rubella vaccines--by about 1.8 percentage points. These results may provide a lower bound for the expected effect of the Affordable Care Act, which mandates coverage of childhood vaccines for all private insurers in the USA. I also find evidence that the mandates shifted a significant portion of vaccinations from publicly funded sources to private ones, with a decline in public health clinic visits and an increase in vaccinations at hospitals and doctor's offices. PMID:25773053

  4. Certified School Nurse Perspectives on State-Mandated Hearing Screens

    ERIC Educational Resources Information Center

    Sekhar, Deepa L.; Beiler, Jessica S.; Schaefer, Eric W.; Henning, Antoinette; Dillon, Judith F.; Czarnecki, Beth; Zalewski, Thomas R.

    2016-01-01

    Background: Approximately 15% of children in the United States 6-19 years of age have hearing loss. Even mild, unilateral hearing loss may adversely affect educational success. In 2014, the Pennsylvania Department of Health (PA DOH) began updating the 2001 regulations on state-mandated school hearing screens. To inform the updates, a needs…

  5. Biosimilar competition in the United States: statutory incentives, payers, and pharmacy benefit managers.

    PubMed

    Falit, Benjamin P; Singh, Surya C; Brennan, Troyen A

    2015-02-01

    Widespread adoption of generic medications, made possible by the Hatch-Waxman Act of 1984, has contained the cost of small-molecule drugs in the United States. Biologics, however, have yet to face competition from follow-on products and represent the fastest-growing sector of the US pharmaceutical market. We compare the legislative framework governing small-molecule generics to that which regulates follow-on biologics, and we examine management tools that are likely to be most successful in promoting biosimilars' adoption. The Biologics Price Competition and Innovation Act established an abbreviated pathway for follow-on biologics, but weak statutory incentives create barriers to entry. Many authors have raised concerns that competition under the biologics act may be weaker than that posed by small-molecule generics under Hatch-Waxman, in part because of legislative choices such as the absence of market exclusivity for the first biosimilar approved and a requirement that follow-on manufacturers disclose their manufacturing processes to the manufacturer of the reference product. Provider skepticism and limited competition from biosimilars will challenge payers and pharmacy benefit managers to reduce prices and maximize uptake of follow-on biologics. Successful payers and pharmacy benefit managers will employ various strategies, including tiered formularies and innovative fee schedules, that can control spending by promoting uptake of biosimilars across both the pharmacy and medical benefits. PMID:25646110

  6. Colorectal Cancer Screening and State Health Insurance Mandates.

    PubMed

    Hamman, Mary K; Kapinos, Kandice A

    2016-02-01

    Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women. PMID:25521438

  7. State-Mandated Economic Education, Teacher Attitudes, and Student Learning.

    ERIC Educational Resources Information Center

    Marlin, James W., Jr.

    1991-01-01

    Investigates factors affecting teacher attitudes and the resultant impact on student learning. Uses data from a 1987 National Assessment of Economic Education (NAEE) survey. Finds that state-mandated economics courses cause a decrease in teacher enthusiasm but that training in how to teach economics increases teacher enthusiasm and has a positive…

  8. Retention as a State Policy Mandate: IREAD in Indiana

    ERIC Educational Resources Information Center

    Stubbs, Velinda F.

    2013-01-01

    The interpretation of Indiana Public Law 109 and subsequent policy adopted by the Indiana Department of Education resulted in the Indiana State Board of Education mandating circumstances implemented during the 2011-2012 school year regarding grade level retention of Grade 3 students. IREAD-3, a standardized, gateway assessment, was administered to…

  9. Do States Have the Capacity to Meet the NCLB Mandates?

    ERIC Educational Resources Information Center

    Sunderman, Gail L.; Orfield, Gary

    2007-01-01

    The states have always been central to the American public school systems, and they have been sharply expanding their authority over local school districts since the 1980s, when they adopted education reforms that increased course requirements (especially in science and math), mandated uniform testing, and put in place higher teaching standards. A…

  10. Lessons from state mandates of preventive cancer screenings.

    PubMed

    Xu, Wendy Yi; Dowd, Bryan; Abraham, Jean

    2016-03-01

    We use the 1997-2008 Medical Expenditure Panel Survey (MEPS) and variation in the timing of state mandates for coverage of colorectal, cervical, and prostate cancer screenings to investigate the behavioral and financial effects of mandates on privately insured adults. We find that state mandates did not result in increased rates of cancer screening. However, coverage of preventive care, whether mandated or not, moves the cost of care from the consumer's out-of-pocket expense to the premium, resulting in a cross-subsidy of users of the service by non-users. While some cross-subsidies are intentional, others may be unintentional. We find that users of cancer screening have higher levels of income and education, while non-users tend to be racial minorities, lack a usual source of care, and live in communities with fewer physicians per capita. These results suggest that coverage of preventive care may transfer resources from more advantaged individuals to less advantaged individuals. PMID:25773049

  11. The Little State That Couldn't Could? The Politics of "Single-Payer" Health Coverage in Vermont.

    PubMed

    Fox, Ashley M; Blanchet, Nathan J

    2015-06-01

    In May 2011, a year after the passage of the Affordable Care Act (ACA), Vermont became the first state to lay the groundwork for a single-payer health care system, known as Green Mountain Care. What can other states learn from the Vermont experience? This article summarizes the findings from interviews with nearly 120 stakeholders as part of a study to inform the design of the health reform legislation. Comparing Vermont's failed effort to adopt single-payer legislation in 1994 to present efforts, we find that Vermont faced similar challenges but greater opportunities in 2010 that enabled reform. A closely contested gubernatorial election and a progressive social movement opened a window of opportunity to advance legislation to design three comprehensive health reform options for legislative consideration. With a unified Democratic government under the leadership of a single-payer proponent, a high-profile policy proposal, and relatively weak opposition, a framework for a single-payer system was adopted by the legislature - though with many details and political battles to be fought in the future. Other states looking to reform their health systems more comprehensively than national reform can learn from Vermont's design and political strategy. PMID:25700374

  12. Why the United States should adopt a single-payer system of health care finance.

    PubMed

    DeGrazia, D

    1996-06-01

    Although nothing could be less fashionable today than talk of comprehensive health care reform, the major problems of American health care have not gone away. Only a radical change in the way the U.S. finances health care--specifically, a single-payer system--will permit the achievement of universal coverage while keeping costs reasonably under control. Evidence from other countries, especially Canada, suggests the promise of this approach. In defending the single-payer approach, the author identifies several political and cultural factors that make it difficult for Americans to obtain a clear view of this option. Finally, the author argues that much discussion of rationing is vitiated by bracketing more systemic questions to which the issue of rationing is inextricably linked. PMID:10158031

  13. How Schools Are Meeting State Legal Mandates to Provide Online Education

    ERIC Educational Resources Information Center

    Deschaine, Mark Edward

    2013-01-01

    This study explores how public schools in Michigan are meeting the mandate to provide online learning opportunities as a condition of graduation. Michigan became the first state in the nation to mandate online learning opportunities as a condition for graduation with the passage of the Michigan Merit Curriculum. Although the mandate for compliance…

  14. State law mandates for reporting of healthcare-associated Clostridium difficile infections in hospitals.

    PubMed

    Reagan, Julie; Herzig, Carolyn T A; Pogorzelska-Maziarz, Monika; Dick, Andrew W; Stone, Patricia W; Divya Srinath, Jd

    2015-03-01

    US state and territorial laws were reviewed to identify Clostridium difficile infection reporting mandates. Twenty states require reporting either under state law or by incorporating federal Centers for Medicare & Medicaid Services' reporting requirements. Although state law mandates are more common, the incorporation of federal reporting requirements has been increasing. PMID:25695178

  15. Effectiveness of state-level vaccination mandates: evidence from the varicella vaccine.

    PubMed

    Abrevaya, Jason; Mulligan, Karen

    2011-09-01

    This paper utilizes longitudinal data on varicella (chickenpox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19-35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with previous cost-benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint. PMID:21715035

  16. State-mandated insurance coverage is associated with the approach to hydrosalpinges before IVF

    PubMed Central

    Omurtag, Kenan; Grindler, Natalia M.; Roehl, Kimberly A.; Bates, G. Wright; Beltsos, Angeline N.; Odem, Randall R.; Jungheim, Emily S.

    2014-01-01

    The aim of this study was to determine whether practice in states with infertility insurance mandates is associated with physician-reported practice patterns regarding hydrosalpinx management in assisted reproduction clinics. A cross-sectional, internet-based survey of 442 members of Society for Reproductive Endocrinology and Infertility or Society of Reproductive Surgeons was performed. Physicians practising in states without infertility insurance mandates were more likely to report performing diagnostic surgery after an inconclusive hysterosalpingogram than physicians practising in states with mandates (RR 1.2, 95% CI 1.1–1.3, P < 0.01). Additionally, respondents in states without mandates were more likely to report that, due to lack of infertility insurance coverage, they did not perform salpingectomy (SPX) or proximal tubal occlusion (PTO) before assisted reproduction treatment (RR 1.4, 95% CI 1.1–1.8, P = 0.01). Finally, respondents in states without mandates were less likely to report that the presence of assisted reproduction treatment coverage determined the urgency with which they pursued SPX or PTO before treatment (RR 0.7, 95% CI 0.5–1.0, NS). These results persisted after controlling for physician years in practice, age and clinic volume. In conclusion, self-reported physician practice interventions for hydrosalpinges before assisted reproduction treatment may be associated with state-mandated infertility insurance. PMID:24813751

  17. US state variation in autism insurance mandates: balancing access and fairness.

    PubMed

    Johnson, Rebecca A; Danis, Marion; Hafner-Eaton, Chris

    2014-10-01

    This article examines how nations split decision-making about health services between federal and sub-federal levels, creating variation between states or provinces. When is this variation ethically acceptable? We identify three sources of ethical acceptability-procedural fairness, value pluralism, and substantive fairness-and examine these sources with respect to a case study: the fact that only 30 out of 51 US states or territories passed mandates requiring private insurers to offer extensive coverage of autism behavioral therapies, creating variation for privately insured children living in different US states. Is this variation ethically acceptable? To address this question, we need to analyze whether mandates go to more or less needy states and whether the mandates reflect value pluralism between states regarding government's role in health care. Using time-series logistic regressions and data from National Survey of Children with Special Health Care Needs, Individual with Disabilities Education Act, legislature political composition, and American Board of Pediatrics workforce data, we find that the states in which mandates are passed are less needy than states in which mandates have not been passed, what we call a cumulative advantage outcome that increases between-state disparities rather than a compensatory outcome that decreases between-state disparities. Concluding, we discuss the implications of our analysis for broader discussions of variation in health services provision. PMID:24789870

  18. Implementing Curricular Change through State-Mandated Testing: Ethical Issues.

    ERIC Educational Resources Information Center

    Mathison, Sandra

    1991-01-01

    Explores the ethical issues involved in using standardized tests to implement a state-level policy. Examines the fourth grade science program evaluation test administered in New York State for the first time in 1989. A utilitarian view of ethics ignores the consequences of testing for different constituents, obviates caring behavior, and damages…

  19. Is State-Mandated Redesign an Effective and Sustainable Solution?

    ERIC Educational Resources Information Center

    Young, Michelle D.

    2013-01-01

    There is a pervasive and ongoing perception that leadership preparation is a problem. Important questions remain about the intentions, capacity, and impact of state departments of education engaged in leadership preparation program redesign. In this essay, I take up several issues concerning this state policy work, including whether a one size…

  20. States Stepping up Mandates for School Safety Drills

    ERIC Educational Resources Information Center

    Shah, Nirvi

    2013-01-01

    Hundreds of U.S. schools will supplement fire drills and tornado training next fall with simulations of school shootings. In response to the December shootings by an intruder at Sandy Hook Elementary School in Newtown, Connecticut, several states have enacted or are considering laws that require more and new types of school safety drills, more…

  1. The Financial Education Tool Kit: Helping Teachers Meet State- Mandated Personal Finance Requirements

    ERIC Educational Resources Information Center

    St. Pierre, Eileen; Richert, Charlotte; Routh, Susan; Lockwood, Rachel; Simpson, Mickey

    2012-01-01

    States are recognizing the need for personal financial education and have begun requiring it as a condition for high school graduation. Responding to teacher requests to help them meet state-mandated financial education requirements, FCS educators in the Oklahoma Cooperative Extension Service developed a financial education tool kit. This article…

  2. Linking Scholarship and Practice: Community College Leaders, State Mandates, and Leadership Competencies

    ERIC Educational Resources Information Center

    Hebert-Swartzer, Cathleen A.; McNair, Delores E.

    2010-01-01

    To be an effective leader in today's community college requires a sophisticated set of skills that are often learned through on the job training, mentoring, and professional development activities. Using case study methodology, this study examined how community college leaders in California use their skills to implement a state mandate related to…

  3. State-Mandated Principal Preparation Program Redesign: Impetus for Reform or Invitation to Chaos?

    ERIC Educational Resources Information Center

    Phillips, Joy C.

    2013-01-01

    Increasing criticism of practicing educational leaders has led to additional critiques of the university programs in which they are prepared. In response, many states have mandated statewide university preparation program redesign. The articles in this special issue describe five unique cases of principal preparation program redesign--including…

  4. Evaluation of Alabama Public School Wellness Policies and State School Mandate Implementation

    ERIC Educational Resources Information Center

    Gaines, Alisha B.; Lonis-Shumate, Steven R.; Gropper, Sareen S.

    2011-01-01

    Background: This study evaluated wellness policies created by Alabama public school districts and progress made in the implementation of Alabama State Department of Education (ALSDE) school food and nutrition mandates. Methods: Wellness policies from Alabama public school districts were compared to minimum requirements under the Child Nutrition…

  5. Dangerous Liaisons: Reflections on a Pilot Project for State-Mandated Outcomes Assessment of Written Communication

    ERIC Educational Resources Information Center

    Denny, Harry C.

    2008-01-01

    This study details the development and results of a campus-based writing assessment plan that was mandated by a state-wide university system in order to explore the ''value-added'' from a writing program curriculum to undergraduate students' competence with written expression. Four writing samples (two timed essays and two conventional essays)…

  6. The Relationship of State Funding of Education to Student Performance on State Mandated Assessments in South Dakota

    ERIC Educational Resources Information Center

    Price, Joel Philip

    2012-01-01

    This study determined the relationship of state funding to student performance on state mandated assessments in South Dakota between the years of 2003-2009. A cohort group of 40 school districts between 200 ADM and 600 ADM who had not reorganized were selected. Data was collected using the Dakota STEP assessment portal on the South Dakota…

  7. Continuously Uncertain Reform Effort: State-Mandated History and Social Science Curriculum and the Perceptions of Teachers

    ERIC Educational Resources Information Center

    Martell, Christopher

    2010-01-01

    This study examined teachers' attitudes and beliefs in one over-performing urban/suburban high school of the state-mandated curriculum framework under conditions that I label a continuously uncertain reform effort or a top-down mandated curriculum involving constant mixed-messages as to its content, accountability demands, and future existence.…

  8. State-mandated reporting of health care-associated infections in the United States: trends over time.

    PubMed

    Herzig, Carolyn T A; Reagan, Julie; Pogorzelska-Maziarz, Monika; Srinath, Divya; Stone, Patricia W

    2015-01-01

    Over the past decade, most US states and territories began mandating that acute care hospitals report health care-associated infections (HAIs) to their departments of health. Trends in state HAI law enactment and data submission requirements were determined through systematic legal review; state HAI coordinators were contacted to confirm collected data. As of January 31, 2013, 37 US states and territories (71%) had adopted laws requiring HAI data submission, most of which were enacted and became effective in 2006 and 2007. Most states with HAI laws required reporting of central line-associated bloodstream infections in adult intensive care units (92%), and about half required reporting of methicillin-resistant Staphylococcus aureus and Clostridium difficile infections (54% and 51%, respectively). Overall, data submission requirements were found to vary across states. Considering the facility and state resources needed to comply with HAI reporting mandates, future studies should focus on whether these laws have had the desired impact of reducing infection rates. PMID:24951104

  9. Do Fourteenth Amendment considerations outweigh a potential state interest in mandating cochlear implantation for deaf children?

    PubMed

    Bender, Denise G

    2004-01-01

    Currently, the decision concerning pediatric cochlear implantation for children remains a personal choice for parents to make. Economic factors, educational outcomes, and societal attitudes concerning deafness could result in an increased governmental interest in this choice. This article examines case law related to the issue of parental autonomy to determine whether the state, acting in the role of parens patriae, could use economic and social reasons to mandate the provision of cochlear implants for all eligible children. The author uses previous cases as a framework to develop an opinion on whether a constitutional protection for parents may exist. PMID:15304405

  10. New evidence on hospital profitability by payer group and the effects of payer generosity.

    PubMed

    Friedman, Bernard; Sood, Neeraj; Engstrom, Kelly; McKenzie, Diane

    2004-09-01

    This study provides (a) new estimates of U.S. hospital profitability by payer group, controlling for hospital characteristics, and (b) evidence about the intensity of care for particular diseases associated with the generosity of the patient's payer and other payers at the same hospital. The conceptual framework is a variant of the well-known model of a local monopolist selling in a segmented market. Effects of two kinds of regulation are considered. The data are taken from hospital accounting reports in four states in FY2000, and detailed discharge summaries from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. The profitability of inpatient care for privately insured patients was found to be about 4% less than for Medicare, but 14% higher than for Medicaid and only 9% higher than for self-pay patients. We found significant direct associations but not external effects of payer generosity on the intensity of care. PMID:15277780

  11. Are payers treating orphan drugs differently?

    PubMed Central

    Cohen, Joshua P.; Felix, Abigail

    2014-01-01

    Background Some orphan drugs can cost hundreds of thousands of dollars annually per patient. As a result, payer sensitivity to the cost of orphan drugs is rising, particularly in light of increased numbers of new launches in recent years. In this article, we examine payer coverage in the United States, England and Wales, and the Netherlands of outpatient orphan drugs approved between 1983 and 2012, as well as the 11 most expensive orphan drugs. Methods We collected data from drug regulatory agencies as well as payers and drug evaluation authorities. Results We found that orphan drugs have more coverage restrictions than non-orphan drugs in all three jurisdictions. From an economic perspective, the fact that a drug is an orphan product or has a high per-unit price per se should not imply a special kind of evaluation by payers, or necessarily the imposition of more coverage restrictions. Conclusion Payers should consider the same set of decision criteria that they do with respect to non-orphan drugs: disease severity, availability of treatment alternatives, level of unmet medical need, and cost-effectiveness, criteria that justifiably may be taken into account and traded off against one another in prescribing and reimbursement decisions for orphan drugs.

  12. Improving coordinated responses for victims of intimate partner violence: law enforcement compliance with state-mandated intimate partner violence documentation.

    PubMed

    Cerulli, Catherine; Edwardsen, Elizabeth A; Hall, Dale; Chan, Ko Ling; Conner, Kenneth R

    2015-07-01

    New York State law mandates specific intimate partner violence (IPV) documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n = 191), more often when injury occurred (p < .01) and the defendant had prior court contact (p < .05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation. PMID:25926052

  13. IMPROVING COORDINATED RESPONSES FOR VICTIMS OF INTIMATE PARTNER VIOLENCE: LAW ENFORCEMENT COMPLIANCE WITH STATE MANDATED INTIMATE PARTNER VIOLENCE DOCUMENTATION

    PubMed Central

    Cerulli, Catherine; Edwardsen, Elizabeth A.; Hall, Dale; Chan, Ko Ling; Conner, Kenneth R.

    2015-01-01

    New York State law mandates specific IPV documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n=191), more often when injury occurred (p<.01) and the defendant had prior court contact (p<.05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation. PMID:25926052

  14. Managing benefits for diabetes: changing payer strategies for changing times.

    PubMed

    Tzeel, Albert

    2013-01-01

    Just as there are many ways to treat a condition such as diabetes, there are also many ways for payers to manage the diabetes benefit. Although none of these methods is specifically right or wrong, they are grounded in a payer's philosophy and created in response to the needs of the time. Yet, just as in any other business, new ideas and, for diabetes, new scientific discoveries will surely mandate new strategies to achieve goals. As payers find themselves adapting to new political realities and new partnerships, one cannot be sure if their new strategies will succeed or not. But, in actuality, this becomes moot as the 1 point we can be sure of is that benefit management will continue to evolve. PMID:23725238

  15. Back on the Backburner? Impact of Reducing State-Mandated Social Studies Testing on Elementary Teachers' Instruction

    ERIC Educational Resources Information Center

    Vogler, Kenneth E.

    2011-01-01

    Numerous studies have shown how elementary social studies instruction has been constrained or curtailed in states that do not test social studies as part of their mandated accountability system. South Carolina is a state that tests social studies as well as English, mathematics, and science in grades three through eight as part of its…

  16. West Virginia Physical Education Teacher Perceptions of State Mandated Fitnessgram® Testing and Application of Results

    ERIC Educational Resources Information Center

    Miller, William M.

    2013-01-01

    Background/Purpose: In response to concerns with increasing rates of childhood obesity, many states have enacted policies that affect physical education. A commonly used approach is state mandated fitness test administration in school-based settings. While this approach is widely debated throughout the literature, one area that lacks research is…

  17. Caught in the Current: A Self-Study of State-Mandated Compliance in a Teacher Education Program

    ERIC Educational Resources Information Center

    Kornfeld, John; Grady, Karen; Marker, Perry M.; Ruddell, Martha Rapp

    2007-01-01

    Background/Context: The nationwide preoccupation with accountability continues to grow, with teacher credentialing programs facing growing scrutiny through state-mandated accountability systems. In response to Senate Bill 2042 passed by the California state legislature in 1998, the California Commission for Teacher Credentialing (CCTC) established…

  18. State-mandated school-based BMI screening and parent notification: a descriptive case study.

    PubMed

    Kaczmarski, Jenna M; DeBate, Rita D; Marhefka, Stephanie L; Daley, Ellen M

    2011-11-01

    To address childhood obesity, several states and local school districts across the United States have adopted body mass index (BMI) measurement initiatives. This descriptive case study explored psychosocial, environmental, and behavioral factors among parents of sixth-grade students who received BMI Health Letters (BMIHLs) in one Florida County. A nonexperimental postintervention design was employed to gather quantitative data via self-report Likert-type questionnaire. Participants were parents/guardians of sixth-grade students attending one Hillsborough County public middle school (n = 76). Results indicate three main findings: (a) most parents in this study (67.4%) who discussed the BMIHL with their child reported their child as "very" or "somewhat" uncomfortable with the discussion; (b) some parents of normal weight (NW) children responded by taking their child to a medical professional to control their weight; and (c) more parents of at risk of overweight/overweight (AR/OW) children (vs. NW) reported greater concern about their child's weight, using food restriction and physical activity to control their child's weight, and giving negative weight-related comments/behaviors. This case study illustrates the importance of adapting and tailoring state mandated BMIHLs for parents based on child's BMI status. PMID:22068272

  19. Using General Outcome Measures to Predict Student Performance on State-Mandated Assessments: An Applied Approach for Establishing Predictive Cutscores

    ERIC Educational Resources Information Center

    Leblanc, Michael; Dufore, Emily; McDougal, James

    2012-01-01

    Cutscores for reading and math (general outcome measures) to predict passage on New York state-mandated assessments were created by using a freely available Excel workbook. The authors used linear regression to create the cutscores and diagnostic indicators were provided. A rationale and procedure for using this method is outlined. This method…

  20. Negotiating Dual Accountability Systems: Strategic Responses of Big Picture Schools to State-Mandated Standards and Assessment

    ERIC Educational Resources Information Center

    Suchman, Sara P.

    2012-01-01

    The No Child Left Behind Act of 2001 mandated that states implement standards and test-based accountability systems. In theory, local educators are free to select the means for teaching the standards so long as students achieve a predetermined proficiency level on the exams. What is unclear, however, is how this theory plays out in schools…

  1. Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates

    ERIC Educational Resources Information Center

    Duggan, Mark; Hayford, Tamara

    2013-01-01

    From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from…

  2. A Reflection on Lessons Learned from Implementation of a State-Mandated Co-Teaching Model for Student Teaching

    ERIC Educational Resources Information Center

    Willis, Dottie

    2015-01-01

    The author reflects on challenges faced by teacher educators when Kentucky's Educational Professional Standards Board mandated a new Co-Teaching model for all of the state's student teachers in 2013. This article analyzes the overwhelmingly positive responses of cooperating teachers and the experiences of teacher candidates (student teachers) with…

  3. A Retrospective Cohort Comparison of Career and Technical Education Participants and Non-Participants on a State-Mandated Proficiency Test

    ERIC Educational Resources Information Center

    Bae, Sang Hoon; Gray, Kenneth; Yeager, Georgia

    2007-01-01

    The sometimes poor performance of Career and Technical Education (CTE) concentrators on a state-mandated proficiency test is a major concern of CTE educators. This study examined whether (a) there are performance differences on state-mandated 11th-grade math and reading tests between CTE and non-CTE students with similar proficiency scores in the…

  4. Do biofuel blending mandates reduce gasoline consumption? Implications of state-level renewable fuel standards for energy security

    NASA Astrophysics Data System (ADS)

    Lim, Shinling

    In an effort to keep America's addiction to oil under control, federal and state governments have implemented a variety of policy measures including those that determine the composition of motor gasoline sold at the pump. Biofuel blending mandates known as Renewable Fuel Standards (RFS) are designed to reduce the amount of foreign crude oil needed to be imported as well as to boost the local ethanol and corn industry. Yet beyond looking at changes in gasoline prices associated with increased ethanol production, there have been no empirical studies that examine effects of state-level RFS implementation on gasoline consumption. I estimate a Generalized Least Squares model for the gasoline demand for the 1993 to 2010 period with state and time fixed effects controlling for RFS. States with active RFS are Minnesota, Hawaii, Missouri, Florida, Washington, and Oregon. I find that, despite the onset of federal biofuel mandates across states in 2007 and the lower energy content of blended gasoline, being in a state that has implemented RFS is associated with 1.5% decrease in gasoline consumption (including blended gasoline). This is encouraging evidence for efforts to lessen dependence on gasoline and has positive implications for energy security.

  5. Mandated Testing: Lived Situations.

    ERIC Educational Resources Information Center

    Phillips, Jerry; Phillips, Julie

    This paper describes a father's reflections on his daughter Charlie's failure to pass a state-mandated standardized test; reactions of both to the failure; reactions of both to emerging events; Charlie's next challenge and her looking to the future, and final thoughts and conclusions. The paper is a collaborative effort between father and daughter…

  6. Can ship-to-classroom interactions aid in teaching state-mandated curricula to special needs students?

    NASA Astrophysics Data System (ADS)

    Haddad, A.; Turner, M.; Samuelson, L.; Scientific Team of IODP Expedition 336: Mid-Atlantic Ridge Microbiology

    2011-12-01

    Cutting edge science is so exciting to elementary-level students with special needs that they are constantly asking for more! We drew on this enthusiasm and developed an interaction between special needs students and scientists performing cutting edge research on and below the ocean floor with the goal of teaching them state-mandated curricula. While on board the JOIDES Resolution during IODP Expedition 336: Mid-Atlantic Ridge Microbiology (Fall 2011), scientists interacted with several special needs classrooms in the Phoenix, Arizona metro area via weekly activities, blogs, question-and-answer sessions and Skype calls revolving around ocean exploration. All interactions were developed to address Arizona Department of Education curriculum standards in reading, writing, math and science and tailored to the learning needs of the students. Since the usual modalities of teaching (lecturing, Powerpoint presentations, independent reading) are ineffective in teaching students with special needs, we employed as much hands-on, active student participation as possible. The interactions were also easily adaptable to include every student regardless of the nature of their special needs. The effectiveness of these interactions in teaching mandated standards was evaluated using pre- and post-assessments and are presented here. Our goal is to demonstrate that special needs students benefit from being exposed to real-time science applications.

  7. All-payer ratesetting: Down but not out

    PubMed Central

    Anderson, Gerard F.

    1992-01-01

    In the United States, when the cost-containment paradigm shifted from regulation to competition, all-payer hospital ratesetting went out of favor. After reviewing the published literature and supplementing the existing literature with more current information, the author concludes that all-payer ratesetting is able to meet its multiple objectives of cost containment, reduction of the amount of cost shifting, improvement of access to the uninsured, and increased productivity. At the same time, all-payer ratesetting has not stifled the diffusion of competitive health care systems or new technology, and any impact on length of stay, admissions, and quality of care is small, if it exists at all. PMID:25371975

  8. Barriers to College Opportunity: The Unintended Consequences of State-Mandated Testing

    ERIC Educational Resources Information Center

    Perna, Laura W.; Thomas, Scott L.

    2009-01-01

    This study explores the ways that state high school testing policies shape college opportunity among students attending 15 high schools in five states. The authors use multiple descriptive case studies to explore how testing policies influence key predictors of college enrollment (e.g., high school graduation, academic preparation, knowledge, and…

  9. High school science teacher perceptions of the science proficiency testing as mandated by the State of Ohio Board of Education

    NASA Astrophysics Data System (ADS)

    Jeffery, Samuel Shird

    There is a correlation between the socioeconomic status of secondary schools and scores on the State of Ohio's mandated secondary science proficiency tests. In low scoring schools many reasons effectively explain the low test scores as a result of the low socioeconomics. For example, one reason may be that many students are working late hours after school to help with family finances; parents may simply be too busy providing family income to realize the consequences of the testing program. There are many other personal issues students face that may cause them to score poorly an the test. The perceptions of their teachers regarding the science proficiency test program may be one significant factor. These teacher perceptions are the topic of this study. Two sample groups ware established for this study. One group was science teachers from secondary schools scoring 85% or higher on the 12th grade proficiency test in the academic year 1998--1999. The other group consisted of science teachers from secondary schools scoring 35% or less in the same academic year. Each group of teachers responded to a survey instrument that listed several items used to determine teachers' perceptions of the secondary science proficiency test. A significant difference in the teacher' perceptions existed between the two groups. Some of the ranked items on the form include teachers' opinions of: (1) Teaching to the tests; (2) School administrators' priority placed on improving average test scores; (3) Teacher incentive for improving average test scores; (4) Teacher teaching style change as a result of the testing mandate; (5) Teacher knowledge of State curriculum model; (6) Student stress as a result of the high-stakes test; (7) Test cultural bias; (8) The tests in general.

  10. Retention of High School Economics Knowledge and the Effect of the California State Mandate

    ERIC Educational Resources Information Center

    Gill, Andrew M.; Gratton-Lavoie, Chiara

    2011-01-01

    The authors extend the literature on the efficacy of high school economics instruction in two directions. First, they assess how much economic knowledge that California students acquired in their compulsory high school course is retained on their entering college. Second, using as a control group some college students from the state of Washington,…

  11. The State's Role in Implementing Legislative Mandates: The Urban School Superintendents' Perspective.

    ERIC Educational Resources Information Center

    Tuneberg, Jeffrey

    This paper presents findings of a study that examined urban school district superintendents' perceptions of the methods by which the Ohio Department of Education (DOE) influenced Ohio's public school districts. In particular, the superintendents were asked about the influence and control utilized by the State Department of Education to implement…

  12. Results from the Mandated Evaluation of Extension's Community Resource Development Projects in the United States.

    ERIC Educational Resources Information Center

    Mulford, Charles L.; And Others

    A 1979-1980 nation-wide study of 113 Community Resource Development (CRD) projects evaluated socio-economic impacts, as seen by CRD staff, state leaders, and knowledgeable citizens. Questionnaires were sent to the three groups to determine consequences of the programs in the categories of family income, community facilities and services, public…

  13. US State Variation in Autism Insurance Mandates: Balancing Access and Fairness

    ERIC Educational Resources Information Center

    Johnson, Rebecca A.; Danis, Marion; Hafner-Eaton, Chris

    2014-01-01

    This article examines how nations split decision-making about health services between federal and sub-federal levels, creating variation between states or provinces. When is this variation ethically acceptable? We identify three sources of ethical acceptability--procedural fairness, value pluralism, and substantive fairness--and examine these…

  14. What Can US Single-Payer Supporters Learn From the Swiss Rejection of Single Payer?

    PubMed

    Chaufan, Claudia

    2016-01-01

    On September 27, 2014, Swiss voters rejected a proposal to replace their system of about 60 health insurance companies offering mandatory basic health coverage with a single public insurer, the state, which would offer taxpayer-funded coverage of all medically necessary care. The Swiss and the U.S. media, academia, and business sectors, from conservative and liberal camps, interpreted the results to mean a rejection of single payer and a preference for a privately run system, with important implications for health reform in the United States. While on the surface mainstream interpretations appear reasonable, I argue that they have little basis on fact because they rely on assumptions that, while untrue, are repeated as mantras that conveniently justify the continuation of a model of health insurance that is unraveling, less conspicuously in Switzerland, dramatically in the United States. To make my case, I describe the dominant narrative about Swiss health care and mainstream interpretations of the latest referendum on health reform, unpack the problem within these interpretations, and conclude by identifying what lessons the Swiss referendum contains for single payer advocates in the United States in particular and for those who struggle for social and economic rights more generally. PMID:26880092

  15. 42 CFR 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... entities that received payment from primary payers. 411.22 Section 411.22 Public Health CENTERS FOR... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from primary payers. (a) A primary payer, and an entity that receives payment from a primary payer,...

  16. Effectiveness of a state law mandating use of bicycle helmets among children: an observational evaluation.

    PubMed

    Kanny, D; Schieber, R A; Pryor, V; Kresnow, M J

    2001-12-01

    In spring 1999, the authors evaluated the effectiveness of a 1997 Florida law requiring helmet use by all bicyclists younger than age 16 years. Sixty-four counties in Florida had enacted the bicycle helmet-use law, while the other three counties had opted out. Using a cross-sectional study design, the authors conducted unobtrusive observations at bicycle racks at public elementary schools statewide. Florida children riding bicycles in counties where the state helmet-use law was in place were twice as likely to wear helmets as children in counties without the law. In counties where the state law was in place, 16,907 (79%) of 21,313 riders observed wore a helmet, compared with only 148 (33%) of 450 riders in counties where no such law was in place (crude prevalence ratio = 2.4, 95% confidence interval: 2.1, 2.8). Helmet use by children of all racial groups exceeded 60% under the law. No significant difference in use by gender was found. These data support the positive influence of a law on bicycle helmet use among children. The data reinforce the Healthy People 2010 objective that all 50 states adopt such a law for children in order to increase helmet use and consequently reduce brain injury. PMID:11724725

  17. Effects of a State Mandated Policy (Site-Based Councils) and of Potential Role Incumbents on Teacher Screening Decisions in High and Low Performing Schools

    ERIC Educational Resources Information Center

    Young, I. Phillip; Miller-Smith, Kimberly

    2006-01-01

    Some states have viewed teacher selection as a means of improving student performance and have mandated the use of site-based teacher councils. To assess the utility of this legislative action, an experimental study was conducted. This study uses a 2x3x2 factorial design that varies state legislation, role of the decision maker, and academic…

  18. Controversies in vaccine mandates.

    PubMed

    Lantos, John D; Jackson, Mary Anne; Opel, Douglas J; Marcuse, Edgar K; Myers, Angela L; Connelly, Beverly L

    2010-03-01

    Policies that mandate immunization have always been controversial. The controversies take different forms in different contexts. For routine childhood immunizations, many parents have fears about both short- and long-term side effects. Parental worries change as the rate of vaccination in the community changes. When most children are vaccinated, parents worry more about side effects than they do about disease. Because of these worries, immunization rates go down. As immunization rates go down, disease rates go up, and parents worry less about side effects of vaccination and more about the complications of the diseases. Immunization rates then go up. For teenagers, controversies arise about the criteria that should guide policies that mandate, rather than merely recommend and encourage, certain immunizations. In particular, policy makers have questioned whether immunizations for human papillomavirus, or other diseases that are not contagious, should be required. For healthcare workers, debates have focused on the strength of institutional mandates. For years, experts have recommended that all healthcare workers be immunized against influenza. Immunizations for other infections including pertussis, measles, mumps, and hepatitis are encouraged but few hospitals have mandated such immunizations-instead, they rely on incentives and education. Pandemics present a different set of problems as people demand vaccines that are in short supply. These issues erupt into controversy on a regular basis. Physicians and policy makers must respond both in their individual practices and as advisory experts to national and state agencies. The articles in this volume will discuss the evolution of national immunization programs in these various settings. We will critically examine the role of vaccine mandates. We will discuss ways that practitioners and public health officials should deal with vaccine refusal. We will contrast responses of the population as a whole, within the

  19. Prescription Opioid Abuse: Challenges and Opportunities for Payers

    PubMed Central

    Katz, Nathaniel P.; Birnbaum, Howard; Brennan, Michael J.; Freedman, John D.; Gilmore, Gary P.; Jay, Dennis; Kenna, George A.; Madras, Bertha K.; McElhaney, Lisa; Weiss, Roger D.; White, Alan G.

    2013-01-01

    Objective Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Though difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript’s objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. Method A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research, and develop recommendations on solutions that payers might implement to combat this problem. Results While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies, such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Conclusion Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to6Treatment protocols, have a high potential to reduce insurer risks while addressing a serious public health problem. PMID:23725361

  20. Exploring barriers to payer utilization of genetic counselors.

    PubMed

    Doyle, Nan; Cirino, Allison; Trivedi, Amber; Flynn, Maureen

    2015-02-01

    Access to genetic counselors' services is neither universal nor automatic, due in part to the gatekeeper role of healthcare payers--the companies and agencies that purchase healthcare services on patients' behalf and control the bulk of healthcare spending. This pilot study surveyed and analyzed the relative importance of barriers to expanded payer coverage of genetic counselors' services. Surveys were mailed to 263 medical directors and quality assurance directors at health insurance carriers throughout the United States. Respondents provided demographic information and indicated the importance of nine possible barriers, plus an optional write-in "other." Twenty-two surveys were analyzed. "Evidence that use of genetic counselors improves health outcomes" led the list of factors having a significant/very significant influence on coverage policy. Sixteen respondents (73 %) rated this factor "4" or "5" on a Likert scale; it also received the most #1 rankings and the highest score using a weighted-mean analysis. Provider practice guidelines, CMS/Medicare regulations, and genetic counselor licensure-all of which are outside of payers' direct control-also ranked highly. The research demonstrates that although the potential barriers to expanded reimbursement for genetic counselors are numerous and complex, some are more consistently identified as important and therefore more deserving of legislative and advocacy resources to effect change. Future research should endeavor to increase survey response and include providers as well as payers. PMID:25138080

  1. Linguistic Discrimination in Writing Assessment: How Raters React to African American "Errors," ESL Errors, and Standard English Errors on a State-Mandated Writing Exam

    ERIC Educational Resources Information Center

    Johnson, David; VanBrackle, Lewis

    2012-01-01

    Raters of Georgia's (USA) state-mandated college-level writing exam, which is intended to ensure a minimal university-level writing competency, are trained to grade holistically when assessing these exams. A guiding principle in holistic grading is to not focus exclusively on any one aspect of writing but rather to give equal weight to style,…

  2. A Study of the Impact of Transformative Professional Development on Hispanic Student Performance on State Mandated Assessments of Science in Elementary School

    ERIC Educational Resources Information Center

    Johnson, Carla C.; Fargo, Jamison D.

    2014-01-01

    This paper reports the findings of a study of the impact of the transformative professional development (TPD) model on student achievement on state-mandated assessments of science in elementary school. Two schools (one intervention and one control) participated in the case study where teachers from one school received the TPD intervention across a…

  3. Lost in Translation: Using Video Annotation Software to Examine How a Clinical Supervisor Interprets and Applies a State-Mandated Teacher Assessment Instrument

    ERIC Educational Resources Information Center

    Miller, Matthew James; Carney, Joanne

    2009-01-01

    This case study examines the reasoning of a clinical supervisor as she assesses preservice teacher candidates with a state-mandated performance assessment instrument. The supervisor's evaluations were recorded using video annotation software, which allowed her to record her observations in real-time. The study reveals some of the inherent…

  4. Comparison of Height, Weight, and Body Mass Index Data from State-Mandated School Physical Fitness Testing and a Districtwide Surveillance Project

    ERIC Educational Resources Information Center

    Khaokham, Christina B.; Hillidge, Sharon; Serpas, Shaila; McDonald, Eric; Nader, Philip R.

    2015-01-01

    Background: Approximately one third of California school-age children are overweight or obese. Legislative approaches to assessing obesity have focused on school-based data collection. During 2010-2011, the Chula Vista Elementary School District conducted districtwide surveillance and state-mandated physical fitness testing (PFT) among fifth grade…

  5. The Psoriatic Disease Payer Advisory Panel.

    PubMed

    Greb, Jacqueline E; Merola, Joseph; Garg, Amit; Latella, John; Howard, Leah; Acharya, Nayan; Gottlieb, Alice B

    2016-05-01

    A collaborative exchange of ideas occurred at The Psoriatic Disease Payer Advisory Panel sponsored by International Dermatology Outcomes Measures (IDEOM) and The National Psoriasis Foundation (NPF) in January, 2016. Patient, provider, payer, pharmaceutical industry, IDEOM board member, and NPF leader representatives shared perspectives to address the unmet needs in the treatment of psoriatic patients. The payers who play a crucial role in controlling treatment access and improving patient outcomes played a pivotal role in the discussion. Progress made during the Payer Advisory Panel will ultimately advance psoriatic initiatives and help to address the persistent challenges of all vested stakeholders.

    J Drugs Dermatol. 2016;15(5):641-644. PMID:27168273

  6. Project A.D.A.P.T.: Approaches for Developing Active Participation in State Mandated Training Programs for Child Caregivers.

    ERIC Educational Resources Information Center

    Davis-Dike, Janice

    To increase the participation of child caregivers in mandated inservice training provided at a metropolitan adult/vocational center, changes were made in the curriculum and classroom environment and the research literature was reviewed for ways of activating adult learners. Several specific program innovations were implemented, including the…

  7. A descriptive study of the reported effects of state-mandated testing on the instructional practices and beliefs of middle school science teachers

    NASA Astrophysics Data System (ADS)

    Font-Rivera, Miriam Josefa

    The purpose of this study was to investigate the effects of state-level testing on the instructional practices and beliefs of middle school science teachers. The study addressed four questions: (a) What are the beliefs of middle school science teachers regarding the pressure to improve their students' test scores? (b) What are the beliefs of middle school science teachers about how standardized tests influence their class time? (c) What are the attitudes of middle school science teachers toward state testing? and (d) What commonalities emerge from teachers' responses about the state tests? The sample was composed of 86 middle school science teachers from states that have state mandated testing programs in the area of science. Descriptive statistics and an inductive analysis were performed to answer the research questions. Teachers reported that they and their students were under a great amount of pressure to increase test scores from central office administrators and from the school principal. Teachers reported spending considerable time on certain test preparation activities throughout the school year. Teachers reported that the three strongest influences in instructional planning were reviewing the content and skills covered on the state tests prior to the test administration, having to prepare students for state tests, and adjusting the curriculum sequence based on the content tested by the state tests. Multiple-choice items were reported to be the most often used assessment strategy. Teachers reported that state-mandated tests were not very helpful because the test results presented an inaccurate picture of student learning. The categories formed from the teachers' written comments reflected the findings of the survey questions. Comments concentrated on the negative effects of the tests in the areas of pressure, overemphasis on the test, accountability, reduction of instructional time due to test preparation, and negative uses of state-mandated tests

  8. Payers' dilemma: looming costs for chronic conditions.

    PubMed

    Herskovitz, Stephen

    2005-02-01

    Biotech products for chronic conditions will be coming with regularity in the next few years, and these represent both a clinical opportunity and a financial challenge for health plans. So far, few payers have figured out how to make such treatments available without breaking the bank. The challenges ahead and strategies for handling them. PMID:23393448

  9. Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World.

    PubMed

    Howrigon, Ron

    2016-01-01

    Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed. PMID:27443057

  10. A Mandate for Native History

    ERIC Educational Resources Information Center

    Pember, Mary Annette

    2007-01-01

    The Montana Indian Education For All Act may be setting an audacious national precedent for America's primary and secondary schools. The law requires all Montana schools to include curricula about the history, culture and contemporary status of the state's American Indian population. The new constitutional mandate has eyes throughout Native…

  11. The impact of high-stakes, state-mandated student performance assessment on 10th grade English, mathematics, and science teachers' instructional practices

    NASA Astrophysics Data System (ADS)

    Vogler, Kenneth E.

    The purpose of this study was to determine if the public release of student results on high-stakes, state-mandated performance assessments influence instructional practices, and if so in what manner. The research focused on changes in teachers' instructional practices and factors that may have influenced such changes since the public release of high-stakes, state-mandated student performance assessment scores. The data for this study were obtained from a 54-question survey instrument given to a stratified random sample of teachers teaching at least one section of 10th grade English, mathematics, or science in an academic public high school within Massachusetts. Two hundred and fifty-seven (257) teachers, or 62% of the total sample, completed the survey instrument. An analysis of the data found that teachers are making changes in their instructional practices. The data show notable increases in the use of open-response questions, creative/critical thinking questions, problem-solving activities, use of rubrics or scoring guides, writing assignments, and inquiry/investigation. Teachers also have decreased the use of multiple-choice and true-false questions, textbook-based assignments, and lecturing. Also, the data show that teachers felt that changes made in their instructional practices were most influenced by an "interest in helping my students attain MCAS assessment scores that will allow them to graduate high school" and by an "interest in helping my school improve student (MCAS) assessment scores," Finally, mathematics teachers and teachers with 13--19 years of experience report making significantly more changes than did others. It may be interpreted from the data that the use of state-mandated student performance assessments and the high-stakes attached to this type of testing program contributed to changes in teachers' instructional practices. The changes in teachers' instructional practices have included increases in the use of instructional practices deemed

  12. The Efficiency of a Group-Specific Mandated Benefit Revisited: The Effect of Infertility Mandates

    ERIC Educational Resources Information Center

    Lahey, Joanna N.

    2012-01-01

    This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are…

  13. Partnering with payers? Key lessons to keep in mind.

    PubMed

    Eggbeer, Bill; Sears, Kevin; Homer, Kenneth

    2014-01-01

    Key factors healthcare leaders might wish to consider when evaluating potential partnerships with payers include: Use of safeguards to prevent a payer from using benefit design to shift expected volume from high-revenue service lines or channels. Right to participate in narrow networks. Use of segment-specific language, which protects providers from payers that may try to extend a rate decrease from one patient segment to another. Exclusive co-branding. Automatic price increases if volume is not achieved. PMID:24511782

  14. The role of value in provider-patient-payer relationships.

    PubMed

    Benson, Keith J; Weech-Maldonado, Robert; Gamm, Larry D

    2003-01-01

    Value is becoming a topic of interest to 3 key players in the healthcare field-patients, payers, and providers. This article examines various value definitions and puts forth a composite value definition incorporating cost, quality, and worth elements. A value triad is created to demonstrate how value can be a linking mechanism between patient, payers and providers. Examples are then provided to assist managers in examining the value associated with payers and patients. PMID:15141848

  15. Leading the Way: State Mandates for School Advisory Councils in California, Florida and South Carolina. A Report.

    ERIC Educational Resources Information Center

    Zerchykov, Ross; And Others

    This report reviews the pioneering efforts in California, Florida, and South Carolina to foster citizen participation through school councils and provides data and analysis on one promising policy innovation in each of the states. The experience in the three states suggests that institutional mechanisms are in place, precedents have been set, and…

  16. Large Mandates and Limited Resources: State Response to the "No Child Left Behind Act" and Implications for Accountability

    ERIC Educational Resources Information Center

    Kim, Jimmy; Sunderman, Gail L.

    2004-01-01

    This report examines how state policymakers designed their accountability systems to meet the NCLB Title I requirements and the implications of its provisions for schools with large numbers of low-income and minority students. The authors conducted their study in six states--Arizona, California, Illinois, New York, Virginia, and Georgia--which are…

  17. Maryland's Global Hospital Budgets--Preliminary Results from an All-Payer Model.

    PubMed

    Patel, Ankit; Rajkumar, Rahul; Colmers, John M; Kinzer, Donna; Conway, Patrick H; Sharfstein, Joshua M

    2015-11-12

    In the first year of Maryland's experiment in setting all-payer rates for hospital services, costs were contained and the quality of care improved, though the state still has high rates of hospital admissions and per capita spending for Medicare patients. PMID:26559570

  18. Plessy v. Ferguson Mandate.

    ERIC Educational Resources Information Center

    Mueller, Jean West; Schamel, Wynell Burroughs

    1989-01-01

    Traces the history of the Plessy v. Ferguson case. Includes copies of the U.S. Supreme Court mandate to the Louisiana Supreme Court denying Plessy's request to overturn the Jim Crow law and ordering him to bear the court costs. Provides teaching suggestions for interpreting the document and highlights related topics and questions for research and…

  19. Managing Mandated Educational Change

    ERIC Educational Resources Information Center

    Clement, Jennifer

    2014-01-01

    This paper explores teachers' perspectives on the management of mandated educational change in order to understand how it may be managed more effectively. A case study of teachers' responses to the introduction of a quality teaching initiative in two New South Wales schools found that while some teachers described the strong negative…

  20. Student Transportation Mandate. A Report and Preliminary Recommendations.

    ERIC Educational Resources Information Center

    Illinois State Board of Education, Springfield.

    As part of a comprehensive study of all mandates placed by the state of Illinois on elementary and secondary education, an analysis was undertaken of the student transportation mandate in its historical perspective, inquiring into its original purpose, how well that purpose has been served, whether the mandate is still needed, and whether a…

  1. Perceived Effects of State-Mandated Testing Programs on Teaching and Learning: Findings from a National Survey of Teachers.

    ERIC Educational Resources Information Center

    Pedulla, Joseph J.; Abrams, Lisa M.; Madaus, George F.; Russell, Michael K.; Ramos, Miguel A.; Miao, Jing

    Results from a national survey of teachers are reported for five types of state testing programs, those with: (1) high stakes for districts, schools, or teachers, and students; (2) high stakes for districts, schools, and teachers, and moderate stakes for students; (3) high stakes for districts, schools, and teachers, and low stakes for students;…

  2. Mandating better buildings: a global review of building codes and prospects for improvement in the United States

    DOE PAGESBeta

    Sun, Xiaojing; Brown, Marilyn A.; Cox, Matt; Jackson, Roderick

    2015-03-11

    This paper provides a global overview of the design, implementation, and evolution of building energy codes. Reflecting alternative policy goals, building energy codes differ significantly across the United States, the European Union, and China. This review uncovers numerous innovative practices including greenhouse gas emissions caps per square meter of building space, energy performance certificates with retrofit recommendations, and inclusion of renewable energy to achieve “nearly zero-energy buildings”. These innovations motivated an assessment of an aggressive commercial building code applied to all US states, requiring both new construction and buildings with major modifications to comply with the latest version of themore » ASHRAE 90.1 Standards. Using the National Energy Modeling System (NEMS), we estimate that by 2035, such building codes in the United States could reduce energy for space heating, cooling, water heating and lighting in commercial buildings by 16%, 15%, 20% and 5%, respectively. Impacts on different fuels and building types, energy rates and bills as well as pollution emission reductions are also examined.« less

  3. Mandating better buildings: a global review of building codes and prospects for improvement in the United States

    SciTech Connect

    Sun, Xiaojing; Brown, Marilyn A.; Cox, Matt; Jackson, Roderick

    2015-03-11

    This paper provides a global overview of the design, implementation, and evolution of building energy codes. Reflecting alternative policy goals, building energy codes differ significantly across the United States, the European Union, and China. This review uncovers numerous innovative practices including greenhouse gas emissions caps per square meter of building space, energy performance certificates with retrofit recommendations, and inclusion of renewable energy to achieve “nearly zero-energy buildings”. These innovations motivated an assessment of an aggressive commercial building code applied to all US states, requiring both new construction and buildings with major modifications to comply with the latest version of the ASHRAE 90.1 Standards. Using the National Energy Modeling System (NEMS), we estimate that by 2035, such building codes in the United States could reduce energy for space heating, cooling, water heating and lighting in commercial buildings by 16%, 15%, 20% and 5%, respectively. Impacts on different fuels and building types, energy rates and bills as well as pollution emission reductions are also examined.

  4. Culture clash: aligning payers and providers for real reform.

    PubMed

    Bauer, Jeffrey C

    2010-04-01

    Self-imposed cost containment is not part of providers' heritage. The payer business model and its problems are complicated; simplistic reforms won't help. Health reform needs to be refocused on policies that allow providers and payers to align their cultures so that all parties benefit from potential synergies to provide top-quality care as inexpensively as possible. PMID:20358879

  5. Use of Diagnosis-Related Groups by Non-Medicare Payers

    PubMed Central

    Carter, Grace M.; Jacobson, Peter D.; Kominski, Gerald F.; Perry, Mark J.

    1994-01-01

    Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output. PMID:10142368

  6. A Study of the Impact of Transformative Professional Development on Hispanic Student Performance on State Mandated Assessments of Science in Elementary School

    NASA Astrophysics Data System (ADS)

    Johnson, Carla C.; Fargo, Jamison D.

    2014-11-01

    This paper reports the findings of a study of the impact of the transformative professional development (TPD) model on student achievement on state-mandated assessments of science in elementary school. Two schools (one intervention and one control) participated in the case study where teachers from one school received the TPD intervention across a 2-year period while teachers at the other school received no program and continued business as usual. The TPD program includes a focus on the core conceptual framework for effective professional development (Desimone in Educ Res 38:181-199, 2009) as well as an emphasis on culturally relevant pedagogy (CRP) and other effective science instructional strategies. Findings revealed that participation in TPD had a significant impact on student achievement for Burns Elementary with the percentage of proficient students growing from 25 % at baseline to 67 % at the end of the 2-year program, while the comparison school did not experience similar growth. Implications for future research and implementation of professional development programs to meet the needs of teachers in the realm of CRP in science are discussed.

  7. Fla. Budget Threatens Online Ed. Mandate

    ERIC Educational Resources Information Center

    Manzo, Kathleen Kennedy

    2009-01-01

    As Florida school districts scramble to meet a looming state mandate to offer full-time online instruction for K-8 students, and as high school enrollments in such courses continue to climb, lawmakers are mulling restrictions and budget cuts for the state's nationally known virtual school. Together, online-learning advocates say, the growing…

  8. Bilingual Mandate Challenges Chicago's Public Preschools

    ERIC Educational Resources Information Center

    Zehr, Mary Ann

    2010-01-01

    Administrators in the Chicago public schools are seeking to strike the right balance between providing guidance and permitting flexibility as they put in place the nation's first state mandate for providing bilingual education to preschoolers. New rules approved by the Illinois state board of education in June flesh out a January 2009 change that…

  9. Responding to Accountability Mandates. ERIC Digest.

    ERIC Educational Resources Information Center

    Outcalt, Charles; Rabin, Joel

    In recent years, community colleges have developed innovative assessment programs to respond to more explicit state guidelines and mandates for greater accountability. In California, for example, the State Assembly began requiring community colleges to address specific educational and fiscal performance issues in assessments in 1989, while…

  10. The efficiency of a group-specific mandated benefit revisited: the effect of infertility mandates.

    PubMed

    Lahey, Joanna N

    2012-01-01

    This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are unaffected, but their total labor input decreases. Workers do not value infertility mandates at cost, and so will not take wage cuts in exchange, leading employers to decrease their demand for this affected and identifiable group. Differences in the empirical effects of mandates found in the literature are explained by a model including variations in the elasticity of demand, moral hazard, ability to identify a group, and adverse selection. PMID:22180892

  11. Perceived Effects of State-Mandated Testing Programs on Teaching and Learning: Findings from Interviews with Educators in Low-, Medium-, and High-Stakes States.

    ERIC Educational Resources Information Center

    Clarke, Marguerite; Shore, Arnold; Rhoades, Kathleen; Abrams, Lisa; Miao, Jing; Li, Jie

    The goal of this study was to identify the effects of state-level standards-based reform on teaching and learning, paying particular attention to the state test and associated stakes. On-site interviews were conducted with 360 educators (elementary, middle, and high school teachers) in 3 states (120 in each state) attaching different stakes to the…

  12. Time to Insurance Approval in Private and Public Payers Does Not Influence Survival in Patients Who Undergo Hematopoietic Cell Transplantation.

    PubMed

    Bhatt, Vijaya Raj; Loberiza, Fausto R; Schmit-Pokorny, Kim; Lee, Stephanie J

    2016-06-01

    In the United States, insurance status has been implicated as a barrier to obtaining timely treatment. In this retrospective cohort study of 521 patients who underwent first hematopoietic cell transplantation (HCT), we investigated the association between timeliness of HCT and overall survival. Timeliness was operationally defined in the following 3 ways: (1) payer approval, from request for approval to actual payer approval; (2) transplantation speed, from payer approval to time of actual HCT; and (3) total time, from request for approval to HCT. Patients with private insurance had longer time to payer approval (P < .0001) than those with public payers but shorter time from approval to actual HCT (P < .0001) and total time to HCT (P < .0001). Multivariate Cox regression showed no significant differences in risk of death between slow and fast times in the 3 indices of timeliness in the models that used all patients (n = 509), autologous HCT in lymphoma (n = 278), and autologous HCT in multiple myeloma (n = 121). Additional studies to evaluate the effect of insurance timeliness on all patients for whom HCT is recommended, not just those who undergo HCT, should be conducted. PMID:26988742

  13. Mandated Preparation Program Redesign: Kentucky Case

    ERIC Educational Resources Information Center

    Browne-Ferrigno, Tricia

    2013-01-01

    This case study presents a chronicle of events spanning a decade in Kentucky that led to state policy changes for principal preparation and details the response to those mandated changes by professors at the University of Kentucky. Professors' collaborative efforts resulted in a new teacher leadership program and redesigned principal…

  14. Child Abuse and Mandated Reporting

    ERIC Educational Resources Information Center

    Woika, Shirley; Bowersox, Carissa

    2013-01-01

    Teachers and teachers-in-training are mandated reporters; they are legally required to report any suspected child abuse or neglect. This article describes: (1) How to file a report; (2) How prevalent child abuse is; (3) What abuse is; (4) What it means to be a mandated reporter; (5) When the report should be made; and (6) What to do if abuse is…

  15. Biosimilars: Opportunities to Promote Optimization Through Payer and Provider Collaboration.

    PubMed

    Manolis, Chronis H; Rajasenan, Kiran; Harwin, William; McClelland, Scott; Lopes, Maria; Farnum, Carolyn

    2016-09-01

    A panel was convened that consisted of 1 medical director, 2 pharmacy directors, and 2 oncologists, who represented the University of Pittsburgh Medical Center Health Plan, an integrated delivery network, and Florida Blue, a progressive regional health plan. This panel met in order to share ideas, discuss challenges, and develop practical solutions to promote optimal utilization in order to encourage collaboration between payers and providers to help ensure the success of biosimilar entrants into the marketplace. Live meetings were conducted in Orlando, Florida, and Pittsburgh, Pennsylvania, and were followed by virtual meetings to solidify ideas and concepts for this supplement. It is important for biosimilar manufacturers to identify potential payer, provider, and patient obstacles in order to develop strategic and tactical plans to preemptively address these potential obstacles. Gathering payer and provider insights will shed light on various issues such as access and reimbursement. Biosimilar manufacturers must be proactive in the education of payers, providers, and patients to ensure access to biosimilars. A strong factor emphasized among this group was that the assumption surrounding biosimilar development and use is the potential for health care cost savings. According to the panel, payers and providers must carefully consider economic implications and potential cost-effectiveness in order to increase the acceptance or understanding of biosimilars in clinical practice. The group identified 3 major challenges surrounding biosimilar adoption: (1) provider confidence in biosimilar education and clinical value, (2) provider confidence in reimbursement for new biosimilars, and (3) creating shared payer and provider cost-savings. After identification of the 3 challenges, the group posed potential solutions to help with biosimilar adoption. PMID:27579939

  16. A Comparative Analysis of Mandated Benefit Laws, 1949–2002

    PubMed Central

    Laugesen, Miriam J; Paul, Rebecca R; Luft, Harold S; Aubry, Wade; Ganiats, Theodore G

    2006-01-01

    Objective To understand and compare the trends in mandated benefits laws in the United States. Data Sources/Study Setting Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949–2002 were compiled from multiple published compendia. Study Design Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949–2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage. Data Collection/Extraction Method Data from published tables were entered into a spreadsheet and analyzed using statistical software. Principal Findings A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002. Conclusions There was a large increase in the number of mandated benefits laws during the managed

  17. 42 CFR 422.108 - Medicare secondary payer (MSP) procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare secondary payer (MSP) procedures. 422.108 Section 422.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections §...

  18. 42 CFR 422.108 - Medicare secondary payer (MSP) procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Medicare secondary payer (MSP) procedures. 422.108 Section 422.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections §...

  19. 42 CFR 423.462 - Medicare secondary payer procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare secondary payer procedures. 423.462 Section 423.462 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part...

  20. 42 CFR 422.108 - Medicare secondary payer (MSP) procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Medicare secondary payer (MSP) procedures. 422.108 Section 422.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Benefits and...

  1. 42 CFR 423.462 - Medicare secondary payer procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Medicare secondary payer procedures. 423.462 Section 423.462 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT...

  2. 42 CFR 423.462 - Medicare secondary payer procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Medicare secondary payer procedures. 423.462 Section 423.462 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Coordination of Part...

  3. 42 CFR 422.108 - Medicare secondary payer (MSP) procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Medicare secondary payer (MSP) procedures. 422.108 Section 422.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Benefits and...

  4. 42 CFR 422.108 - Medicare secondary payer (MSP) procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Medicare secondary payer (MSP) procedures. 422.108 Section 422.108 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Benefits and...

  5. 42 CFR 423.462 - Medicare secondary payer procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Medicare secondary payer procedures. 423.462 Section 423.462 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT...

  6. 42 CFR 423.462 - Medicare secondary payer procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Medicare secondary payer procedures. 423.462 Section 423.462 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT...

  7. Payers' Perspectives: Health Economics Outcomes in Managed Care

    PubMed Central

    Bankhead, Charles

    2015-01-01

    The following summaries represent a sample of the many studies presented at the 27th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP), April 7–10, 2015, in San Diego, CA. These summaries highlight some of the main trends in the current US healthcare, reflecting the impact of real-world, evidence-based issues of high interest for payers, employers, drug manufacturers, providers, patients, and other healthcare stakeholders. PMID:26085902

  8. US physician practices versus Canadians: spending nearly four times as much money interacting with payers.

    PubMed

    Morra, Dante; Nicholson, Sean; Levinson, Wendy; Gans, David N; Hammons, Terry; Casalino, Lawrence P

    2011-08-01

    Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada's single-payer agency--just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans--nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently. PMID:21813866

  9. Cost-Effectiveness of Global Endometrial Ablation vs. Hysterectomy for Treatment of Abnormal Uterine Bleeding: US Commercial and Medicaid Payer Perspectives

    PubMed Central

    Lenhart, Gregory M.; Bonafede, Machaon M.; Lukes, Andrea S.; Laughlin-Tommaso, Shannon K.

    2015-01-01

    Abstract Cost-effectiveness modeling studies of global endometrial ablation (GEA) for treatment of abnormal uterine bleeding (AUB) from a US perspective are lacking. The objective of this study was to model the cost-effectiveness of GEA vs. hysterectomy for treatment of AUB in the United States from both commercial and Medicaid payer perspectives. The study team developed a 1-, 3-, and 5-year semi-Markov decision-analytic model to simulate 2 hypothetical patient cohorts of women with AUB—1 treated with GEA and the other with hysterectomy. Clinical and economic data (including treatment patterns, health care resource utilization, direct costs, and productivity costs) came from analyses of commercial and Medicaid claims databases. Analysis results show that cost savings with simultaneous reduction in treatment complications and fewer days lost from work are achieved with GEA versus hysterectomy over almost all time horizons and under both the commercial payer and Medicaid perspectives. Cost-effectiveness metrics also favor GEA over hysterectomy from both the commercial payer and Medicaid payer perspectives—evidence strongly supporting the clinical-economic value about GEA versus hysterectomy. Results will interest clinicians, health care payers, and self-insured employers striving for cost-effective AUB treatments. (Population Health Management 2015;18:373–382) PMID:25714906

  10. Mandated Psychotherapy with the Impaired Physician

    PubMed Central

    2008-01-01

    Physicians and other prescribers of medication are in a unique position with regard to substance misuse. Each physician must abide by the licensing guidelines of the state medical board in their geographical location of practice. When a physician has legal charges regarding substance use, he or she must report to the medical board and undergo monitoring for several years. The recommendations of the board may include mandatory psychotherapy. The following composite cases are illustrative of the implications of one physician treating another physician under the auspices of a mandate. PMID:19727294

  11. Physician response to fee changes with multiple payers.

    PubMed

    McGuire, T G; Pauly, M V

    1991-01-01

    This paper develops a general model of physician behavior with demand inducement encompassing the two benchmark cases of profit maximization and target-income behavior. It is shown that when income effects are absent, physicians maximize profits, and when income effects are very strong, physicians seek a target income. The model is used to derive own and cross-price expressions for the response of physicians to fee changes in the realistic context of more than one payer under the alternative behavior assumptions of profit maximization and target income behavior. The implications for public and private fee policy, and empirical research on physician response to fees, are discussed. PMID:10117011

  12. State-Level Mandates for Financial Literacy Education, JA Finance Park, and the Impact on Eighth-Grade Students in Colorado

    ERIC Educational Resources Information Center

    Mitchell, Sherri L.

    2013-01-01

    In 2008, the Colorado General Assembly passed legislation requiring the adoption of personal financial literacy (PFL) education standards for kindergarten through 12th-grade students. Beginning in 2014, the state plans to conduct standardized testing to determine financial literacy of 3rd- through 12th-grade students. The state did not allocate…

  13. Biosimilars: How Can Payers Get Long-Term Savings?

    PubMed

    Mestre-Ferrandiz, Jorge; Towse, Adrian; Berdud, Mikel

    2016-06-01

    The term 'biosimilar' refers to an alternative similar version of an off-patent innovative originator biotechnology product (the 'reference product'). Several biosimilars have been approved in Europe, and a number of top-selling biological medicines have lost, or will lose, patent protection over the next 5 years. We look at the experience in Europe so far. The USA has finally implemented a regulatory route for biosimilar approval. We recommend that European and US governments and payers take a strategic approach to get value for money from the use of biosimilars by (1) supporting and incentivising generation of high-quality comprehensive outcomes data on the effectiveness and safety of biosimilars and originator products; and (2) ensuring that incentives are in place for budget holders to benefit from price competition. This may create greater willingness on the part of budget holders and clinicians to use biosimilar and originator products with comparable outcomes interchangeably, and may drive down prices. Other options, such as direct price cuts for originator products or substitution rules without outcomes data, are likely to discourage biosimilar entry. With such approaches, governments may achieve a one-off cut in originator prices but may put at risk the creation of a more competitive market that would, in time, produce much greater savings. It was the creation of competitive markets for chemical generic drugs-notably, in the USA, the UK and Germany-rather than price control, that enabled payers to achieve the high discounts now taken for granted. PMID:26792791

  14. 40 CFR 1500.3 - Mandate.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Mandate. 1500.3 Section 1500.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PURPOSE, POLICY, AND MANDATE § 1500.3 Mandate... significant impact (when such a finding will result in action affecting the environment), or takes action...

  15. 40 CFR 1500.3 - Mandate.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Mandate. 1500.3 Section 1500.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PURPOSE, POLICY, AND MANDATE § 1500.3 Mandate... significant impact (when such a finding will result in action affecting the environment), or takes action...

  16. 40 CFR 1500.3 - Mandate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Mandate. 1500.3 Section 1500.3 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY PURPOSE, POLICY, AND MANDATE § 1500.3 Mandate... significant impact (when such a finding will result in action affecting the environment), or takes action...

  17. How to Successfully Survive a Mandated Project

    ERIC Educational Resources Information Center

    Ellern, Jill

    2011-01-01

    With information technologies' pervasive use within all departments and by all staff, libraries and library staff get their fair share of mandated projects. Knowing how to successfully operate in this kind of environment is important to the overall success of the library as a whole. What is meant by mandated project? A mandated project is a…

  18. Sex education mandates: are they the answer?

    PubMed

    Muraskin, L D

    1986-01-01

    This article examines the question of mandating family life education in schools. Findings are presented of a recent study on the implementation of New Jersey's family life education requirement, (proposed by the State Board of Education and Education Department) which, in its original form in 1979, required that 31 specific topics be addressed by the end of high school; (e.g. human reproduction, child abuse and assault, and others). Intense pressure from conservative activist groups, education associations fearing a threat to local control of curricula, and important elements of the press, caused a change in the language of the draft regulation to be much less specific. In 5 school districts selected, the norm was conformity to the very broad mandates simply by verifying that certain topics were touched on in courses already offered in the curriculum. Teachers did not seem motivated to give out more than simple correct information on human reproduction, and family life education is commonly discussed in a limited way as part of health education. Beyond more emphasis being placed on the topic of child abuse in elementary schools, little structural change took place in curricula, and there was little actual training of staff. In a 6th district (chosen on the basis of prior knowledge about its program), specific teacher training and curriculum development were evident. It is proposed that information connected with reproduction be regared as something students have a right to know, and that family life education be designed with this goal in mind, and not with the idea of making a political staement, or with the strategy of politically dangerous mandates. PMID:3792530

  19. The Working Patient with Cancer: Implications for Payers and Employers

    PubMed Central

    Lawless, Grant D.

    2009-01-01

    Cancer is seen today more often as a manageable chronic disease, resulting in changing workplace characteristics of the patient with cancer. A growing number of employees continue to work while being treated for cancer or return to work shortly after their cancer treatment is completed. To respond to these changes and the potential impact on the working patient's attitude, employers need updated, factual information related to this patient population. This type of information will support future benefit considerations by employers on employee contributions and future employee health and productivity. In 2005, Amgen launched a 3-year initiative to better understand cancer as a chronic disease, as well as the impact on the working patient with cancer and on the employer. The data from this initiative described in this article provide insights into cancer as a chronic and manageable disease in the workforce, and the broader implications to payers and employers. PMID:25126288

  20. 78 FR 57800 - Medicare Program; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-20

    ... security feature known as multifactor authentication to the Web portal. Multifactor authentication uses a...; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal AGENCY: Centers for... Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and...

  1. 38 CFR 17.106 - VA collection rules; third-party payers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false VA collection rules; third-party payers. 17.106 Section 17.106 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Charges, Waivers, and Collections § 17.106 VA collection rules; third-party payers. (a)(1) General rule. VA has the right to...

  2. 38 CFR 17.106 - VA collection rules; third-party payers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false VA collection rules; third-party payers. 17.106 Section 17.106 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Charges, Waivers, and Collections § 17.106 VA collection rules; third-party payers. (a)(1) General rule. VA has the right to...

  3. Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix.

    PubMed

    Pines, Jesse M; Zocchi, Mark; Moghtaderi, Ali; Black, Bernard; Farmer, Steven A; Hufstetler, Greg; Klauer, Kevin; Pilgrim, Randy

    2016-08-01

    In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume. PMID:27503974

  4. Guidelines and Value-Based Decision Making: An Evolving Role for Payers.

    PubMed

    McCauley, Janet L

    2015-01-01

    Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. PMID:26509518

  5. Mandated Mental Health Insurance: A Complex Case of Pros and Cons. Human Resources Series.

    ERIC Educational Resources Information Center

    Paterson, Andrea

    1986-01-01

    The pros and cons of state laws mandating mental health insurance are discussed in this report. The history of a 1985 Supreme Court case which held that states could mandate mental health benefits introduces the report. In an overview of the issue, the long-standing argument between the insurance industry and the mental health establishment is…

  6. Are Teachers Prepared? Predictors of Teachers' Readiness to Serve as Mandated Reporters of Child Abuse

    ERIC Educational Resources Information Center

    Greytak, Emily A.

    2009-01-01

    The Child Abuse Prevention and Treatment Act (1974) requires that states receiving U.S. federal funds directed at child abuse implement mandated reporting laws. As a result, all states have adopted legislation requiring teachers and other professionals who deal with children to report suspicions of child abuse. The federal mandate for such…

  7. States Address Civics with Mandated Task Forces

    ERIC Educational Resources Information Center

    Delander, Brady

    2014-01-01

    By coincidence or not, Massachusetts, Illinois and Virginia created civic education task forces not long after national test results showed a dismal understanding of the subject matter across all grade levels. Results of the 2010 National Assessment of Educational Progress showed just 25 percent of all testtakers in grades 4, 8 and 12 demonstrated…

  8. Treatment of Depression in Voluntary Versus Mandated Physicians.

    PubMed

    Johnson, R Scott; Fowler, J Christopher; Sikes, Kristi A; Allen, Jon G; Oldham, John M

    2015-12-01

    Few if any publications discuss the effectiveness of voluntary versus mandated treatment for impaired physicians. This retrospective case-control study compared the recovery rates of physicians whose treatment was mandated or coerced by either licensure boards or employers (mandated physicians) with the rates for physicians admitted voluntarily (voluntary physicians) to the Menninger Clinic's Professionals in Crisis program from 2009 through 2012. Beck Depression Inventory (BDI)-II scores served as the primary outcome measure. At the time of admission, voluntary physicians were more depressed, but the improvement rates in the voluntary and mandated groups did not differ significantly. In addition, the two groups differed neither in rates of return to the healthy range of BDI-II scores, nor in whether BDI-II scores had decreased by at least two standard deviations by the time of discharge. These findings suggest that state physician health programs can continue to mandate physicians into treatment despite concerns that mandatory treatment may be less efficacious than voluntary treatment. PMID:26668225

  9. Gene therapy, fundamental rights, and the mandates of public health.

    PubMed

    Lynch, John

    2004-01-01

    Recent and near-future developments in the field of molecular biology will make possible the treatment of genetic disease on an unprecedented scale. The potential applications of these developments implicate important public policy considerations. Among the questions that may arise is the constitutionality of a state-mandated program of gene therapy for the purpose of eradicating certain genetic diseases. Though controversial, precedents of public health jurisprudence suggest that such a program could survive constitutional scrutiny. This article provides an overview of gene therapy in the context of fundamental rights and the mandates of public health. PMID:15255004

  10. The Mandate: To Identify Children with Handicapping Conditions.

    ERIC Educational Resources Information Center

    Mazzullo, Mariann C.

    Reviewed are 10 Child Find projects to locate possibly handicapped children as mandated by Public Law 94-142 with particular emphasis on Child Find activities in New York State. Noted are efforts of Colorado, and Idaho including public awareness campaigns, and screening programs. It is reported that more than 30 projects have been funded in New…

  11. Intergovernmental Mandates in Federal Legislation. Economic and Budget Issue Brief

    ERIC Educational Resources Information Center

    Lex, Leo

    2009-01-01

    Federal law sometimes requires state, local, or tribal governments to spend money to achieve certain goals. In some cases, a requirement is imposed as a condition for receiving federal aid; in others, requirements can be imposed through the exercise of the federal government's sovereign power. The Unfunded Mandates Reform Act of 1995 (UMRA)…

  12. External Mandates and Instructional Leadership: School Leaders as Mediating Agents

    ERIC Educational Resources Information Center

    Louis, Karen Seashore; Robinson, Viviane M.

    2012-01-01

    Purpose: The purpose of this paper is to examine how US school leaders make sense of external mandates, and the way in which their understanding of state and district accountability policies affects their work. It is posited that school leaders' responses to external accountability are likely to reflect a complex interaction between their…

  13. Using External Accountability Mandates to Create Internal Change

    ERIC Educational Resources Information Center

    Petrides, Lisa A.; McClelland, Sara I.; Nodine, Thad R.

    2004-01-01

    In light of a new state-mandated performance-based funding mechanism for community colleges in California, this article discusses how one district sought to implement new internal evaluation procedures to improve student outcomes in line with systemwide goals outlined in the performance-based funding. These efforts introduced an evaluative …

  14. Mandated Reporting Thresholds for Community Professionals

    ERIC Educational Resources Information Center

    Crowell, Kathryn; Levi, Benjamin H.

    2012-01-01

    This study examines how community-based mandated reporters understand and interpret "reasonable suspicion", the standard threshold for mandated reporting of suspected child abuse. Respondents were asked to identify the probability necessary for "suspicion of child abuse" to constitute "reasonable suspicion". Data were analyzed for internal…

  15. Implications of the Virginia human papillomavirus vaccine mandate for parental vaccine acceptance.

    PubMed

    Pitts, Margaret Jane; Adams Tufts, Kimberly

    2013-05-01

    In 2009, Virginia became the first state in the United States to enact a school vaccine mandate for the human papillomavirus (HPV), putting it at the forefront of the national HPV vaccine mandate controversy. It is critical to explore the public response and sensemaking where the mandate has already been enacted. Thus, we conducted 8 focus group discussions among 33 Virginia parents to explore how they conceptualized the virus and vaccine and their responses to the mandate. Findings suggest that many parents are skeptical of and reluctant to follow a state-mandated vaccine requirement, choosing instead to opt out of the vaccine until they decide the time is right for their daughter and/or until they feel confident in their knowledge about the virus, vaccine, and the impetus for the mandate. Study results can inform future legislation among states considering HPV-related mandates and aid in the development of health-promotion materials within the context of a state mandate. PMID:23275459

  16. Print News Coverage of School-Based Human Papillomavirus Vaccine Mandates

    ERIC Educational Resources Information Center

    Casciotti, Dana M.; Smith, Katherine C.; Andon, Lindsay; Vernick, Jon; Tsui, Amy; Klassen, Ann C.

    2014-01-01

    Background: In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding…

  17. Parent Involvement in the Special Education Eligibility Process: Implementation of Legal Mandates and Best Practices

    ERIC Educational Resources Information Center

    McEvoy, Cathleen K.

    2013-01-01

    School psychologists throughout New York State were surveyed regarding their schools' policies to include parents in the special education eligibility process related to legal mandates and best practices. Differences were found in the implementation of legal mandates compared to implementation of best practices. Location differences were…

  18. A Review of CBO's Activities in 2008 under the Unfunded Mandates Reform Act. A CBO Report

    ERIC Educational Resources Information Center

    Lex, Leo

    2009-01-01

    In this report, part of an annual series that began in 1997, the Congressional Budget Office (CBO) reviews its activities under the Unfunded Mandates Reform Act of 1995. The report covers public laws enacted and legislation considered by the Congress in 2008 that would impose federal mandates on state, local, or tribal governments or on the…

  19. Adolescent Abortion and Mandated Parental Involvement: The Impact of Back Alley Laws on Young Women.

    ERIC Educational Resources Information Center

    Flinn, Susan; And Others

    This document notes that many states have passed, or are considering, laws that would mandate parental consent for, or notification of, a young woman's decision to obtain an abortion. Constructed in a question-and-answer format, the document then examines a number of issues concerned with such mandated parental involvement. It examines who is…

  20. A Retrospective and an Analysis of Roles of Mandated Testing in Education Reform.

    ERIC Educational Resources Information Center

    Archbald, Douglas A.; Porter, Andrew C.

    The role and influence of mandated testing in educational reform are reviewed. Mandated testing refers to large-scale (districtwide or statewide) multiple-choice testing programs used for policy purposes of evaluation and accountability, which includes nationally normed standardized achievement tests and tests custom-developed to reflect state and…

  1. 77 FR 35917 - Medicare Program; Medicare Secondary Payer and “Future Medicals”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-15

    ... interest with respect to Medicare Secondary Payer (MSP) claims involving automobile and liability insurance...' compensation law or plan, automobile and liability insurance (including self-insurance), or no- fault...

  2. Single-payer health insurance systems: national myths and immovable mountains.

    PubMed Central

    Lightfoote, J. B.; Ragland, K. D.

    1996-01-01

    Leaders in both government and the health-care industry have strong and varied opinions regarding the present US health-care system, but concur that health-care financing and organization need restructuring. The single-payer system offers the best framework for improving health-care universality, delivery, quality, access, choice, and cost effectiveness. However, the single-payer alternative often is dismissed early in debates on health-care reform. Popular aversion to collective governmental funding of health-care costs and the economic interests of the management, insurance, information, and profit sectors of the health-care industry are the critical impediments to adoption of single-payer insurance systems. This article examines the psychosocial and economic obstacles that prevent development of an efficient and effective health-care system and preclude recognition of the single-payer system as the best answer to health-care reform. PMID:8648657

  3. Modified mandated choice for organ procurement.

    PubMed

    Chouhan, P; Draper, H

    2003-06-01

    Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing the procurement rate. In this paper, we meet the main objections to mandated choice (namely that it undermines autonomy and that mandated donation is preferable). We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation. PMID:12796435

  4. Great patient experiences can earn big payer bonuses.

    PubMed

    Luallin, Meryl D

    2014-01-01

    Although many healthcare providers have been railing against the stringent new requirements of the Affordable Care Act and the burdensome mandates from the Centers for Medicare & Medicaid Services, making simple improvements in patient satisfaction can require little to no expense and can result in increased dollars, as well as more satisfied patients. By following six simple steps, successful organizations have been able to transform their patients' experiences and raise satisfaction scores through a series of practical activities designed to assess the current environment, improve patient and employee/provider experience, and maintain the improvement gains. It doesn't always take money to make money. It's a matter of telling employees what the organization expects of them and holding them accountable. When the patient has a positive experience, everyone profits! PMID:25807613

  5. Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective.

    PubMed

    Silverman, Stuart; Agodoa, Irene; Kruse, Morgan; Parthan, Anju; Orwoll, Eric

    2015-01-01

    Purpose. To evaluate the cost-effectiveness of denosumab versus other osteoporotic treatments in older men with osteoporosis from a US payer perspective. Methods. A lifetime cohort Markov model previously developed for postmenopausal osteoporosis (PMO) was used. Men in the model were 78 years old, with a BMD T-score of -2.12 and a vertebral fracture prevalence of 23%. During each 6-month Markov cycle, patients could have experienced a hip, vertebral or nonhip, nonvertebral (NHNV) osteoporotic fracture, remained in a nonfracture state, remained in a postfracture state, or died. Background fracture risks, mortality rates, persistence rates, health utilities, and medical and drug costs were derived from published sources. Previous PMO studies were used for drug efficacy in reducing fracture risk. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, risedronate, ibandronate, teriparatide, and zoledronate. Results. Denosumab had an incremental cost-effectiveness ratio (ICER) of $16,888 compared to generic alendronate and dominated all other treatments. Results were most sensitive to changes in costs of denosumab and the relative risk of hip fracture. Conclusion. Despite a higher annual treatment cost compared to other medications, denosumab is cost-effective compared to other osteoporotic treatments in older osteoporotic US men. PMID:26783494

  6. Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective

    PubMed Central

    Silverman, Stuart; Agodoa, Irene; Kruse, Morgan; Parthan, Anju; Orwoll, Eric

    2015-01-01

    Purpose. To evaluate the cost-effectiveness of denosumab versus other osteoporotic treatments in older men with osteoporosis from a US payer perspective. Methods. A lifetime cohort Markov model previously developed for postmenopausal osteoporosis (PMO) was used. Men in the model were 78 years old, with a BMD T-score of −2.12 and a vertebral fracture prevalence of 23%. During each 6-month Markov cycle, patients could have experienced a hip, vertebral or nonhip, nonvertebral (NHNV) osteoporotic fracture, remained in a nonfracture state, remained in a postfracture state, or died. Background fracture risks, mortality rates, persistence rates, health utilities, and medical and drug costs were derived from published sources. Previous PMO studies were used for drug efficacy in reducing fracture risk. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, risedronate, ibandronate, teriparatide, and zoledronate. Results. Denosumab had an incremental cost-effectiveness ratio (ICER) of $16,888 compared to generic alendronate and dominated all other treatments. Results were most sensitive to changes in costs of denosumab and the relative risk of hip fracture. Conclusion. Despite a higher annual treatment cost compared to other medications, denosumab is cost-effective compared to other osteoporotic treatments in older osteoporotic US men. PMID:26783494

  7. Legislative Mandates and Financial Reporting.

    ERIC Educational Resources Information Center

    Bock, Almon C., II

    1983-01-01

    Asserts the importance of each school business official's responsibility to accurately report the school's financial situation to the state legislature. Uses Minnesota's 33 area vocational technical institutes to illustrate the application of statewide uniform financial accounting and reporting standards to Minnesota public school districts. (JBM)

  8. Patient-Reported Outcomes Are Changing the Landscape in Oncology Care: Challenges and Opportunities for Payers

    PubMed Central

    Zagadailov, Erin; Fine, Michael; Shields, Alan

    2013-01-01

    Background A patient-reported outcome (PRO) is a subjective report that comes from a patient without interpretation by a clinician. Because of the increasingly significant role of PROs in the development and evaluation of new medicines, the US Food and Drug Administration (FDA) issued a formal guidance to describe how PRO instruments will be reviewed and evaluated with respect to claims in approved medical product labeling. Meanwhile, PROs continue to appear in oncology clinical trials more frequently; however, it is unclear how payers and policymakers can use PRO data in the context of decision-making for cancer treatments. Objective The objective of this article is to discuss the challenges and opportunities of incorporating oncology-related PRO data into payer decision-making. Discussion Payer concerns with PRO instruments are often related to issues regarding measurement, relevance, quality, and interpretability of PROs. Payers may dismiss PROs that do not independently predict improved outcomes. The FDA guidance released in 2009 demonstrates, as evidenced by the case of ruxolitinib, how PRO questionnaires can be generated in a relevant, trustworthy, and meaningful way, which provides an opportunity for payers and policy decision makers to focus on how to use PRO data in their decision-making. This is particularly relevant in oncology, where a recent and sizable number of clinical trials include PRO measures. Conclusion As an increasing number of oncology medications enter the market with product labeling claims that contain PRO data, payers will need to better familiarize themselves with the opportunities associated with PRO questionnaires when making coverage decisions. PRO measures will continue to provide valuable information regarding the risk–benefit profile of novel agents. As such, PRO measures may provide evidence that should be considered in payers' decisions and discussions; however, the formal role of PROs and the pertinence of PROs in decision

  9. Primary Payer at DX: Issues with Collection and Assessment of Data Quality.

    PubMed

    Sherman, Recinda L; Williamson, Laura; Andrews, Patricia; Kahn, Amy

    2016-01-01

    An individual's access to health insurance influences the amount and type of health services a patient receives for prevention and treatment, and, ultimately, influences survival. The North American Association of Central Cancer Registries (NAACCR) Item #630, Primary Payer at DX, is a required field intended to document health insurance status for the purpose of supporting patterns-of-care studies and other research. However, challenges related to the uniformity of collection and availability of data needed to populate this field diminish the value of the Primary Payer at DX data. A NAACCR taskforce worked on issues surrounding the collection of Primary Payer at DX; including proposing a crosswalk between Primary Payer at DX and the new Public Health Payment Typology standard, often available in hospital discharge databases. However, there are issues with compatibility between coding systems, intent of data collection, timelines for coding insurance, and changes in insurance coverage (partly due to the Affordable Care Act) that continue to complicate the collection and use of Primary Payer at DX data. PMID:27556850

  10. State Test Programs Mushroom as NCLB Mandate Kicks in: Nearly Half of States Are Expanding Their Testing Programs to Additional Grades This School Year to Comply with the Federal No Child Left Behind Act

    ERIC Educational Resources Information Center

    Olson, Lynn

    2005-01-01

    Twenty-three states are expanding their testing programs to additional grades this school year to comply with the federal No Child Left Behind Act. In devising the new tests, most states have defied predictions and chosen to go beyond multiple-choice items, by including questions that ask students to construct their own responses. But many state…

  11. Ethanol mandate thrown out by appeals court

    SciTech Connect

    Begley, R.

    1995-05-10

    In a victory for the oil industry, a federal appeals court has overturned EPA`s mandate for ethanol use in reformulated gasoline (REG), saying the agency lacks authority to require 30% of the oxygenate market be reserved for ethanol. EPA says the ruling does not prevent ethanols use in RFG - {open_quotes}It only says that EPA cannot dictate the recipe.{close_quotes} Charles DiBona, president of the American Petroleum Institute (API), says {open_quotes}API and its member companies are not opposed to the use of ethanol as an oxygenate. We oppose this illegal mandate.{close_quotes} Urvan Sternfels, president of the National Petroleum Refiners Association, says, {open_quotes}Mandating market shares for any product is unsound economic policy.{close_quotes} The two trade groups led the legal battle against the ethanol requirement.

  12. Forensic evaluations and mandated reporting of child abuse.

    PubMed

    Kapoor, Reena; Zonana, Howard

    2010-01-01

    Statutes requiring physicians to report suspected cases of child abuse create a potential conflict for psychiatrists working in the forensic setting. What happens in the case in which a forensic psychiatrist, during the course of an evaluation requested by a defense attorney, learns about child abuse perpetrated by the evaluee? A complicated legal, ethics-related, and interpersonal dilemma emerges. Reporting the abuse may contribute directly to further legal harm to the evaluee and place a strain on the relationship with the attorney. However, not reporting the abuse potentially involves ignoring a legal mandate and risking further harm to a child. This article first reviews mandated reporting statutes across the states. Next, the arguments for and against reporting are outlined. Existing solutions to the problem are reviewed, and several alternative solutions are explored. Finally, an approach to negotiating the dilemma that can be used by forensic psychiatrists in practice is suggested. PMID:20305075

  13. The National Oncology Working Group (NOW) initiative: payer and provider collaborations in oncology benefits management.

    PubMed

    Soper, Aileen M; Reeder, C E; Brown, Loreen M; Stojanovska, Ana; Lennert, Barbara J

    2010-04-01

    Payers recognize the need to expand benefits management for oncology but struggle to find effective solutions amid the complexity of available therapies and skepticism from oncologists, who are facing their own set of economic pressures. An effort called the National Oncology Working Group (NOW) Initiative is trying to change the sometimes adversarial relationship between payers and oncologists through a collaborative model. The group, which is supported by pharmaceutical manufacturer sanofi-aventis, is developing patient-centered strategies for successful and sustainable oncology benefits management. The focus includes finding consensus between payers and providers and devising solutions for oncology management such as decreasing variability of cancer care and improving end-of-life care for patients with terminal illness. NOW is designing tools that will be tested in small-scale regional demonstration projects, which NOW participants anticipate will set an example for successful oncology benefits management that can be replicated and expanded. PMID:20370311

  14. Proposal for Canadian-style single-payer health care receives cool reception in US.

    PubMed Central

    Korcok, M

    1995-01-01

    Is health care reform dead in the US? It may be, if the reception given President Clinton's reform plan and a proposal for a single-payer program in California is any indication. There has been a dramatic move to the right south of the border, where people have lined up to oppose "big government" and additional government programs. Still, American proponents of a single-payer program similar to Canada's insist that the battle for reform is not yet over. Images p407-a PMID:7828107

  15. Improving state Medicaid policies with comparative effectiveness research: a key role for academic health centers.

    PubMed

    Zerzan, Judy T; Gibson, Mark; Libby, Anne M

    2011-06-01

    After the Patient Protection and Affordable Care Act is fully implemented, Medicaid will be the largest single health care payer in the United States. Each U.S. state controls the size and scope of the medicine benefit beyond the federally mandated minimum; however, regulations that require balanced budgets and prohibit deficit spending limit each state's control. In a recessionary environment with reduced revenue, state Medicaid programs operate under a fixed or shrinking budget. Thus, the state Medicaid experience of providing high-quality care under explicit financial limits can inform Medicare and private payers of measures that control per-capita costs without adversely affecting health outcomes. The academic medicine community must play an expanded role in filling evidence gaps in order to continuously improve health policy making among U.S. states. The Drug Effectiveness Review Project and the Medicaid Evidence-based Decisions Project are two multistate Medicaid collaborations that leverage academic health center researchers' comparative effectiveness research (CER) projects to answer policy-relevant research questions. The authors of this article highlight how academic medicine can support states' health policies through CER and how CER-driven benefit-design choices can help states meet their cost and quality needs. PMID:21512359

  16. Effectiveness of an Electronic Booster Session Delivered to Mandated Students.

    PubMed

    Linowski, Sally A; DiFulvio, Gloria T; Fedorchak, Diane; Puleo, Elaine

    2016-01-01

    College student drinking continues to be a problem in the United States. Students who have violated campus alcohol policy are at particularly high risk for dangerous drinking. While Brief Alcohol Screening and Intervention for College Students (BASICS) has been found to be an effective strategy in reducing high-risk drinking and associated consequences, questions remain about ways to further reduce risk or sustain changes associated with a face-to face intervention. The purpose of this study was to assess the effectiveness of a computer-delivered personalized feedback (electronic booster) delivered to policy violators who completed a mandated BASICS program. At 3-month post-intervention, 346 participants (60.4% male and 39.6% female) were randomized to one of two conditions: assessment only (n = 171) or electronic booster feedback (n = 175). Follow-up assessments were given to all participants at 3, 6, and 12-month post-initial intervention. Both groups showed reductions in drinking after the in-person BASICS intervention, but no additional reductions were seen with the addition of an electronic booster session. Findings suggest that although brief motivational interventions delivered in person to mandated students have been shown to be effective with mandated students, there is no additional benefit from an electronic booster session delivered 3-month post-intervention for this population. PMID:26857563

  17. 78 FR 75304 - Medicare Program; Medicare Secondary Payer and Certain Civil Money Penalties

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... either the Office of Inspector General (OIG) or CMS (See the October 20, 1994 (58 FR 52967) notice titled...; Medicare Secondary Payer and Certain Civil Money Penalties AGENCY: Centers for Medicare & Medicaid Services... rulemaking (ANPRM) solicits public comment on specific practices for which civil money penalties (CMPs)...

  18. Quality of care in single-payer and multipayer health systems.

    PubMed

    Feldman, Roger

    2009-08-01

    In this article, I argue that unregulated markets will not find the right level of health care quality but that at the same time it is not clear that single-payer systems will do any better. My perspective combines the economic theory of public goods and the institutional payment arrangements found in many single-payer systems. If, as I believe, health care quality is a public good, it will be underprovided in a multipayer system. Single-payer systems often allocate a fixed budget to health care professionals or administrators and give them considerable discretion in determining quality as well as quantity of service. With care being free or almost free at the point of use, patients will demand more services than administrators want to provide. The result is rationing by waiting -- which should be present in all such systems and is present in most of them. I develop several implications of the theory and an agenda for future research on quality of care in single-payer and multipayer health systems. PMID:19633227

  19. 42 CFR 417.528 - Payment when Medicare is not primary payer.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Payment when Medicare is not primary payer. 417.528 Section 417.528 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  20. 42 CFR 417.528 - Payment when Medicare is not primary payer.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment when Medicare is not primary payer. 417.528 Section 417.528 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  1. 42 CFR 417.528 - Payment when Medicare is not primary payer.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment when Medicare is not primary payer. 417.528 Section 417.528 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS,...

  2. 42 CFR 417.528 - Payment when Medicare is not primary payer.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Payment when Medicare is not primary payer. 417.528 Section 417.528 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  3. 42 CFR 417.528 - Payment when Medicare is not primary payer.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment when Medicare is not primary payer. 417.528 Section 417.528 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS,...

  4. 10 CFR 490.305 - Acquisitions satisfying the mandate.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ....305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The... light duty vehicle (regardless of the model year of manufacture), capable of operating on...

  5. 10 CFR 490.305 - Acquisitions satisfying the mandate.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ....305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The... light duty vehicle (regardless of the model year of manufacture), capable of operating on...

  6. 10 CFR 490.305 - Acquisitions satisfying the mandate.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ....305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The... light duty vehicle (regardless of the model year of manufacture), capable of operating on...

  7. 10 CFR 490.305 - Acquisitions satisfying the mandate.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ....305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The... light duty vehicle (regardless of the model year of manufacture), capable of operating on...

  8. 10 CFR 490.305 - Acquisitions satisfying the mandate.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The... light duty vehicle (regardless of the model year of manufacture), capable of operating on...

  9. The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment.

    PubMed

    Chatterji, Pinka; Decker, Sandra L; Markowitz, Sara

    2015-01-01

    As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period. PMID:25893237

  10. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ....302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a..., when the mandated acquisition percentage of alternative fuel vehicles is applied to the number of...

  11. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a..., when the mandated acquisition percentage of alternative fuel vehicles is applied to the number of...

  12. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ....302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a..., when the mandated acquisition percentage of alternative fuel vehicles is applied to the number of...

  13. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ....302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a..., when the mandated acquisition percentage of alternative fuel vehicles is applied to the number of...

  14. 10 CFR 490.302 - Vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ....302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a..., when the mandated acquisition percentage of alternative fuel vehicles is applied to the number of...

  15. A single-payer system in Jackson Hole clothing.

    PubMed

    Enthoven, A C; Singer, S J

    1994-01-01

    President Clinton's Health Security Act relies on government regulation, not market forces, to control costs. The act creates an entitlement to comprehensive benefits and places the federal budget at risk for total health care costs in order to achieve universal coverage; it creates a system of new state purchasing monopsonies; and it attempts to control costs with price controls on health plan premiums, set and administered by a National Health Board that would be part of the executive branch, not insulated from political considerations. We believe there is a better way. PMID:8188160

  16. Legislating clinical practice: counselor responses to an evidence-based practice mandate.

    PubMed

    Rieckmann, Traci; Bergmann, Luke; Rasplica, Caitlin

    2011-09-01

    The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon's Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians' sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates. PMID:22185037

  17. Legislating Clinical Practice: Counselor Responses to an Evidence-Based Practice Mandate

    PubMed Central

    Rieckmann, Traci; Bergmann, Luke; Rasplica, Caitlin

    2013-01-01

    The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon’s Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians’ sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates. PMID:22185037

  18. Legal Briefing: Mandated Reporters and Compulsory Reporting Duties.

    PubMed

    Pope, Thaddeus Mason

    2016-01-01

    This issue's "Legal Briefing" column, one product of a Greenwall Foundation grant, reviews recent developments concerning compulsory reporting duties. Most licensed clinicians in the United States are "mandated reporters." When these clinicians discover certain threats to the safety of patients or the public, they are legally required to report that information to specified government officials. Over the past year, several states have legislatively expanded the scope of these reporting duties. In other states, new court cases illustrate the vigorous enforcement of already existing duties. I have organized all these legal developments into the following eight categories: 1. Overview of Mandatory Reporting Duties 2. Controversy over the Benefits of Mandatory Reporting 3. New and Expanded Duties to Report 4. Criminal Penalties for Failing to Report 5. Civil Liability for Failing to Report 6. Disciplinary Penalties for Failing to Report 7. Legal Immunity for Good-Faith Reporting 8. Protection against Employers' Retaliation. PMID:27045312

  19. Single-payer, defined contribution or portable HRAs: will market-based models prevail?

    PubMed

    Gupta, Amit K

    2003-01-01

    Rising healthcare costs have created a crisis situation in employee health benefits. For the first time in a decade, the call for a single-payer healthcare system has been renewed. Although the single-payer system might help expand access to care and reduce administrative costs, the potential costs and bureaucracy make its implementation unrealistic. Consumer-centric health benefit models such as defined contribution and portable HRAs are the first attempts by the private sector to involve consumers in the healthcare decision process. Portable HRAs, which treat health benefits as portable assets to be managed and saved over a lifetime, have the potential to reduce employer costs while improving the quality and continuity of care, with equal access to care for all. PMID:12968441

  20. Distinctions in Disclosure: Mandated Informed Consent in Abortion and ART.

    PubMed

    Daar, Judith

    2015-01-01

    Enactment of mandated pre-procedure disclosures in abortion and assisted reproductive technology (ART) services has swelled in recent years. Calls to equally regard these mandates as neutral tools in furtherance of patient protection fail to acknowledge key substantive and structural differences in these reproduction-affecting mandates. While ART mandates permit physicians to use their medical judgment to protect presumptively vulnerable egg donors and gestational carriers, abortion disclosures impart scientifically suspect messaging aimed at dissuading women from pursuing pregnancy termination. These and other distinctions counsel in favor of regarding and analyzing abortion and ART mandated disclosures as separate and distinguishable informed consent tools. PMID:26242946

  1. UnitedHealthcare experience illustrates how payers can enable patient engagement.

    PubMed

    Sandy, Lewis G; Tuckson, Reed V; Stevens, Simon L

    2013-08-01

    Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers' unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients' choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an "earn-back" program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth's experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries. PMID:23918489

  2. Estimating Nitrogen Load Resulting from Biofuel Mandates.

    PubMed

    Alshawaf, Mohammad; Douglas, Ellen; Ricciardi, Karen

    2016-01-01

    The Energy Policy Act of 2005 and the Energy Independence and Security Act (EISA) of 2007 were enacted to reduce the U.S. dependency on foreign oil by increasing the use of biofuels. The increased demand for biofuels from corn and soybeans could result in an increase of nitrogen flux if not managed properly. The objectives of this study are to estimate nitrogen flux from energy crop production and to identify the catchment areas with high nitrogen flux. The results show that biofuel production can result in an increase of nitrogen flux to the northern Gulf of Mexico from 270 to 1742 thousand metric tons. Using all cellulosic (hay) ethanol or biodiesel to meet the 2022 mandate is expected to reduce nitrogen flux; however, it requires approximately 25% more land when compared to other scenarios. Producing ethanol from switchgrass rather than hay results in three-times more nitrogen flux, but requires 43% less land. Using corn ethanol for 2022 mandates is expected to have double the nitrogen flux when compared to the EISA-specified 2022 scenario; however, it will require less land area. Shifting the U.S. energy supply from foreign oil to the Midwest cannot occur without economic and environmental impacts, which could potentially lead to more eutrophication and hypoxia. PMID:27171101

  3. Estimating Nitrogen Load Resulting from Biofuel Mandates

    PubMed Central

    Alshawaf, Mohammad; Douglas, Ellen; Ricciardi, Karen

    2016-01-01

    The Energy Policy Act of 2005 and the Energy Independence and Security Act (EISA) of 2007 were enacted to reduce the U.S. dependency on foreign oil by increasing the use of biofuels. The increased demand for biofuels from corn and soybeans could result in an increase of nitrogen flux if not managed properly. The objectives of this study are to estimate nitrogen flux from energy crop production and to identify the catchment areas with high nitrogen flux. The results show that biofuel production can result in an increase of nitrogen flux to the northern Gulf of Mexico from 270 to 1742 thousand metric tons. Using all cellulosic (hay) ethanol or biodiesel to meet the 2022 mandate is expected to reduce nitrogen flux; however, it requires approximately 25% more land when compared to other scenarios. Producing ethanol from switchgrass rather than hay results in three-times more nitrogen flux, but requires 43% less land. Using corn ethanol for 2022 mandates is expected to have double the nitrogen flux when compared to the EISA-specified 2022 scenario; however, it will require less land area. Shifting the U.S. energy supply from foreign oil to the Midwest cannot occur without economic and environmental impacts, which could potentially lead to more eutrophication and hypoxia. PMID:27171101

  4. The Mandate Mystery: How Mandates Impact School Districts Physically and Financially

    ERIC Educational Resources Information Center

    Dorris, Denae

    2010-01-01

    Renovation and construction of Texas public schools is occurring at a rapid pace and at high prices. Business continues to blossom in the area of school construction. Several factors influence the need to renovate or construct schools, but the impact curriculum mandates have on school construction is seldom explored. This study investigated the…

  5. Mandated data archiving greatly improves access to research data.

    PubMed

    Vines, Timothy H; Andrew, Rose L; Bock, Dan G; Franklin, Michelle T; Gilbert, Kimberly J; Kane, Nolan C; Moore, Jean-Sébastien; Moyers, Brook T; Renaut, Sébastien; Rennison, Diana J; Veen, Thor; Yeaman, Sam

    2013-04-01

    The data underlying scientific papers should be accessible to researchers both now and in the future, but how best can we ensure that these data are available? Here we examine the effectiveness of four approaches to data archiving: no stated archiving policy, recommending (but not requiring) archiving, and two versions of mandating data deposition at acceptance. We control for differences between data types by trying to obtain data from papers that use a single, widespread population genetic analysis, structure. At one extreme, we found that mandated data archiving policies that require the inclusion of a data availability statement in the manuscript improve the odds of finding the data online almost 1000-fold compared to having no policy. However, archiving rates at journals with less stringent policies were only very slightly higher than those with no policy at all. We also assessed the effectiveness of asking for data directly from authors and obtained over half of the requested datasets, albeit with ∼8 d delay and some disagreement with authors. Given the long-term benefits of data accessibility to the academic community, we believe that journal-based mandatory data archiving policies and mandatory data availability statements should be more widely adopted. PMID:23288929

  6. Eight reasons payer interoperability and data sharing are essential in ACOs. Interoperability standards could be a prerequisite to measuring care.

    PubMed

    Mookencherry, Shefali

    2012-01-01

    It makes strategic and business sense for payers and providers to collaborate on how to take substantial cost out of the healthcare delivery system. Acting independently, neither medical groups, hospitals nor health plans have the optimal mix of resources and incentives to significantly reduce costs. Payers have core assets such as marketing, claims data, claims processing, reimbursement systems and capital. It would be cost prohibitive for all but the largest providers to develop these capabilities in order to compete directly with insurers. Likewise, medical groups and hospitals are positioned to foster financial interdependence among providers and coordinate the continuum of patient illnesses and care settings. Payers and providers should commit to reasonable clinical and cost goals, and share resources to minimize expenses and financial risks. It is in the interest of payers to work closely with providers on risk-management strategies because insurers need synergy with ACOs to remain cost competitive. It is in the interest of ACOs to work collaboratively with payers early on to develop reasonable and effective performance benchmarks. Hence, it is essential to have payer interoperability and data sharing integrated in an ACO model. PMID:22352172

  7. A constructive Indian country response to the evidence-based program mandate.

    PubMed

    Walker, R Dale; Bigelow, Douglas A

    2011-01-01

    Over the last 20 years governmental mandates for preferentially funding evidence-based "model" practices and programs has become doctrine in some legislative bodies, federal agencies, and state agencies. It was assumed that what works in small sample, controlled settings would work in all community settings, substantially improving safety, effectiveness, and value-for-money. The evidence-based "model" programs mandate has imposed immutable "core components," fidelity testing, alien programming and program developers, loss of familiar programs, and resource capacity requirements upon tribes, while infringing upon their tribal sovereignty and consultation rights. Tribal response in one state (Oregon) went through three phases: shock and rejection; proposing an alternative approach using criteria of cultural appropriateness, aspiring to evaluability; and adopting logic modeling. The state heard and accepted the argument that the tribal way of knowing is different and valid. Currently, a state-authorized tribal logic model and a review panel process are used to approve tribal best practices for state funding. This constructive response to the evidence-based program mandate elevates tribal practices in the funding and regulatory world, facilitates continuing quality improvement and evaluation, while ensuring that practices and programs remain based on local community context and culture. This article provides details of a model that could well serve tribes facing evidence-based model program mandates throughout the country. PMID:22400457

  8. The economics of regulatory mandates on the HMO market.

    PubMed

    Encinosa, W

    2001-01-01

    Recently proposed HMO regulations have involved mandates of two forms: (1) minimum quality standards, and (2) mandated increases in access to speciality care. I show that piecemeal regulation, which uses only one of either mandate (1) or (2), may decrease welfare for all HMO consumers. Under full regulation using both (1) and (2), if the minimum standard is set too low, say, due to political bargaining, a floor-to-ceiling effect occurs. This involves HMOs setting quality at the minimum standard, even when their quality would be above the standard in an unregulated market. Finally, I show how premiums may either increase or decrease under a mandate. PMID:11148873

  9. HAC-POA Policy Effects on Hospitals, Other Payers, and Patients

    PubMed Central

    Sorensen, Asta; Jarrett, Nikki; Tant, Elizabeth; Bernard, Shulamit; McCall, Nancy

    2014-01-01

    Background Prior to the implementation of the Hospital-Acquired Condition-Present on Admission (HAC-POA) payment policy, concerns regarding its potential impact were raised by a number of organizations and individuals. The purpose of this study was to explore direct and indirect effects of the HAC-POA payment policy on hospitals, patients, and other payers during the policy’s first 3 years of implementation. Methods The study included semi-structured telephone interviews with representatives of national organizations, hospitals, patient advocacy organizations, and other payers. Interview notes were coded using QSR NVivo qualitative analysis software using inductive and deductive qualitative analysis techniques. We conducted interviews with 106 individuals representing 56 organizations. Hospital staff included physicians, nurses, patient safety officers, coders, and finance, senior management, and information management staff. Individuals from other organizations represented leadership positions. Results Key changes to hospitals included: cultural shifts involving attention, commitment, and support from hospital leadership for patient safety; hiring new staff to assure the accuracy of clinical documentation and POA oversight structures; increased time burden for physicians, nurses, and coders; need to upgrade or purchase new software; and need to collaborate with hospital departments or staff that did not interface directly in the past. The policy was adopted by a majority of other payers, although the list of conditions and payment penalties varies. The HAC-POA policy is invisible to patients; therefore, the presence or lack of unintended consequences to patients cannot be fully assessed at this time. Understanding of policy effects to all stakeholders is important for maximizing its successful implementation and desired impact. PMID:25343058

  10. Managing biotechnology in a network-model health plan: a U.S. private payer perspective.

    PubMed

    Watkins, John B; Choudhury, Sanchita Roy; Wong, Ed; Sullivan, Sean D

    2006-01-01

    Emerging biotechnology poses challenges to payers, including access, coverage, reimbursement, patient selection, and affordability. Premera Blue Cross, a private regional health plan, developed an integrated cross-functional approach to managing biologics, built around a robust formulary process that is fast, flexible, fair, and transparent to stakeholders. Results are monitored by cost and use reporting from merged pharmacy and medical claims. Utilization management and case management strategies will integrate with specialty pharmacy programs to improve outcomes and cost-effectiveness. Creative approaches to provider reimbursement can align providers' incentives with those of the plan. Redesign of member benefits can also encourage appropriate use of biotechnology. PMID:16966732

  11. Managed competition. An analysis of consumer concerns. Single-Payer Coalition for Health Security.

    PubMed

    1993-01-01

    This analysis of managed competition was written by the Single-Payer Coalition for Health Security, a broad-based coalition of groups representing for the most part consumers of health care, including American Public Health Association; Church Women United; Citizen Action; Consumers Union; National Association of Social Workers; National Council of Senior Citizens; Neighbor to Neighbor; NETWORK: A National Catholic Social Justice Lobby; Oil, Chemical & Atomic Workers International Union; Older Women's League; Physicians for a National Health Program; Public Citizen; United Cerebral Palsy Associations; and United Church of Christ. What follows is a substantial excerpt from their working paper, issued in January 1993. PMID:10126171

  12. Mandated Coverage of Preventive Care and Reduction in Disparities: Evidence From Colorectal Cancer Screening

    PubMed Central

    Kapinos, Kandice A.

    2015-01-01

    Objectives. We identified correlates of racial/ethnic disparities in colorectal cancer screening and changes in disparities under state-mandated insurance coverage. Methods. Using Behavioral Risk Factor Surveillance System data, we estimated a Fairlie decomposition in the insured population aged 50 to 64 years and a regression-adjusted difference-in-difference-in-difference model of changes in screening attributable to mandates. Results. Under mandated coverage, blood stool test (BST) rates increased among Black, Asian, and Native American men, but rates among Whites also increased, so disparities did not change. Endoscopic screening rates increased by 10 percentage points for Hispanic men and 3 percentage points for non-Hispanic men. BST rates fell among Hispanic relative to non-Hispanic men. We found no changes for women. However, endoscopic screening rates improved among lower income individuals across all races and ethnicities. Conclusions. Mandates were associated with a reduction in endoscopic screening disparities only for Hispanic men but may indirectly reduce racial/ethnic disparities by increasing rates among lower income individuals. Findings imply that systematic differences in insurance coverage, or health plan fragmentation, likely existed without mandates. These findings underscore the need to research disparities within insured populations. PMID:25905835

  13. Who are the donors in organ donation? The family's perspective in mandated choice.

    PubMed

    Klassen, A C; Klassen, D K

    1996-07-01

    Evidence that families requested to permit organ donation refuse half the time has led to proposals for mandated choice. Under mandated choice, a person's donation wishes would be collected and retrieved at death, and requests to families would be avoided. There are both ethical and logistic problems with mandated choice. The view of the family should be respected in organ requests, even when patient wishes are known. Public sentiment against overriding family wishes could cause low rates of pro-donation registration. Caregivers have usually refused to take organs when families oppose donation. Logistic issues with mandated choice include the cost and complexity of maintaining a national database on donors and the enforcement of registration. No such database of adults currently exists, even for tax purposes. Two states that have mandated choice programs through departments of motor vehicles report relatively low number of pro-donation registrants compared with nondonors or undecided persons. Public education and voluntary donor identification hold more potential to increase donation. PMID:8644991

  14. Utilizing Online Education in Florida to Meet Mandated Class Size Limitations

    ERIC Educational Resources Information Center

    Mattox, Kari Ann

    2012-01-01

    With the passage of a state constitutional amendment in 2002, Florida school districts faced the challenge of meeting class size mandates in core subjects, such as mathematics, English, and science by the 2010-2011 school year, or face financial penalties. Underpinning the amendment's goals was the argument that smaller classes are more effective…

  15. 10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Alternative fueled vehicle acquisition mandate schedule. 490.201 Section 490.201 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory State Fleet Program § 490.201 Alternative fueled vehicle acquisition...

  16. 10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Alternative fueled vehicle acquisition mandate schedule. 490.201 Section 490.201 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory State Fleet Program § 490.201 Alternative fueled vehicle acquisition...

  17. 10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Alternative fueled vehicle acquisition mandate schedule. 490.201 Section 490.201 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory State Fleet Program § 490.201 Alternative fueled vehicle acquisition...

  18. 10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Alternative fueled vehicle acquisition mandate schedule. 490.201 Section 490.201 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory State Fleet Program § 490.201 Alternative fueled vehicle acquisition...

  19. 10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Alternative fueled vehicle acquisition mandate schedule. 490.201 Section 490.201 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory State Fleet Program § 490.201 Alternative fueled vehicle acquisition...

  20. A Qualitative Case Study of Teachers' Perceptions of Professional Learning through Mandated Collaboration

    ERIC Educational Resources Information Center

    Wilt, Barbara C.

    2016-01-01

    Teacher collaboration is a school improvement priority that has the potential to positively impact student learning by building the capacity of teachers. In some states, teacher collaboration is mandated by legislation. The literature indicates that policy-driven collaboration in a top-down approach results in unintentional consequences and…

  1. California Secondary School Physical Education Teachers' Attitudes toward the Mandated Use of the Fitnessgram

    ERIC Educational Resources Information Center

    Ferguson, Robert H.; Keating, Xiaofen Deng; Guan, Jianmin; Chen, Li; Bridges, Dwan M.

    2007-01-01

    This study aimed to determine how California secondary physical education teachers perceive the state mandated youth fitness testing for the 5th, 7th, and 9th grades using Fitnessgram. The participants were secondary school physical education teachers (N = 323). A previously validated attitudinal instrument (Keating & Silverman, 2004a) was used to…

  2. Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

    PubMed Central

    McHugh, Matthew D; Brooks Carthon, Margo; Sloane, Douglas M; Wu, Evan; Kelly, Lesly; Aiken, Linda H

    2012-01-01

    Context California is the first and only state to implement a patient-to-nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care—safety-net hospitals—remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safety-net hospitals following the mandate, while the skill mix remained essentially unchanged for safety-net hospitals. The difference between the two groups of hospitals was not significant. Conclusions California's mandate improved staffing for all hospitals, including safety-net hospitals

  3. Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

    PubMed

    Weiss, Robert

    2016-12-01

    Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that

  4. What can be gained from increased early-stage interaction between regulators, payers and the pharmaceutical industry?

    PubMed

    Wonder, Michael

    2014-08-01

    New medicines are the lifeblood of the global innovative pharmaceutical industry. Developments in genomics, proteomics, immunology and cellular biology are set to promise a plethora of novel targets for the industry to create and develop innovative new medicines. For a new medicine to fulfill its therapeutic and commercial potential (i.e., successful market access), it is now simply no longer a matter of its creator/developer generating evidence to demonstrate its quality, safety and efficacy to a standard expected by those responsible for making a decision on its marketing authorization ('regulators'). Nowadays, the successful market access of a new medicine not only requires market authorisation with an acceptable (i.e., competitive) label, but also that those responsible for making a decision on whether or not it is worth paying for (i.e., independent appraisal committees who advise payers as well as payers themselves; the term 'payers' has been used as an umbrella term to capture both groups) have the necessary clinical and other evidence they need to make a timely and favorable reimbursement determination at the proposed price. Typically this means that the clinical evidence for a development compound's that is available at the end of its Phase III clinical trial program to demonstrate its therapeutic value is both strong and relevant to the decisions payers are called upon to make. This poses strategic and operational challenges for the global pharmaceutical industry because the clinical evidence needs of the payers differ both qualitatively and quantitatively from those of the regulators. PMID:24820934

  5. WHY DO AMERICANS STILL NEED SINGLE-PAYER HEALTH CARE AFTER MAJOR HEALTH REFORM?

    PubMed

    Chaufan, Claudia

    2015-01-01

    Many observers have considered the Affordable Care Act (ACA) the most significant health care overhaul since Medicare, in the tradition of Great Society programs. And yet, in opinion polls, Americans across the political spectrum repeatedly express their strong support for Medicare, alongside their disapproval of the ACA. This feature of American public opinion is often seen as a contradiction and often explained as "incoherence," a mere feature of Americans' "muddled mind." In this article I argue that what explains this seeming contradiction is not any peculiarity of Americans' psychology but rather the grip of the corporate class on the political process and on key social institutions (e.g., mass media, judiciary), no less extraordinary today than in the past. I also argue that ordinary Americans, like millions of their counterparts in the world, would eagerly support a single-payer national health program that speaks to their interests rather than to those of the 1 percent. I will describe the ACA, compare it to Medicare, explain the concept of single payer, and conclude that the task is not to persuade presumably recalcitrant Americans to support the ACA but rather to organize a mass movement to struggle for what is right and join the rest of the world in the road toward health justice. PMID:26460454

  6. Policy Implications of First-Dollar Coverage: A Qualitative Examination from the Payer Perspective

    PubMed Central

    Shortridge, Emily F.; Moore, Jonathan R.; Whitmore, Heidi; O'Grady, Michael J.; Shen, Angela K.

    2011-01-01

    Objectives Immunization against potentially life-threatening illnesses for children and adults has proved to be one of the great public health successes of the 20th century and is extremely cost-effective. The Patient Protection and Affordable Care Act includes a number of provisions to increase coverage and access to immunizations for the consumer, including a provision for health plans to cover all Advisory Committee on Immunization Practices-recommended vaccines at first dollar, or without cost sharing. In this study, we examined payers' perspectives on first-dollar coverage of vaccines and strategies to improve vaccination rates. Methods This was a qualitative study, using a literature review and semistructured expert interviews with payers. Results Four key themes emerged, including (1) the cost implications of the first-dollar change; (2) the importance of examining barriers to children, adolescents, and adults separately to focus interventions more strategically; (3) the importance of provider knowledge and education in increasing immunization; and (4) the effect of first-dollar coverage on those who decline vaccination for personal reasons. Conclusions We determined that, while reducing financial barriers through first-dollar coverage is an important first step to increasing immunization rates, there are structural and cultural barriers that also will require collaborative, strategic work among all vaccine stakeholders. PMID:21553668

  7. Mandated Disciplinary Counseling: Working Effectively with Challenging Clients

    ERIC Educational Resources Information Center

    Kiracofe, Norman M.; Buller, Allison E.

    2009-01-01

    Mandated disciplinary counseling has been a long-established practice for many college and university counseling centers. Although the practice is well established, practitioners continue to raise questions about its appropriateness and effectiveness. Student dynamics and other issues influencing the efficacy of mandated counseling are explored.…

  8. A Chronological History of Federal Fleet Actions and Mandates

    SciTech Connect

    2011-04-22

    This chronological history of Federal fleet actions and mandates provides a year-by-year timeline of the acts, amendments, executive orders, and other regulations that affect Federal fleets. The fleet actions and mandates included in the timeline span from 1988 to 2009.

  9. Discipline and Play with/in a Mandated Literacy Curriculum

    ERIC Educational Resources Information Center

    Kontovourki, Stavroula; Siegel, Marjorie

    2009-01-01

    In this article, the authors explore a young child's lived experience of discipline and play with/in a mandated balanced literacy curriculum. Mandating balanced literacy presents an interesting case of disciplining literacy because it is rooted in the progressive tradition of meaning-and-process pedagogies. As such, it avoids the most obvious…

  10. Chronological History of Federal Fleet Actions and Mandates (Brochure)

    SciTech Connect

    Not Available

    2011-04-01

    This chronological history of Federal fleet actions and mandates provides a year-by-year timeline of the acts, amendments, executive orders, and other regulations that affect Federal fleets. The fleet actions and mandates included in the timeline span from 1988 to 2009.

  11. Teaching to and beyond the Test: The Influence of Mandated Accountability Testing in One Social Studies Teacher's Classroom

    ERIC Educational Resources Information Center

    Neumann, Jacob

    2013-01-01

    Background/Context: The nature of the impact of state-mandated accountability testing on teachers' classroom practices remains contested. While many researchers argue that teachers change their teaching in response to mandated testing, others contend that the nature and degree of the impact of testing on teaching remains unclear. The research…

  12. Medicare Program; Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal. Final rule.

    PubMed

    2016-05-17

    This final rule specifies the process and timeline for expanding CMS' existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act). The final rule specifies a timeline for developing a multifactor authentication solution to securely permit authorized users other than the beneficiary to access CMS' MSP conditional payment amounts and claims detail information via the MSP Web portal. It also requires that we add functionality to the existing MSP Web portal that permits users to: Notify us that the specified case is approaching settlement; obtain time and date stamped final conditional payment summary statements and amounts before reaching settlement; and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation. PMID:27192735

  13. The UK relative to other single payer-dominated healthcare markets for regenerative medicine therapies.

    PubMed

    Rose, James B; Williams, David J

    2012-05-01

    The UK has for many years been considered by businesses, including those based in the UK, as at best a second market for the launch of innovative medical technology products. Historically, this has been attributed to the slow pace of adoption in its National Health Service (NHS). The NHS is perceived to be subject to cost containment, high levels of fragmentation and a lack of strategic incentives to resolve its key failings as a market. Canada and Sweden offer examples of different operating models of healthcare delivery in a single payer-dominated market, and as a consequence, have evolved with different market characteristics. Together, these economies represent an important subsection of healthcare markets that are predominantly publically funded. This report examines the barriers to market entry for regenerative medicine products in these economies and attempts to evaluate the upcoming UK healthcare reforms in terms of impact on the regenerative medicine industry sector. PMID:22594333

  14. Phone-Delivered Brief Motivational Interventions for Mandated College Students Delivered During the Summer Months

    PubMed Central

    Borsari, Brian; Short, Erica Eaton; Mastroleo, Nadine R.; Hustad, John T.P.; Tevyaw, Tracy O’Leary; Barnett, Nancy P.; Kahler, Christopher W.; Monti, Peter M.

    2014-01-01

    Objective Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions. Method Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention. Results Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems. Conclusion Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months. PMID:24512944

  15. The payers perspective on MIH-CP programs. How to make a case for funding your project.

    PubMed

    Zavadsky, Matt

    2015-07-01

    Here are some key points to consider when engaging in conversations with potential payers for EMS-based MIH-CP programs. The realignment of fiscal incentives within the healthcare system has created an environment that encourages providers and payers to work together to right-size utilization. Providers and payers are often unaware of the true value EMS agencies can bring to their patients through proactive and innovative patient navigation services. You need to tell them--or, better yet, show them. You may need to do a small demonstration project with a handful of patients to prove you can make a difference. In order to understand the new environment, you need to become well-versed in healthcare metrics, specifically as they relate to the partners to whom you'll be proposing. Be sure you know things like readmission rates and penalties, value-based purchasing penalties, HCAHPS scores, MSPB and other motivating factors you. can use to help build the business case for your audience. For many in EMS, crafting partnerships for. payment of services not related to ambulance transport is a new and scary thing. Hopefully the examples provided here from payers paying for MIH services have demonstrated that their perspective is not much different from ours. We are all trying to do the right things for our patients, improve their experience of care and reduce the cost of the healthcare system. PMID:26281458

  16. Minnesota State Colleges and Universities '99 Session: Mandates and Curiosities.

    ERIC Educational Resources Information Center

    Minnesota State Colleges and Universities System, St. Paul.

    This publication highlights and explains relevant Minnesota legislative developments affecting higher education. For each bill, there is a summary provided in plain English, followed by copies of related portions of the legislation. The bills presented are: (1) Higher Education Omnibus Funding Bill (H.F. 2380); (2) Bonding Omnibus Bill (H.F.…

  17. School Administrator Assessments of Bullying and State-Mandated Testing

    ERIC Educational Resources Information Center

    Lacey, Anna; Cornell, Dewey G.

    2016-01-01

    Bully victimization is associated with lower academic performance for individual students; however, less is known about the impact of bullying on the academic performance of the school as a whole. This study examined how retrospective administrator reports of both the prevalence of teasing and bullying (PTB) and the use of evidence-based bullying…

  18. Rationale for Systematic Vocabulary Development: Antidote for State Mandates

    ERIC Educational Resources Information Center

    Manzo, Anthony V.; Manzo, Ula C.; Thomas, Matthew M.

    2006-01-01

    The authors assert that vocabulary development is one of the most important things teachers can promote for students--cognitively, culturally, socially, and in preparation for standardized tests. A broad-based review of the literature reveals solid reasons for using systematic vocabulary instruction, which is especially helpful with youngsters…

  19. Evaluating Inservice Training Programs: District Response to State Mandate.

    ERIC Educational Resources Information Center

    Barbery, Madeline

    This paper describes the development of standardized evaluation procedures for Pasco County's inservice teacher education. Since 1983, legislation requires teacher education centers in Florida to report attainment data based on measurable objectives. Using a classification system adapted from the "Rand Change Agent Study," directors and…

  20. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care

    PubMed Central

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-01-01

    Abstract Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205) PMID:26348492

  1. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care.

    PubMed

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Mohlman, Mary Kate; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-06-01

    Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by -$482 relative to the comparison (95% CI, -$573 to -$391; P < .001). The lower costs were driven primarily by inpatient (-$218; P < .001) and outpatient hospital expenditures (-$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196-205). PMID:26348492

  2. Muddle by Mandate: A Fictionalized Account.

    ERIC Educational Resources Information Center

    Tyson-Bernstein, Harriet

    1988-01-01

    Presents a fictionalized account illustrating the process by which willful states, misguided experts, cunning marketeers, and overworked teachers and administrators produce textbooks that are ill-written, confusing, misleading, and boring. (BJV)

  3. Mandated Community Involvement: A Question of Equity

    ERIC Educational Resources Information Center

    Schwarz, Kaylan C.

    2011-01-01

    Based on the assumption that all young people and their communities would benefit from students' active participation in community endeavours, some Canadian provinces and US states have included community involvement activities graduation requirement. Debates continue over whether students should be "forced" to volunteer. Ontario's 40-hour…

  4. Socioeconomic Effects of Chronic Obstructive Pulmonary Disease from the Public Payer's Perspective in Poland.

    PubMed

    Wziątek-Nowak, Weronika; Gierczyński, Jakub; Dąbrowiecki, Piotr; Gałązka-Sobotka, Małgorzata; Fal, Andrzej M; Gryglewicz, Jerzy; Badyda, Artur J

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is currently the third most common cause of death worldwide and the total number of people affected reaches over 200 million. It is estimated that approximately 50 % of persons having COPD are not aware of it. In the EU, it is estimated that the total annual costs of COPD exceed €140 billion, and the expected increase in the number of cases and deaths due to COPD would further enhance economic and social costs of the disease. In this article we present the results of cost analysis of health care benefits associated with the treatment of COPD and with the disease-related incapacity for work. The analysis is based on the data of the National Health Fund and the Social Insurance Institutions, public payers of health benefits in Poland. The annual 2012 expenditures incurred for COPD treatment was €40 million, and the benefits associated with incapacity for work reached more than €55 million. The extent of these expenditures indicates that it is necessary to optimize the functioning system, including the allocation of resources for prevention, social awareness, and detection of COPD at early stages when treatment costs are relatively low. PMID:26801147

  5. Health reform and the constitutionality of the individual mandate.

    PubMed

    Lee, Jeffrey J; Kelly, Deena; McHugh, Matthew D

    2011-11-01

    The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty-the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the "activities" Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating "inactivity," that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform. PMID:22454219

  6. Adverse Selection and an Individual Mandate: When Theory Meets Practice*

    PubMed Central

    Hackmann, Martin B.; Kolstad, Jonathan T.; Kowalski, Amanda E.

    2014-01-01

    We develop a model of selection that incorporates a key element of recent health reforms: an individual mandate. Using data from Massachusetts, we estimate the parameters of the model. In the individual market for health insurance, we find that premiums and average costs decreased significantly in response to the individual mandate. We find an annual welfare gain of 4.1% per person or $51.1 million annually in Massachusetts as a result of the reduction in adverse selection. We also find smaller post-reform markups. PMID:25914412

  7. Payer Perspectives on PCSK9 Inhibitors: A Conversation with Stephen Gorshow, MD, and James T. Kenney, RPh, MBA.

    PubMed

    Mehr, Stanton R

    2016-02-01

    The new proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can have significant budget effects, depending on the breadth of the US Food and Drug Administration (FDA)'s approved labeling. American Health & Drug Benefits asked Stephen Gorshow, MD, Regional Medical Director, UnitedHealthcare, and James T. Kenney, RPh, MBA, Manager, Specialty and Pharmacy Contracts, Harvard Pilgrim Health Care, to participate in a teleconference to better understand how payers are approaching the management of these agents. PMID:27066194

  8. Payer Perspectives on PCSK9 Inhibitors: A Conversation with Stephen Gorshow, MD, and James T. Kenney, RPh, MBA

    PubMed Central

    Mehr, Stanton R.

    2016-01-01

    The new proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can have significant budget effects, depending on the breadth of the US Food and Drug Administration (FDA)'s approved labeling. American Health & Drug Benefits asked Stephen Gorshow, MD, Regional Medical Director, UnitedHealthcare, and James T. Kenney, RPh, MBA, Manager, Specialty and Pharmacy Contracts, Harvard Pilgrim Health Care, to participate in a teleconference to better understand how payers are approaching the management of these agents. PMID:27066194

  9. 42 CFR 137.60 - May a statutorily mandated grant be added to a funding agreement?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false May a statutorily mandated grant be added to a... Statutorily Mandated Grants § 137.60 May a statutorily mandated grant be added to a funding agreement? Yes, in accordance with section 505(b)(2) of the Act , a statutorily mandated grant may be added to the...

  10. 42 CFR 137.60 - May a statutorily mandated grant be added to a funding agreement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false May a statutorily mandated grant be added to a... Statutorily Mandated Grants § 137.60 May a statutorily mandated grant be added to a funding agreement? Yes, in accordance with section 505(b)(2) of the Act , a statutorily mandated grant may be added to the...

  11. 42 CFR 137.60 - May a statutorily mandated grant be added to a funding agreement?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false May a statutorily mandated grant be added to a... Statutorily Mandated Grants § 137.60 May a statutorily mandated grant be added to a funding agreement? Yes, in accordance with section 505(b)(2) of the Act , a statutorily mandated grant may be added to the...

  12. 42 CFR 137.60 - May a statutorily mandated grant be added to a funding agreement?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false May a statutorily mandated grant be added to a... Statutorily Mandated Grants § 137.60 May a statutorily mandated grant be added to a funding agreement? Yes, in accordance with section 505(b)(2) of the Act , a statutorily mandated grant may be added to the...

  13. 42 CFR 137.60 - May a statutorily mandated grant be added to a funding agreement?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false May a statutorily mandated grant be added to a... Statutorily Mandated Grants § 137.60 May a statutorily mandated grant be added to a funding agreement? Yes, in accordance with section 505(b)(2) of the Act , a statutorily mandated grant may be added to the...

  14. Providers, Payers, The Community, And Patients Are All Obliged To Get Patient Activation And Engagement Ethically Right

    PubMed Central

    Danis, Marion; Solomon, Mildred

    2016-01-01

    Active and engaged patients seek the understanding, knowledge, and skills to promote their own health. Efforts to promote such patient activation and engagement are ethically justified because they are consonant with the well-established principle of respect for persons and, as the evidence shows, because they are likely to produce better outcomes for patients. Yet patient activation and engagement can also go ethically awry if, for example, nonadherent patients are abandoned or are unduly disadvantaged by punitive policies and practices, or if the conditions for successful activation and engagement are missing. In this article we discuss the ethical issues and responsibilities that pertain to patients, clinicians, health care organizations, delivery systems, insurers, payers, and communities. For example, physicians or payers could hold patients blameworthy for not following recommendations, but we suggest that a better approach would be for providers and payers to empower patients to effectively share responsibility for defining goals and achieving them. An ethical approach to patient activation and engagement should place obligations not only on patients but also on clinicians, health care organizations and delivery systems, insurers, and communities. PMID:23381534

  15. Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies?

    PubMed

    Edlin, Richard; Hall, Peter; Wallner, Klemens; McCabe, Christopher

    2014-06-01

    The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice. PMID:24969005

  16. Targeting Scarce Resources under the Older Americans Act. Hearing before the Subcommittee on Aging of the Committee on Labor and Human Resources. United States Senate, Ninety-Eighth Congress, First Session on Examination of the Targeting of Services Needed to Maintain Economic and Social Independence of Older People as Mandated in Title III of the Older Americans Act.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    This document presents prepared statements and witness testimony from the Congressional hearing on the Older Americans Act. An opening statement by Senator Charles Grassley, subcommittee chairman, contains a brief overview of the Older Americans Act. An extensive statement on the proposed targeting of services mandated under Title III of the Older…

  17. Relational Contexts and Aesthetics: Achieving Positive Connections with Mandated Clients

    ERIC Educational Resources Information Center

    McKaig, Ann McCullough

    2003-01-01

    This article describes a model for group art therapy using an art-based and relational-aesthetic approach. The group was developed to address the complicated issues presented when working with survivors of abuse who are court-mandated to attend counseling. The concept of "gender entrapment" (Richie, 1996) is offered to explain the survivors'…

  18. Music Educators' Expertise and Mandate: Who Decides, Based on What?

    ERIC Educational Resources Information Center

    Angelo, Elin

    2016-01-01

    Who should define music educators' expertise and mandate, and on what basis? Is this for example individual music educators, diverse collectives, employment institutions or political frameworks? How can one discuss professional quality and codes of ethic in this field, where these questions inseparably adhere to personal qualities and quality of a…

  19. A Practical Response to a Legislative Phonics Mandate.

    ERIC Educational Resources Information Center

    Fox, Barbara; Wright, Marypat

    2000-01-01

    In response to a legislative mandate to teach phonics, a rural North Carolina school district devised a plan where at-risk children received small-group instruction in phonics, reading, writing, and spelling in addition to regular reading instruction. A local university trained teacher assistants to implement the plan. Reading, writing, and…

  20. 17 CFR 232.101 - Mandated electronic submissions and exceptions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Federal Register citations affecting § 232.101 see the List of CFR Sections Affected, which appears in the... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing...

  1. 17 CFR 232.101 - Mandated electronic submissions and exceptions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... affecting § 232.101 see the List of CFR Sections Affected, which appears in the Finding Aids section of the... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing...

  2. 17 CFR 232.101 - Mandated electronic submissions and exceptions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...)). Editorial Note: For Federal Register citations affecting § 232.101 see the List of CFR Sections Affected... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing...

  3. 17 CFR 232.101 - Mandated electronic submissions and exceptions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ....S.C. 78l(h)). Editorial Note: For Federal Register citations affecting § 232.101 see the List of CFR... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing...

  4. Keeping Children Safe: Afterschool Staff and Mandated Child Maltreatment Reporting

    ERIC Educational Resources Information Center

    Gandarilla, Maria; O'Donnell, Julie

    2014-01-01

    With 8.4 million children in the U.S. spending an average of eight hours a week in afterschool programs, afterschool providers are an important part of the network of caring adults who can help to keep children safe. In addition, afterschool staff are "mandated reporters." Whether or not the laws specifically mention afterschool staff,…

  5. Implementing Mandated Change: The School as Change Contractor.

    ERIC Educational Resources Information Center

    van der Vegt, Rein; Knip, Hans

    This paper analyzes a research project that maps implementation efforts of comprehensive and mandated change at the primary school level in The Netherlands. In examining this large-scale national reform program, the report deals with schools whose innovation efforts acquired funding from the central education department in return for their local…

  6. Legal and Judicial Problems in Mandating Equal Time for Creationism.

    ERIC Educational Resources Information Center

    Skoog, Gerald

    This paper, presented at the annual meeting of the National Association of Biology Teachers, is focused on legal and judicial problems in mandating equal time for creationism. Past events provide evidence that legislation, policies, and local resolutions that require science textbooks and curricula to include the Genesis account of creation are…

  7. Resisting Reading Mandates: How To Triumph with the Truth.

    ERIC Educational Resources Information Center

    Garan, Elaine M.

    Teachers today are in a stranglehold as a glut of mandates and standards restrict their ability to make decisions in their own classrooms. In many schools, scripted, regimented commercial programs further erode their power to view their students as individuals with unique talents and needs. Even the words they use "to teach" are no longer their…

  8. What Motivates Public Support for Legally Mandated Mental Health Treatment?

    ERIC Educational Resources Information Center

    Watson, Amy C.; Corrigan, Patrick W.; Angell, Beth

    2005-01-01

    The use of legal coercion to compel individuals to participate in mental health treatment is expanding despite a lack of empirical support for many of its forms. Policies supporting mandated treatment are made by legislators and judges, often based on perceptions of public concern. Using data from the MacArthur Mental Health Module contained in…

  9. The HHS Mandate and Religious Liberty: A Primer

    ERIC Educational Resources Information Center

    Keim, Adele Auxier

    2013-01-01

    "We are in a war," Health and Human Services Secretary Kathleen Sebelius declared to cheers at a 2011 National Abortion and Reproductive Rights Action League (NARAL) Pro-Choice America fund-raiser. Secretary Sebelius was referring in part to the uproar caused by the "HHS Mandate," her agency's rule that employer-provided…

  10. Mandated Competency-Based Teacher Certification and the Public Interest.

    ERIC Educational Resources Information Center

    Spaulding, Robert L.

    Responding to the current lack of an empirical basis for competency-based teacher certification, Georgia has mandated studies leading to the establishment of empirical criteria. In the Carroll County Competency-Based Teacher Certification Project, the instructional behaviors of some 60 certified teachers and the classroom behaviors of the…