Sample records for care act includes

  1. 45 CFR 156.280 - Segregation of funds for abortion services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

  2. 45 CFR 156.280 - Segregation of funds for abortion services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS... its essential health benefits, as described in section 1302(b) of the Affordable Care Act, for any... may discriminate against any individual health care provider or health care facility because of its...

  3. The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

    PubMed

    Miller, Edward Alan

    2012-01-01

    The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.

  4. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

    PubMed

    Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

    2016-03-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

  5. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  6. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  7. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  8. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  9. 29 CFR 825.114 - Inpatient care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  10. The widening U.S. health care crisis three years after the passage of 'Obamacare'.

    PubMed

    Rao, Birju; Hellander, Ida

    2014-01-01

    This report presents information on the state of the U.S. health system in 2012 and early 2013, specifically the period prior to the implementation of the individual mandate and full rollout of the Affordable Care Act's online health exchanges. The authors include data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, the rising costs of the U.S. health system, and the role of corporate money in health care, with special reference to the pharmaceutical industry. They also provide updates on Medicare health maintenance organizations, Medicaid, and a prelude to the complete implementation of the Affordable Care Act. In addition, the authors include some results from public opinion polls on health systems and international system comparisons. The article concludes with an assessment of the rapid consolidation in the delivery of health care being driven by the Affordable Care Act.

  11. 48 CFR 352.237-72 - Crime Control Act-requirement for background checks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. “Child care services” include, but are not limited to, social services, health and mental health care, child (day) care, education (whether...

  12. 48 CFR 352.237-72 - Crime Control Act-requirement for background checks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. “Child care services” include, but are not limited to, social services, health and mental health care, child (day) care, education (whether...

  13. 48 CFR 352.237-72 - Crime Control Act-requirement for background checks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. “Child care services” include, but are not limited to, social services, health and mental health care, child (day) care, education (whether...

  14. 48 CFR 352.237-72 - Crime Control Act-requirement for background checks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. “Child care services” include, but are not limited to, social services, health and mental health care, child (day) care, education (whether...

  15. 48 CFR 352.237-72 - Crime Control Act-requirement for background checks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of 1990 (Act), requires that all individuals involved with the provision of child care services to children under the age of 18 undergo a criminal background check. “Child care services” include, but are not limited to, social services, health and mental health care, child (day) care, education (whether...

  16. Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

    PubMed

    Ellimoottil, Chandy; Miller, David C

    2014-02-01

    The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

  17. 45 CFR 156.155 - Enrollment in catastrophic plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 156.155 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO...(d) of the Affordable Care Act. (3) Provides coverage of the essential health benefits under section...

  18. 45 CFR 156.155 - Enrollment in catastrophic plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 156.155 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO...(d) of the Affordable Care Act. (3) Provides coverage of the essential health benefits under section...

  19. Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

    PubMed Central

    Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

    2016-01-01

    In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

  20. Racial and Ethnic Health Disparities and the Affordable Care Act: a Status Update

    PubMed Central

    Sealy-Jefferson, Shawnita; Vickers, Jasmine; Elam, Angela; Wilson, M. Roy

    2015-01-01

    Persistent racial and ethnic health disparities exist in the USA, despite decades of research and public health initiatives. Several factors contribute to health disparities, including (but not limited to) implicit provider bias, access to health care, social determinants, and biological factors. Disparities in health by race/ethnicity are unacceptable and correctable. The Patient Protection and Affordable Care Act is a comprehensive legislation that is focused on improving health care access, quality, and cost control. This health care reform includes specific provisions which focus on preventive care, the standardized collection of data on race, ethnicity, primary language and disability status, and health information technology. Although some provisions of the Patient Protection and Affordable Care Act have not been implemented, such as funding for the U.S. Public Health Sciences track, which would have addressed the shortage of medical professionals in the USA who are trained to use patient-centered, interdisciplinary, and care coordination approaches, this legislation is still poised to make great strides toward eliminating health disparities. The purpose of this manuscript is to highlight the unprecedented opportunities that exist for the Patient Protection and Affordable Care Act to reduce racial and ethnic disparities in health in the USA. PMID:26668787

  1. 45 CFR 156.235 - Essential community providers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....235 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

  2. 45 CFR 156.235 - Essential community providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....235 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

  3. 45 CFR 156.235 - Essential community providers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....235 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... result of violating Federal law: (1) Health care providers defined in section 340B(a)(4) of the PHS Act...

  4. Fostering Health: The Affordable Care Act, Medicaid, and Youth Transitioning from Foster Care. Policy Brief

    ERIC Educational Resources Information Center

    Wilson-Simmons, Renée; Dworsky, Amy; Tongue, Denzel; Hulbutta, Marikate

    2016-01-01

    The Affordable Care Act includes language that requires states to provide Medicaid coverage to youth who were in foster care in their state before aging out of the child welfare system. However, most states have interpreted the law differently for youth who move to their state after aging out, determining that automatic Medicaid coverage is an…

  5. Balancing Demand and Supply for Veterans' Health Care: A Summary of Three RAND Assessments Conducted Under the Veterans Choice Act.

    PubMed

    Farmer, Carrie M; Hosek, Susan D; Adamson, David M

    2016-06-20

    In response to concerns that the Department of Veterans Affairs (VA) has faced about veterans' access to care and the quality of care delivered, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 ("Veterans Choice Act") in August 2014. The law was passed to help address access issues by expanding the criteria through which veterans can seek care from civilian providers. In addition, the law called for a series of independent assessments of the VA health care system across a broad array of topics related to the delivery of health care services to veterans in VA-owned and -operated facilities, as well as those under contract to VA. RAND conducted three of these assessments: Veteran demographics and health care needs (A), VA health care capabilities (B), and VA authorities and mechanisms for purchasing care (C). This article summarizes the findings of our assessments and includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.

  6. Diabetes and the Affordable Care Act

    PubMed Central

    Schade, David S.

    2014-01-01

    Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

  7. Models of community care for severe mental illness: a review of research on case management.

    PubMed

    Mueser, K T; Bond, G R; Drake, R E; Resnick, S G

    1998-01-01

    We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

  8. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    PubMed

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

  9. 45 CFR 156.110 - EHB-benchmark plan standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....110 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... newborn care. (5) Mental health and substance use disorder services, including behavioral health treatment...

  10. 45 CFR 156.110 - EHB-benchmark plan standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....110 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES... newborn care. (5) Mental health and substance use disorder services, including behavioral health treatment...

  11. Critical Care Implications of the Affordable Care Act

    PubMed Central

    Dogra, Anjali P.; Dorman, Todd

    2015-01-01

    Objectives To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA. Data Sources and Synthesis Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO). As all of the ACA's provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms. Conclusion The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era. PMID:26565630

  12. 78 FR 20581 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-05

    ... Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance..., training and certification, and meaningful access standards applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non...

  13. 77 FR 70583 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... renewability protections, by prohibiting the use of factors such as health status, medical history, gender, and... comply with the provisions of the final rule, including administrative and marketing costs.... SUMMARY: This proposed rule would implement the Affordable Care Act's policies related to fair health...

  14. Advance care treatment plan (ACT-Plan) for African American family caregivers: a pilot study.

    PubMed

    Bonner, Gloria J; Wang, Edward; Wilkie, Diana J; Ferrans, Carol E; Dancy, Barbara; Watkins, Yashika

    2014-01-01

    Research is limited on end-of-life treatment decisions made by African American family caregivers. In a pilot study, we examined the feasibility of implementing an advance care treatment plan (ACT-Plan), a group-based education intervention, with African American dementia caregivers. Theoretically based, the ACT-Plan included strategies to enhance knowledge, self-efficacy, and behavioral skills to make end-of-life treatment plans in advance. Cardiopulmonary resuscitation, mechanical ventilation, and tube feeding were end-of-life treatments discussed in the ACT-Plan. In a four-week pre/posttest two-group design at urban adult day care centers, 68 caregivers were assigned to the ACT-Plan or attention-control health promotion conditions. Findings strongly suggest that the ACT-Plan intervention is feasible and appropriate for African American caregivers. Self-efficacy and knowledge about dementia, cardiopulmonary resuscitation, mechanical ventilation, and tube feeding increased for ACT-Plan participants but not for the attention-control. More ACT-Plan than attention-control participants developed advance care plans for demented relatives. Findings warrant a randomized efficacy trial.

  15. Medicaid Program; Disproportionate Share Hospital Payments--Treatment of Third Party Payers in Calculating Uncompensated Care Costs. Final rule.

    PubMed

    2017-04-03

    This final rule addresses the hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments under section 1923(g)(1)(A) of the Social Security Act (Act), and the application of such limitation in the annual DSH audits required under section 1923(j) of the Act, by clarifying that the hospital-specific DSH limit is based only on uncompensated care costs. Specifically, this rule makes explicit in the text of the regulation, an existing interpretation that uncompensated care costs include only those costs for Medicaid eligible individuals that remain after accounting for payments made to hospitals by or on behalf of Medicaid eligible individuals, including Medicare and other third party payments that compensate the hospitals for care furnished to such individuals. As a result, the hospital-specific limit calculation will reflect only the costs for Medicaid eligible individuals for which the hospital has not received payment from any source.

  16. 77 FR 27281 - Proposed Collection; Comment Request for Form 990 and Schedules

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ... 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning... Internal Revenue Code (except black lung benefit trust or private foundation), and schedules. DATES... Care Act (Affordable Care Act), Public Law 111-148, 124 Stat. 119 (March 23, 2010), included new...

  17. Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff

    ERIC Educational Resources Information Center

    Mueller, Keith J.; Coburn, Andrew F.; MacKinney, Clinton; McBride, Timothy D.; Slifkin, Rebecca T.; Wakefield, Mary K.

    2005-01-01

    Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to…

  18. The Patient Protection and Affordable Care Act: implications for pediatric pharmacy practice.

    PubMed

    Vallejos, Ximena; Benavides, Sandra

    2013-01-01

    The impact of the Patient Protection and Affordable Care Act on the pediatric health care landscape includes expanded health insurance coverage and health care delivery improvements by increasing implementation of patient-centered medical homes and accountable care organizations. These offer opportunities for pharmacists to assume responsibility for the medication-related needs of pediatric patients through pharmacotherapy selection, medication therapy management performance, and medication reconciliation at each transition of care. Medically complex children with at least 2 chronic disease states may be the target population. Studies demonstrating the positive outcomes and cost-effectiveness of pharmacists in pediatric ambulatory care settings are needed.

  19. The Patient Protection and Affordable Care Act - The Role of the School Nurse: Position Statement.

    PubMed

    2015-07-01

    It is the position of the National Association of School Nurses that the registered professional school nurse (hereinafter referred to as the school nurse) serves a vital role in the delivery of health care to our nation’s students within the health care system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the health care system through three primary goals: expanding access, improving quality, and reducing cost (U.S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save health care dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other health care providers to improve overall health outcomes, including insurance reimbursement for services provided to students.

  20. 20 CFR 702.401 - Medical care defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Medical care defined. 702.401 Section 702.401... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.401 Medical care defined. (a) Medical care shall include medical, surgical, and other attendance...

  1. 76 FR 2288 - TRICARE; Changes Included in the National Defense Authorization Act for Fiscal Year 2010...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-13

    ... facility referred care to the private sector; and authorized remote dental care in the private sector... remote care will be administered by TRICARE's Active Duty Dental Program (ADDP). TDP eligibility will... viewing on the Internet at http://regulations.gov as they are received without change, including any...

  2. Patient Protection and Affordable Care Act; annual eligibility redeterminations for exchange participation and insurance affordability programs; health insurance issuer standards under the Affordable Care Act, including standards related to exchanges. Final rule.

    PubMed

    2014-09-05

    This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience.

  3. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Supervision of medical care. 702.407 Section... Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district... the Act. Such supervision shall include: (a) The requirement that periodic reports on the medical care...

  4. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Supervision of medical care. 702.407 Section... Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district... the Act. Such supervision shall include: (a) The requirement that periodic reports on the medical care...

  5. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Supervision of medical care. 702.407 Section... Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district... the Act. Such supervision shall include: (a) The requirement that periodic reports on the medical care...

  6. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Supervision of medical care. 702.407 Section... Care and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district... the Act. Such supervision shall include: (a) The requirement that periodic reports on the medical care...

  7. Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

    PubMed Central

    Ghitza, Udi E.; Tai, Betty

    2014-01-01

    Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care. PMID:24583486

  8. Evolution of US Health Care Reform.

    PubMed

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2017-03-01

    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  9. Opportunities in the Affordable Care Act to Advance Long-Term Services and Supports: The Role of Rehabilitation Counseling

    ERIC Educational Resources Information Center

    Caldwell, Joe; Alston, Reginald J.

    2012-01-01

    The Affordable Care Act includes many new provisions for long-term services and supports (LTSS). Among these are several new options, improvements, and incentives within Medicaid to balance service systems and expand access to home and community-based services. This article discusses some of the major provisions, implementations, and implications…

  10. 78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-15

    ...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

  11. The Patient Protection and Affordable Care Act: opportunities for prevention and public health.

    PubMed

    Shaw, Frederic E; Asomugha, Chisara N; Conway, Patrick H; Rein, Andrew S

    2014-07-05

    The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. United States Chiropractic Practice Acts and Institute of Medicine defined primary care practice

    PubMed Central

    Duenas, Richard

    2002-01-01

    Abstract Objective This review was conducted to analyze the law for the practice of chiropractic throughout the United States, including the District of Columbia, Puerto Rico and the U.S. Virgin Islands, to determine the legal ability of the Doctor of Chiropractic in each jurisdiction to provide primary care service as described by the 1996 Institute of Medicine Definition of Primary Care. Method The practice acts for each State, the District of Columbia, Puerto Rico and the U.S. Virgin Islands were reviewed for language that would permit the chiropractic doctor to meet the 9 criteria of primary care practice described by the Institute of Medicine. Forty-four practice acts were cross referenced with the results of a scope of practice survey of State Boards of Chiropractic in 1999. Results The review of the practice acts and the survey on chiropractic scope of practice revealed a varied degree of chiropractic scope of practice with 23 of 53 of the jurisdictions limiting the ability of the chiropractic doctor to fully provide IOM defined primary care. Conclusion The varied practice act definitions for chiropractic practice throughout the United States the District of Columbia, Puerto Rico and the U.S. Virgin Islands reveal an inability of the chiropractic profession to respond to a call for a standard nationally-based primary-care policy that could be readily achieved by all chiropractic practitioners throughout the Union. This void of primary-care qualification in many State and Commonwealth practice acts will need to be addressed by the leaders of the profession if government entities and national third party organizations are to utilize chiropractic health care services to the standard of chiropractic education and clinical experience. The need for a broad range chiropractic scope of practice model practice act is suggested. PMID:19674578

  13. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 3 2012-07-01 2012-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only: (1...

  14. 29 CFR 825.125 - Definition of health care provider.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only: (1...

  15. 77 FR 33745 - Agency Forms Undergoing Paperwork Reduction Act Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-07

    ... collect statistics on health resources * * * [and] utilization of health care, including extended care..., physical functioning, and cognitive functioning of users (RCC residents and ADSC participants) aggregated...

  16. Anticipating the Impact of the Patient Protection and Affordable Care Act for Patients with Urological Cancer

    PubMed Central

    Ellimoottil, Chandy; Miller, David C.

    2014-01-01

    The Affordable Care Act seeks to overhaul the US healthcare system by providing insurance for more Americans, improving the quality of healthcare delivery, and reducing healthcare expenditures. While the law’s intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the ACA, including the proposed insurance expansion, payment and delivery system reforms (e.g. bundled payments and Accountable Care Organizations) and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may impact patients with urological cancers. PMID:24588021

  17. Post-acute care and vertical integration after the Patient Protection and Affordable Care Act.

    PubMed

    Shay, Patrick D; Mick, Stephen S

    2013-01-01

    The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

  18. Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

    PubMed

    2013-10-30

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

  19. 20 CFR 702.407 - Supervision of medical care.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Supervision of medical care. 702.407 Section... and Supervision § 702.407 Supervision of medical care. The Director, OWCP, through the district... the Act. Such supervision shall include: (a) The requirement that periodic reports on the medical care...

  20. 45 CFR 156.245 - Treatment of direct primary care medical homes.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes. 156.245 Section 156.245 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING...

  1. The CLASS Act: is it dead or just sleeping?

    PubMed

    Wiener, Joshua M

    2012-01-01

    The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration announced that the program would not be implemented because of the high risk of fiscal insolvency. Under the legislative design, adverse selection was a major risk and premiums would have been very high. This article discusses several CLASS Act design and implementation issues, including the design features that led to the decision not to implement the program: the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers and students.

  2. How the affordable care act and mental health parity and addiction equity act greatly expand coverage of behavioral health care.

    PubMed

    Beronio, Kirsten; Glied, Sherry; Frank, Richard

    2014-10-01

    The Patient Protection and Affordable Care Act (ACA) will expand coverage of mental health and substance use disorder benefits and federal parity protections to over 60 million Americans. The key to this expansion is the essential health benefit provision in the ACA that requires coverage of mental health and substance use disorder services at parity with general medical benefits. Other ACA provisions that should improve access to treatment include requirements on network adequacy, dependent coverage up to age 26, preventive services, and prohibitions on annual and lifetime limits and preexisting exclusions. The ACA offers states flexibility in expanding Medicaid (primarily to childless adults, not generally eligible previously) to cover supportive services needed by those with significant behavioral health conditions in addition to basic benefits at parity. Through these various new requirements, the ACA in conjunction with Mental Health Parity and Addiction Equity Act (MHPAEA) will expand coverage of behavioral health care by historic proportions.

  3. Promoting Prevention Through the Affordable Care Act: Workplace Wellness

    PubMed Central

    Roffenbender, Jason S.; Goetzel, Ron Z.; Millard, Francois; Wildenhaus, Kevin; DeSantis, Charles; Novelli, William

    2012-01-01

    Public health in the United States can be improved by building workplace “cultures of health” that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public’s health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness. PMID:23237245

  4. [Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

    PubMed

    Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

    2009-02-01

    The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

  5. 45 CFR 234.130 - Assistance in the form of institutional services in intermediate care facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the intermediate care facility. (3) Provide methods of administration that include: (i) Placing of... intermediate care facility, whether the services actually rendered are adequate and responsive to the... intermediate care facility services under the medical assistance program, title XIX of the Act, but not later...

  6. Medicaid and Children's Health Insurance Programs: essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeal processes, and premiums and cost sharing; exchanges: eligibility and enrollment. Final rule.

    PubMed

    2013-07-15

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

  7. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    PubMed

    Mechanic, David; Olfson, Mark

    2016-01-01

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce.

  8. 76 FR 25409 - Privacy Act of 1974

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-04

    ... Medicare beneficiaries from CMS databases including: health care usage, demographic, enrollment, and survey... and timely assess the current health care usage by the patient population served by VA, to forecast..., and to understand the numerous implications of cross-usage between VA and non-VA health care systems...

  9. 45 CFR 156.145 - Determination of minimum value.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 156.145 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO... the expected spending for health care costs in a benefit year so that: (i) Any current year HSA...

  10. 45 CFR 156.145 - Determination of minimum value.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 156.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO... the expected spending for health care costs in a benefit year so that: (i) Any current year HSA...

  11. 25 CFR 63.3 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT INDIAN CHILD PROTECTION AND FAMILY VIOLENCE... violence means any act, or threatened act, of violence, including any forceful detention of an individual... abusers, victims, and dependents in family violence situations; referrals for appropriate health-care...

  12. TRICARE; Changes included in the John Warner National Defense Authorization Act for Fiscal Year 2007; authorization of anesthesia and other costs for dental care for children and certain other patients. Final rule.

    PubMed

    2007-09-25

    This final rule implements section 702 of the John Warner National Defense Authorization Act for Fiscal Year 2007, Public Law 109-364. The rule provides coverage of contracted medical care with respect to dental care beyond that care required as a necessary adjunct to medical or surgical treatment. The entitlement of institutional and anesthesia services is authorized in conjunction with non-covered dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under. This final rule does not eliminate any contracted medical care that is currently covered for spouses and children. The entitlement of anesthesia services includes general anesthesia services only. Institutional services include institutional benefits associated with both hospital and in-out surgery settings. Patients with developmental, mental, or physical disabilities are those patients with conditions that prohibit dental treatment in a safe and effective manner. Therefore, it is medically or psychologically necessary for these patients to require general anesthesia for dental treatment.

  13. Potential impact of HITECH security regulations on medical imaging.

    PubMed

    Prior, Fred; Ingeholm, Mary Lou; Levine, Betty A; Tarbox, Lawrence

    2009-01-01

    Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA) of 2009 [1] include a provision commonly referred to as the "Health Information Technology for Economic and Clinical Health Act" or "HITECH Act" that is intended to promote the electronic exchange of health information to improve the quality of health care. Subtitle D of the HITECH Act includes key amendments to strengthen the privacy and security regulations issued under the Health Insurance Portability and Accountability Act (HIPAA). The HITECH act also states that "the National Coordinator" must consult with the National Institute of Standards and Technology (NIST) in determining what standards are to be applied and enforced for compliance with HIPAA. This has led to speculation that NIST will recommend that the government impose the Federal Information Security Management Act (FISMA) [2], which was created by NIST for application within the federal government, as requirements to the public Electronic Health Records (EHR) community in the USA. In this paper we will describe potential impacts of FISMA on medical image sharing strategies such as teleradiology and outline how a strict application of FISMA or FISMA-based regulations could have significant negative impacts on information sharing between care providers.

  14. Health Reforms as Examples of Multilevel Interventions in Cancer Care

    PubMed Central

    Fennell, Mary L.; Devers, Kelly J.

    2012-01-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

  15. Health reforms as examples of multilevel interventions in cancer care.

    PubMed

    Flood, Ann B; Fennell, Mary L; Devers, Kelly J

    2012-05-01

    To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

  16. A framework for current public mental health care practice in South Africa.

    PubMed

    Janse Van Rensburg, A B

    2007-11-01

    One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to "limited resources" practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).

  17. 78 FR 47322 - Privacy Act of 1974; Report of an Altered System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-05

    ... reports for all health care practitioners (e.g., physicians, dentists, nurses, optometrists, pharmacists... appropriate decisions in the delivery of health care. 6. To state Medicaid Fraud Control Units that request... Information on Physicians and other Health Care Practitioners (NPDB), 09-15-0054, to include information...

  18. Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual?

    PubMed

    Jacobson, Peter D; Jazowski, Shelley A

    2011-08-01

    The Patient Protection and Affordable Care Act 1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation's primary care needs. In this commentary, we argue that physicians should take the lead in developing policies to address the primary care shortage. First, physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers. Second, physicians should re-imagine how primary care is delivered, including shifting routine care to NPPs while retaining responsibility for complex patients and oversight of the new primary care arrangements. Third, the ACA's focus on wellness and prevention creates opportunities for physicians to integrate population health into primary care practice.

  19. Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

    PubMed Central

    Tai, Betty; Volkow, Nora D.

    2016-01-01

    Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

  20. Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

    PubMed

    Cusano, David; Lucia, Kevin

    2016-02-01

    A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

  1. [Reality of Inter-Professional Cooperation in Medical Day Care Facilities - What is Visible from the Level of Inter-Professional Cooperation].

    PubMed

    Ugai, Chizuru; Hata, Kiyomi

    2015-12-01

    In order to improve the quality of life of patients with moderate to severe symptoms who are highly dependent on medical care and to reduce the physical and psychological burden on family members, at medical day care facilities, care and services, such as functional training, is provided to improve daily life for patients in need of significant care who have intractable diseases under the Long-Term Care Insurance Act; home care patients, such as those in the final stages of cancer; and severely mentally and physically handicapped children under the Child Welfare Act. This study conducted semi-structured interviews with 15 nurses working in medical day care facilities with the objective of clarifying the reality of inter-professional cooperation of nurses working in these facilities and contributing to delivery of high-quality care. The results of the study revealed that the level of inter-professional cooperation of nurses at medical day care facilities was high and that professions that are involved in cooperation include visiting nurses, doctors, medical staff, such as physical therapists, caregivers, and welfare professions, such as care managers. The study also showed that the contents of cooperation include information exchange, information sharing, continuation of care, implementation of care that respects the intentions of the patient, care proposals, and guidance and control regarding care.

  2. 45 CFR 156.1105 - Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

  3. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  4. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  5. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  6. An overview of Medicaid managed care litigation.

    PubMed

    Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T

    1998-11-01

    Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of administrative and regulatory law. Thus, Medicaid managed care cases have implications for other public purchasers of managed care arrangements, including state mental health and alcohol and substance abuse agencies.

  7. 78 FR 54069 - Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... Parts 147, 153, 155, et al. Patient Protection and Affordable Care Act; Program Integrity: Exchange... 147, 153, 155, and 156 [CMS-9957-F] RIN 0938-AR82 Patient Protection and Affordable Care Act; Program... Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as...

  8. 75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-24

    ...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security Act and 42 CFR 412.103 to receive reasonable cost payments for anesthesia services and related care furnished by nonphysician anesthetists from cost reporting periods beginning on or after October 1, 2010, to December 2, 2010.

  9. 45 CFR 156.1220 - Administrative appeals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1220 Administrative appeals. (a) Requests for reconsideration...

  10. Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

    PubMed

    Schneider, D A; Hardwick, K S; Marconi, K M; Niemcryk, S J; Bowen, G S

    1993-01-01

    The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

  11. Procedures for the Handling of Retaliation Complaints Under Section 1558 of the Affordable Care Act. Final rule.

    PubMed

    2016-10-13

    This document provides the final text of regulations governing employee protection (retaliation or whistleblower) claims under section 1558 of the Affordable Care Act, which added section 18C to the Fair Labor Standards Act to provide protections to employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions (for example, health insurance premium tax credits) or for reporting potential violations of the Affordable Care Act's consumer protections (for example, the prohibition on rescissions). An interim final rule (IFR) governing these provisions and request for comments was published in the Federal Register on February 27, 2013. Thirteen comments were received; eleven were responsive to the IFR. This rule responds to those comments and establishes the final procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary of Labor's (Secretary's) final decision. It also sets forth the Secretary's interpretations of the Affordable Care Act whistleblower provision on certain matters.

  12. Improving the Quality of Child Care. Hearing of the Committee on Labor and Human Resources on Examining Proposals To Improve the Quality of Child Care in the United States, Including the Proposed Creating Improved Delivery of Child Care: Affordable, Reliable, and Educational Act of 1997. United States Senate, One Hundred Fifth Congress. First Session.

    ERIC Educational Resources Information Center

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

    These hearings transcripts present testimony on proposals to improve the quality of child care in the United States. Both oral and submitted written statements are included. Contributors are: Representative Peter Deutsch (Florida); Senator James M. Jeffords, committee chairman; Senator Mike Enzi (Wyoming); Senator Edward M. Kennedy…

  13. 78 FR 60877 - Advisory Committee on Immunization Practices (ACIP)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Advisory... Affordable Care Act, at section 2713 of the Public Health Service Act, immunization recommendations of the... covered by applicable health plans. Matters To Be Discussed: The agenda will include discussions on: child...

  14. Zero-sum politics, the Herbert thesis, and the Ryan White CARE Act: lessons learned from the local side of AIDS.

    PubMed

    Slack, J

    2001-01-01

    This study examines the dynamics of grass-roots decision-making processes involved in the implementation of the Ryan White CARE Act. Providing social services to persons with HIV/AIDS, the CARE act requires participation of all relevant groups, including representatives of the HIV/AIDS and gay communities. Decision-making behavior is explored by applying a political (zero-sum) model and a bureaucratic (the Herbert Thesis) model. Using qualitative research techniques, the Kern County (California) Consortium is used as a case study. Findings shed light on the decision-making behavior of social service organizations characterized by intense advocacy and structured on the basis of volunteerism and non-hierarchical relationships. Findings affirm bureaucratic behavior predicted by the Herbert Thesis and also discern factors which seem to trigger more conflictual zero-sum behavior.

  15. 76 FR 73025 - Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

  16. 45 CFR 156.200 - QHP issuer participation standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 156.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

  17. 45 CFR 156.200 - QHP issuer participation standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.200 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

  18. 45 CFR 156.200 - QHP issuer participation standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 156.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.200 QHP issuer...

  19. 45 CFR 156.285 - Additional standards specific to SHOP.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 156.285 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

  20. 45 CFR 156.220 - Transparency in coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

  1. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  2. 45 CFR 156.285 - Additional standards specific to SHOP.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 156.285 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

  3. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  4. 45 CFR 156.220 - Transparency in coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

  5. 45 CFR 156.230 - Network adequacy standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....230 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

  6. 45 CFR 156.1215 - Payment and collections processes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.1215 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1215 Payment and collections...

  7. 45 CFR 156.255 - Rating variations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.255 Rating variations. (a) Rating areas. A QHP issuer...

  8. 45 CFR 156.220 - Transparency in coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.220 Transparency in coverage. (a) Required information...

  9. 45 CFR 156.230 - Network adequacy standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

  10. 45 CFR 156.285 - Additional standards specific to SHOP.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.285 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.285 Additional standards...

  11. 45 CFR 156.230 - Network adequacy standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.230 Network adequacy standards. (a) General...

  12. 75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-02

    ...This notice contains the final wage indices, hospital reclassifications, payment rates, impacts, and other related tables effective for the fiscal year (FY) 2010 hospital inpatient prospective payment systems (IPPS) and rate year 2010 long-term care hospital (LTCH) prospective payment system (PPS). The rates, tables, and impacts included in this notice reflect changes required by or resulting from the implementation of several provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. These provisions require the extension of the expiration date for certain geographic reclassifications and special exception wage indices through September 30, 2010; and certain market basket updates for the IPPS and LTCH PPS.

  13. [Violent acts against health care providers].

    PubMed

    Irinyi, Tamás; Németh, Anikó

    2016-07-01

    Violence against health care providers is getting more awareness nowadays. These are usually deliberate actions committed by patients or family members of them resulting in short and long term physical or psychological debilitating harm in the staff members. The causes of the violent acts are usually rooted in patient-related factors, although some characteristics of the professionals and of the workplace may also play some role. The present article presents different definitions of violence and possible reasons for violence against health care providers based on relevant international and national literature. The paper discusses the different forms and frequency of violence, furthermore, details about the effects, consequences and some options for prevention in health care settings are also included. Orv. Hetil., 2016, 157(28), 1105-1109.

  14. 20 CFR 30.403 - Will OWCP pay for the services of an attendant?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... attendant? OWCP will authorize payment for personal care services under section 7384t of the Act, whether or not such care includes medical services, so long as the personal care services have been determined to be medically necessary and are provided by a home health aide, licensed practical nurse, or similarly...

  15. Opportunities in the American Recovery and Reinvestment Act for Supports and Services for Youth Transitioning from Foster Care

    ERIC Educational Resources Information Center

    Flynn-Khan, Margaret; Langford, Barbara Hanson

    2009-01-01

    To address the economic crisis facing the country, the President signed the American Recovery and Reinvestment Act (ARRA) into law on February 17, 2009. This sweeping legislation provides $789 billion to jumpstart the economy and boost employment. This act includes $463 billion in new spending and $326 billion in tax relief directed at those…

  16. Accelerating Research Impact in a Learning Health Care System

    PubMed Central

    Elwy, A. Rani; Sales, Anne E.; Atkins, David

    2017-01-01

    Background: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. Objectives: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA’s transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. Design: QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. Results: QUERI’s national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law’s further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Conclusions: Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health. PMID:27997456

  17. New York's Health Care Workforce Recruitment and Retention Act: an investigation of the effects of nonrecurring increases in health worker wage on health worker supply.

    PubMed

    Patel, Kavin

    2014-01-01

    This article analyzes New York's Health Care Workforce Recruitment and Retention Act of 2002. The analysis comes in 4 parts: part 1 provides a brief overview of New York's economy as it relates to health care, a feel for the political climate at the time, and a detailed presentation of the chain of events that connect this climate to the birth of the Health Care Workforce Recruitment and Retention Act of 2002; part 2 consists of a breakdown of the provisions contained within bill, including major and minor goals, intended effects, and the mechanics behind raising supporting funds; part 3 explores what actually happened by evaluating available data to determine whether the bill's 2 major goals of workforce recruitment and retention were fulfilled; and finally, part 4 will take all the aforementioned information to determine the overall success of the bill, the implications, and specific suggestions for future policy changes that time has revealed since its inception.

  18. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care

    PubMed Central

    Hoben, Matthias; Estabrooks, Carole A.; Squires, Janet E.; Behrens, Johann

    2016-01-01

    We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90–0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group. PMID:27656156

  19. [The common issues of health policy in Russia concerning private system].

    PubMed

    Kasimovskii, K K

    2016-01-01

    The article considers main principles of national policy specified in the constitution of the Russian Federation and other legislative acts concerning health care of population and development of private health care of Russia. The public policy intends wholeness and unity of national health care system and also state control of its functioning. All official documents and normative legislative acts relate to all sectors of national health care that substantiates unity of public policy. The important emphasis in actual policy is made on development of involvement of private sector in activities related to mandatory health insurance programs and implementation of various forms ofpublic-private partnership in health care. It is pointed out that omnipresent is delay of federal legislation from legislative base of regions, including its vagueness and incompleteness. The principle of self-regulation is described that is more and more implemented in private health care.

  20. 16 CFR 1115.22 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. A knowing and willful violation of section 19(a), after the violator has...

  1. 16 CFR 1115.22 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. A knowing and willful violation of section 19(a), after the violator has...

  2. 16 CFR 1115.22 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. A knowing and willful violation of section 19(a), after the violator has...

  3. 16 CFR § 1115.22 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. A knowing and willful violation of section 19(a), after the violator has...

  4. 16 CFR 1115.22 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. A knowing and willful violation of section 19(a), after the violator has...

  5. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... under section 1903 of the Social Security Act for any amounts expended for providing medical assistance... (the Act) authorizes Federal grants to the States for Medicaid programs to provide medical assistance... all Federal requirements. The Federal government pays its share of medical assistance expenditures to...

  6. 45 CFR 156.260 - Enrollment periods for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....260 Section 156.260 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

  7. 45 CFR 156.130 - Cost-sharing requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

  8. 45 CFR 156.265 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....265 Section 156.265 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

  9. 45 CFR 156.290 - Non-renewal and decertification of QHPs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 156.290 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

  10. 45 CFR 156.140 - Levels of coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

  11. 45 CFR 156.225 - Marketing and Benefit Design of QHPs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 156.225 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

  12. 45 CFR 156.265 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....265 Section 156.265 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

  13. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  14. 45 CFR 156.1240 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....1240 Section 156.1240 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1240 Enrollment process for...

  15. 45 CFR 156.225 - Marketing and Benefit Design of QHPs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 156.225 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

  16. 45 CFR 156.340 - Standards for downstream and delegated entities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... 156.340 Section 156.340 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange Qualified Health Plan Issuer Standards § 156...

  17. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 156.210 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  18. 45 CFR 156.270 - Termination of coverage for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... 156.270 Section 156.270 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

  19. 45 CFR 156.1255 - Renewal and re-enrollment notices.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.1255 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1255 Renewal and re-enrollment...

  20. 45 CFR 156.270 - Termination of coverage for qualified individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    .... 156.270 Section 156.270 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

  1. 45 CFR 156.210 - QHP rate and benefit information.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 156.210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.210 QHP rate and benefit information...

  2. 45 CFR 156.130 - Cost-sharing requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.130 Cost-sharing requirements. (a) Annual limitation on cost sharing. (1...

  3. 45 CFR 156.270 - Termination of coverage for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... 156.270 Section 156.270 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.270 Termination...

  4. 45 CFR 156.260 - Enrollment periods for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....260 Section 156.260 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

  5. 45 CFR 156.115 - Provision of EHB.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.115 Provision of EHB. (a) Provision of EHB means that a health plan...

  6. 45 CFR 156.1240 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....1240 Section 156.1240 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1240 Enrollment process for...

  7. 45 CFR 156.225 - Marketing and Benefit Design of QHPs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.225 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.225 Marketing and Benefit...

  8. 45 CFR 156.290 - Non-renewal and decertification of QHPs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 156.290 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

  9. 45 CFR 156.290 - Non-renewal and decertification of QHPs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 156.290 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.290 Non-renewal and...

  10. 45 CFR 156.115 - Provision of EHB.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.115 Provision of EHB. (a) Provision of EHB means that a health plan...

  11. 45 CFR 156.265 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....265 Section 156.265 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.265 Enrollment process...

  12. 45 CFR 156.340 - Standards for downstream and delegated entities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... 156.340 Section 156.340 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange Qualified Health Plan Issuer Standards § 156...

  13. 45 CFR 156.140 - Levels of coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.140 Levels of coverage. (a) General requirement for levels of coverage. AV...

  14. 45 CFR 156.260 - Enrollment periods for qualified individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....260 Section 156.260 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification Standards § 156.260 Enrollment periods...

  15. Validation of 2 Spanish-Language Scales to Assess HIV-Related Stigma in Communities.

    PubMed

    Franke, Molly F; Nelson, Adrianne K; Muñoz, Maribel; Cruz, Janeth Santa; Atwood, Sidney; Lecca, Leonid; Shin, Sonya S

    2015-01-01

    We report the psychometric properties of 2 Spanish-language scales designed to measure (1) opinions about HIV in the community and particularly among health care workers and (2) observed acts of stigma toward people living with HIV/AIDS (PLWHA) by health care workers. The Opinions about HIV Scale included 3 components (policy, avoidance, and empathy) and 9 items, while an adapted version of the HIV/AIDS Stigma Instrument-Nurse, designed to capture acts of stigma, included 2 components (discrimination related to clinical care and refusal to share or exchange food/gifts). Scales demonstrated good reliability and construct validity. Relative to community health workers, treatment supporters were more likely to have stigmatizing opinions related to avoidance and empathy. We offer 2 Spanish-language scales that could be used to identify populations with high levels of stigmatizing opinions and behaviors toward PLWHA. Formal training of health care workers, especially treatment supporters, may raise awareness and reduce stigma toward HIV. © The Author(s) 2014.

  16. The affordable care ACT on loyalty programs for federal beneficiaries.

    PubMed

    Piacentino, Justin J; Williams, Karl G

    2014-02-01

    To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.

  17. Health Care Reform and Young Adults' Access to Sexual Health Care: An Exploration of Potential Confidentiality Implications of the Affordable Care Act

    PubMed Central

    Garcia, Carolyn M.; Long, Sharon K.; Lechner, Kate E.; Lust, Katherine; Eisenberg, Marla E.

    2012-01-01

    One provision of the 2010 Affordable Care Act is extension of dependent coverage for young adults aged up to 26 years on their parent’s private insurance plan. This change, meant to increase insurance coverage for young adults, might yield unintended consequences. Confidentiality concerns may be triggered by coverage through parental insurance, particularly regarding sexual health. The existing literature and our original research suggest that actual or perceived limits to confidentiality could influence the decisions of young adults about whether, and where, to seek care for sexual health issues. Further research is needed on the scope and outcomes of these concerns. Possible remedial actions include enhanced policies to protect confidentiality in billing and mechanisms to communicate confidentiality protections to young adults. PMID:22897544

  18. Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

    PubMed

    Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

    2018-04-17

    The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  19. Evaluating Appropriateness of Prescribing of Long-Acting Risperidone for Injection in Acute Care Settings

    PubMed Central

    Mah, Greg T; Dumontet, Jane; Lakhani, Anisha; Corrigan, Susan

    2010-01-01

    Background Long-acting risperidone for injection is a second-generation antipsychotic indicated for the treatment of schizophrenia and related psychotic disorders. It is a relatively new agent with pharmacokinetic and dosing properties unlike those of conventional long-acting antipsychotic drugs administered by injection. Objective To determine the proportion of patients for whom long-acting risperidone for injection was prescribed appropriately in acute care settings in the Fraser Health Authority of British Columbia, according to the following 4 criteria: approved indication for therapy, 2-week dosing intervals, dose increases no sooner than every 4 weeks, and initial overlap supplementation with another antipsychotic for at least 3 weeks. A variety of other variables, including documented approval under special authority from the provincial drug coverage program, length of hospital stay, initial dose of risperidone, and total number of doses, were assessed as secondary outcomes. Methods A chart review was conducted for all patients for whom therapy with long-acting risperidone for injection was prescribed during stays in 8 acute care hospitals between July 1, 2007, and July 22, 2008. The appropriateness of prescribing was assessed according to the 4 prespecified criteria. Results Long-acting risperidone for injection was prescribed for 116 patients during the study period, and 82 of these started therapy and were included in the evaluation. The primary outcome could not be assessed for 27 of these 82 patients, because they were discharged early, and data for some or all of the 4 criteria were not available. For 33 (60%) of the 55 remaining patients, long-acting risperidone for injection had been prescribed appropriately. In contrast, for 22 (40%) of the patients, prescription of risperidone was deemed inappropriate because of failure to meet at least 1 of the 4 criteria. Premature escalation of the dose and inadequate overlap with antipsychotic supplementation were the most common reasons for designation of the prescription as inappropriate. Conclusions Opportunities exist to improve prescribing practices for long-acting risperidone for injection in acute care institutions in this health authority. PMID:22479015

  20. 26 CFR 1.6055-1 - Information reporting for minimum essential coverage.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... section. (2) Affordable Care Act. The term Affordable Care Act refers to the Patient Protection and Affordable Care Act, Public Law 111-148 (124 Stat. 119 (2010)), and the Health Care and Education...(a) of the Affordable Care Act (42 U.S.C. 18021(a)). (10) Reporting entity. A reporting entity is any...

  1. 75 FR 60482 - Proposed Extension of Information Collection Request Submitted for Public Comment; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-30

    ... Collection Request Submitted for Public Comment; Affordable Care Act Enrollment Opportunity Notice Relating to Dependent Coverage; Affordable Care Act Grandfathered Health Plan Disclosure and Recordkeeping Requirement; Affordable Care Act Rescission Notice; Affordable Care Act Patient Protections Notice; Affordable...

  2. Consumer-Centric Care: Latest Buzzword or New Reality?

    PubMed

    Boston-Fleischhauer, Carol

    2017-11-01

    With the industry in flux as federal healthcare reform legislation debates continue, leaders are preparing for what the post-Affordable Care Act world might look like. Predictions include patients assuming more responsibility for healthcare costs and therefore behaving like consumers, including choosing providers based on perceived value. What actions should chief nurse executives take to ensure the nursing enterprise responds to rising consumerism in healthcare?

  3. 78 FR 31562 - Agency Information Collection Activities: Submission to OMB for Review and Approval; Public...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-24

    ...' (HHS) priority policies to improve health care delivery. Some of these priorities include: improving... the Public Health Service Act, Section 330A(f) (42 U.S.C. 254c(f)) as amended by the Health Care Safety Net Amendments of 2002 (Pub. L. 107-251), is to improve health care and support the adoption of...

  4. Antibody-mediated delivery of therapeutics for cancer therapy.

    PubMed

    Parakh, Sagun; Parslow, Adam C; Gan, Hui K; Scott, Andrew M

    2016-01-01

    Antibody-conjugated therapies (ACTs) combine the specificity of monoclonal antibodies to target cancer cells directly with highly potent payloads, often resulting in superior efficacy and/or reduced toxicity. This represents a new approach to the treatment of cancer. There have been highly promising clinical trial results using this approach with improvements in linker and payload technology. The breadth of current trials examining ACTs in haematological malignancies and solid tumours indicate the potential for clinical impact. This review will provide an overview of ACTs currently in clinical development as well as the principles of antibody delivery and types of payloads used, including cytotoxic drugs, radiolabelled isotopes, nanoparticle-based siRNA particles and immunotoxins. The focus of much of the clinical activity in ACTs has, understandably, been on their use as a monotherapy or in combination with standard of care drugs. This will continue, as will the search for better targets, linkers and payloads. Increasingly, as these drugs enter routine clinical care, important questions will arise regarding how to optimise ACT treatment approaches, including investigation of resistance mechanisms, biomarker and patient selection strategies, understanding of the unique toxicities of these drugs, and combinatorial approaches with standard therapies as well as emerging therapeutic agents like immunotherapy.

  5. The Impact of the Affordable Care Act on Funding for Newborn Screening Services.

    PubMed

    Costich, Julia F; Durst, Andrea L

    2016-01-01

    The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.

  6. 45 CFR 156.250 - Health plan applications and notices.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

  7. 45 CFR 156.250 - Health plan applications and notices.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

  8. 45 CFR 156.1120 - Quality rating system.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Quality rating system. 156.1120 Section 156.1120 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

  9. 45 CFR 156.715 - Compliance reviews of QHP issuers in Federally-facilitated Exchanges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...'s enrollees; (2) The QHP issuer's policies and procedures, protocols, standard operating procedures... REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Oversight and Financial Integrity Standards for Issuers of...

  10. 45 CFR 156.1250 - Acceptance of certain third party payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....1250 Section 156.1250 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1250 Acceptance of certain third...

  11. 45 CFR 156.250 - Health plan applications and notices.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Health plan applications and notices. 156.250 Section 156.250 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS...

  12. 45 CFR 156.100 - State selection of benchmark.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....100 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.100 State selection of benchmark. Each State may identify a single...

  13. 45 CFR 156.100 - State selection of benchmark.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....100 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.100 State selection of benchmark. Each State may identify a single...

  14. Disaster Averted, For Now: How the American Health Care Act Would Have Affected Californians.

    PubMed

    Rasmussen, Petra W

    2017-03-01

    Although the American Health Care Act (AHCA) was recently defeated, the policies in the bill represented a mix of ideas long favored by conservatives. If enacted, this repeal-and-replace bill would have had devastating consequences for most of the 5 million Californians currently receiving direct benefits from the Affordable Care Act (ACA), including more than 1 million who receive subsidies through Covered California and almost 4 million who have enrolled in the Medi-Cal expansion. Although the bill failed to garner enough votes for passage, it is likely that efforts to chip away at the ACA will continue and that some of the ideas contained within the AHCA will be revisited. This policy brief summarizes some of the most significant reversals that would have occurred under the Republican plan in the individual and small group insurance markets.

  15. The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply.

    PubMed

    Daar, David A; Alvarez-Estrada, Miguel; Alpert, Abigail E

    2018-02-01

    The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.

  16. Assertive Community Treatment for alcohol dependence (ACTAD): study protocol for a randomised controlled trial

    PubMed Central

    2012-01-01

    Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. Methods/Design In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one of two conditions: (1) ACT plus care as usual, or (2) care as usual. Those allocated to the ACT plus care as usual will receive the same treatment that is routinely provided by services, plus a trained key worker who will provide ACT. ACT comprises intensive and assertive contact at least once a week, over 50% of contacts in the participant's home or local community, and comprehensive case management across social and health care, for a period of one year. All participants will be followed up at 6 months and 12 months to assess outcome post randomisation. The primary outcome measures will be alcohol consumption: mean drinks per drinking day and percentage of days abstinent measured by the Time Line Follow Back interview. Secondary outcome measures will include severity of alcohol dependence, alcohol related problems, motivation to change, social network involvement, quality of life, therapeutic relationship and service use. Other outcome variables are treatment engagement including completion of assessment, detoxification and aftercare. Discussion Results of this trial will help clarify the potential beneficial effects of ACT for people with alcohol dependence and provide information to design a definitive trial. Trial registration number ISRCTN: ISRCTN22775534 PMID:22348423

  17. Commentary: improving the supply and distribution of primary care physicians.

    PubMed

    Dorsey, E Ray; Nicholson, Sean; Frist, William H

    2011-05-01

    The current medical education system and reimbursement policies in the United States have contributed to a maldistribution of physicians by specialty and geography. The causes of this maldistribution include financial barriers that prevent the individuals who would be the most likely to serve in primary care and underserved areas from entering the profession, large taxpayer subsidies to teaching hospitals that provide incentives to act in ways that are not in the best interest of society, and reimbursement policies that discourage physicians from providing primary care. The authors propose that the maldistribution of physicians can be addressed successfully by reducing the financial barriers to becoming a primary care physician, aligning subsidies with societal interests, and providing financial incentives that target primary care. They suggest that the Patient Protection and Affordable Care Act of 2010 takes steps in the right direction but that more financially prudent measures should be taken as politicians revisit health care reform with heightened financial scrutiny. Copyright © by the Association of American medical Colleges.

  18. 16 CFR 1117.9 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... means the having of actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. Section 20(d) of the CPSA, 15 U.S.C. 2069(d). (d) Any...

  19. 16 CFR § 1117.9 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... means the having of actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. Section 20(d) of the CPSA, 15 U.S.C. 2069(d). (d) Any...

  20. 16 CFR 1117.9 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... means the having of actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. Section 20(d) of the CPSA, 15 U.S.C. 2069(d). (d) Any...

  1. 16 CFR 1117.9 - Prohibited acts and sanctions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... means the having of actual knowledge or the presumed having of knowledge deemed to be possessed by a reasonable person who acts in the circumstances, including knowledge obtainable upon the exercise of due care to ascertain the truth of representations. Section 20(d) of the CPSA, 15 U.S.C. 2069(d). (d) Any...

  2. The Role of Nutrition-Related Initiatives in Addressing Community Health Needs Assessments

    ERIC Educational Resources Information Center

    George, Daniel R.; Rovniak, Liza S.; Dillon, Judy; Snyder, Gail

    2017-01-01

    Academic Health Centers and nonprofit hospitals are exploring strategies to meet Affordable Care Act mandates requiring tax-exempt institutions to address community health needs, which commonly include major chronic illnesses. We explore the implications of this regulatory landscape, describing methods that nonprofit health care institutions are…

  3. National Council on Disability. Annual Report, Volume 15. Fiscal Year 1994.

    ERIC Educational Resources Information Center

    National Council on Disability, Washington, DC.

    This annual report describes major activities of the National Council on Disability (NCD) for Fiscal Year 1994. Activities included: conducted a summit meeting on the Americans with Disabilities Act (ADA); held health care reform town meetings; communicated with the Health Care Financing Administration concerning reimbursement of medical…

  4. 45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

  5. 45 CFR 156.105 - Determination of EHB for multi-state plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....105 Section 156.105 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.105 Determination of EHB for multi-state...

  6. 45 CFR 156.330 - Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Health Plans in Federally-facilitated Exchanges. 156.330 Section 156.330 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Federally-Facilitated Exchange...

  7. 45 CFR 156.215 - Advance payments of the premium tax credit and cost-sharing reduction standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... cost-sharing reduction standards. 156.215 Section 156.215 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum Certification...

  8. 45 CFR 156.1210 - Confirmation of HHS payment and collections reports.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... reports. 156.1210 Section 156.1210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1210 Confirmation of HHS...

  9. 45 CFR 156.105 - Determination of EHB for multi-state plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....105 Section 156.105 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Essential Health Benefits Package § 156.105 Determination of EHB for multi-state...

  10. Home healthcare workers and the Fair Labor Standards Act.

    PubMed

    Fowler, Rebecca M

    2008-04-01

    In a major industry shift, long term care is moving from nursing homes and institutions to the private home. This change results from a number of factors, including the lower cost of home-based care. These lower costs can be traced to a number of exemptions from the Fair Labor Standards Act requirements for minimum wage and premium overtime payments which apply to many home healthcare workers. These include the companionship, live-in, and professional exemptions. As the home healthcare industry has grown, home healthcare workers have challenged the applicability of these exemptions. This article will explore the issues reflected in those challenges and their resolution, and provide suggestions to help employers ensure that their employees fall within the exemptions.

  11. 75 FR 46169 - Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and CY...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-03

    ...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These proposed changes would be applicable to services furnished on or after January 1, 2011. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this proposed rule, we set forth the proposed applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2011. This proposed rule also includes proposals to implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest.

  12. The accountable health care act of Massachusetts: mixed results for an experiment in universal health care coverage.

    PubMed

    Norbash, Alexander; Hindson, David; Heineke, Janelle

    2012-10-01

    The affordable health care act of Massachusetts, signed into law in 2006, resulted in 98% of Massachusetts residents' having some form of insurance coverage by 2011, the highest coverage rate for residents of any state in the nation. With a strong economy, a low unemployment rate, a robust health care delivery system, an extremely low number of undocumented immigrants, and a low baseline uninsured rate, Massachusetts was well positioned for such an effort. Ingredients included mandates, the creation of separate insurance vehicles directed to both poverty-level and non-poverty-level residents, and the reallocation of the former free care pool. The mandates included consumer mandates and employer mandates; the consumer mandate applies to all Massachusetts residents at the risk of losing personal state tax exemptions, and the employer mandate applies to all Massachusetts businesses with 10 or more employees at the risk of per employee financial penalties. The insurance vehicles were created with premiums allocated on the basis of ability to pay by income classes. Unexpected effects included escalating taxpayer health care costs, with taxpayers shouldering the burden for the newly insured, continuing escalating health care costs at a rate greater than the national average, overburdening primary caregivers as newly insured sought new primary care gatekeepers in a system with primary caregiver shortages, and deprivation of support to the safety-net hospitals as a result of siphoned commonwealth free care pool funds. This exercise demonstrates specific benefits and shortfalls of the Massachusetts health care reform experiment, given the conditions and circumstances found in Massachusetts at the time of implementation. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule.

    PubMed

    2015-08-04

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.

  14. Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act.

    PubMed

    Quadagno, Jill

    2014-02-01

    On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.

  15. Regulation and federalism: legal impediments to state health care reform.

    PubMed

    Parmet, W E

    1993-01-01

    In recent years, many states have attempted to address the cost and access problems that face their health care systems. Such efforts, however, are significantly impeded by a variety of federalism doctrines that limit the ability of states to regulate the health care market. This Article surveys some of those federalism barriers, including the constitutional restraints imposed by the Commerce Clause, the Privileges and Immunities Clause, and the Fourteenth Amendment, and the statutory hurdles created by ERISA, the Social Security Act, and the Americans with Disabilities Act of 1990. This Article concludes that the restraints that these doctrines and statutes place on states reflect not only federalism concerns, but also deeper ambivalence about governmental regulation of the health care market. Only when that ambivalence is resolved can a proper division of labor between the states and federal government be determined.

  16. 21 CFR 882.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  17. 21 CFR 882.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  18. 21 CFR 890.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  19. 21 CFR 888.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  20. 21 CFR 888.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  1. 21 CFR 870.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  2. 21 CFR 886.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  3. 21 CFR 886.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  4. 21 CFR 892.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  5. 21 CFR 870.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  6. 21 CFR 888.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  7. 21 CFR 892.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  8. 21 CFR 882.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  9. 21 CFR 886.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  10. 21 CFR 870.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  11. 21 CFR 890.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  12. 21 CFR 886.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  13. 21 CFR 892.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  14. 21 CFR 882.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  15. 21 CFR 870.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  16. 21 CFR 890.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  17. 21 CFR 872.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  18. 21 CFR 868.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  19. 21 CFR 868.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  20. 21 CFR 872.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  1. 21 CFR 868.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  2. 21 CFR 888.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  3. 21 CFR 890.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  4. 21 CFR 868.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  5. 21 CFR 892.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES General... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  6. The Patient Protection and Affordable Care Act: The Impact on Urologic Cancer Care

    PubMed Central

    Keegan, Kirk A.; Penson, David F.

    2012-01-01

    In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the United States. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urological cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. PMID:22819697

  7. NCCN Biosimilars White Paper: regulatory, scientific, and patient safety perspectives.

    PubMed

    Zelenetz, Andrew D; Ahmed, Islah; Braud, Edward Louis; Cross, James D; Davenport-Ennis, Nancy; Dickinson, Barry D; Goldberg, Steven E; Gottlieb, Scott; Johnson, Philip E; Lyman, Gary H; Markus, Richard; Matulonis, Ursula A; Reinke, Denise; Li, Edward C; DeMartino, Jessica; Larsen, Jonathan K; Hoffman, James M

    2011-09-01

    Biologics are essential to oncology care. As patents for older biologics begin to expire, the United States is developing an abbreviated regulatory process for the approval of similar biologics (biosimilars), which raises important considerations for the safe and appropriate incorporation of biosimilars into clinical practice for patients with cancer. The potential for biosimilars to reduce the cost of biologics, which are often high-cost components of oncology care, was the impetus behind the Biologics Price Competition and Innovation Act of 2009, a part of the 2010 Affordable Care Act. In March 2011, NCCN assembled a work group consisting of thought leaders from NCCN Member Institutions and other organizations, to provide guidance regarding the challenges health care providers and other key stakeholders face in incorporating biosimilars in health care practice. The work group identified challenges surrounding biosimilars, including health care provider knowledge, substitution practices, pharmacovigilance, naming and product tracking, coverage and reimbursement, use in off-label settings, and data requirements for approval.

  8. Analysis of Productivity Improvement Act for Clinical Staff Working in the Health System: A Qualitative Study

    PubMed Central

    Vali, Leila; Tabatabaee, Seyed Saeed; Kalhor, Rohollah; Amini, Saeed; Kiaei, Mohammad Zakaria

    2016-01-01

    Introduction: The productivity of healthcare staff is one of the main issues for health managers. This study explores the concept of executive regulation of Productivity Improvement Act of clinical staff in health. Methods: In this study phenomenological methodology has been employed. The data were collected through semi-structured interviews and focus group composed of 10 hospital experts and experts in human resources department working in headquarter of Mashhad University of Medical Sciences and 16 nursing managers working in public and private hospitals of Mashhad using purposive sampling. Findings were analyzed using Colaizzi’s seven step method. Results: The strengths of this Act included increasing spirit of hope in nurses, paying attention to quality of nursing care and decreasing problems related to the work plan development. Some of the weaknesses of Productivity Improvement Act included lack of required executive mechanisms, lack of considering nursing productivity indicator, increasing non-public hospitals problems, discrimination between employees, and removal of resting on night shifts. Suggestions were introduced to strengthen the Act such as increased organizational posts, use of a coefficient for wage in unusual work shifts and consideration of a performance indicator. Conclusion: The results may be used as a proper tool for long term management planning at organization level. Finally, if high quality care by health system staff is expected, in the first step, we should take care of them through proper policy making and focusing on occupational characteristics of the target group so that it does not result in discrimination among the staff. PMID:26383203

  9. Federal Subsidies of Advanced Telecommunications for Schools, Libraries, and Health Care Providers. CBO Papers.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Congressional Budget Office.

    The Telecommunications Act of 1996 directs the Federal Communications Commission (FCC) to include support for advanced telecommunications--such as the Internet and computer networking--for elementary and secondary schools, public libraries, and nonprofit rural health care providers among the Universal Service Fund (USF) mandates. In its plan, the…

  10. Keep It Simple: A Lesson in Linking Teens to Health Care

    ERIC Educational Resources Information Center

    Eisler, Alexandra; Avellino, Lia; Chilcoat, Deborah; Schlanger, Karen

    2016-01-01

    The "Keep It Simple" package, which includes a short animated film (available online for streaming or download), a lesson plan, and supporting materials, was designed to be used with adolescents ages 15-19 to empower them to seek sexual and reproductive health care, and emphasize the availability of long-acting reversible contraception…

  11. 45 CFR 156.298 - Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Health Plans in the Federally-facilitated Exchanges. 156.298 Section 156.298 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Minimum...

  12. 45 CFR 156.1230 - Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... considered to be through the Exchange. 156.1230 Section 156.1230 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities...

  13. 45 CFR 156.120 - Collection of data from certain issuers to define essential health benefits.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... essential health benefits. 156.120 Section 156.120 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Standards for Essential Health Benefits, Actuarial Value, and Cost...

  14. 45 CFR 156.1230 - Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... considered to be through the Exchange. 156.1230 Section 156.1230 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities...

  15. 75 FR 20541 - Homeless Emergency Assistance and Rapid Transition to Housing: Defining “Homeless”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-20

    ... Housing Stability Program. The HEARTH Act also codifies in statutory law the Continuum of Care planning... activities and to add rapid re-housing activities. The new Rural Housing Stability program replaces the Rural... Care program, and the Rural Housing Stability program. Each of these programs will include the...

  16. Integrating Health and Mental Health Services: A Past and Future History.

    PubMed

    Druss, Benjamin G; Goldman, Howard H

    2018-04-25

    The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services.

  17. 77 FR 33133 - Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-05

    ... includes both quantitative and non-quantitative limits on benefits. Examples of quantitative limits include... duration of treatment. Examples of non-quantitative limits include prior authorization and step therapy... relevant issuers would submit data and descriptive information on the [[Page 33136

  18. Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception.

    PubMed

    Vela, Veronica X; Patton, Elizabeth W; Sanghavi, Darshak; Wood, Susan F; Shin, Peter; Rosenbaum, Sara

    Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain. Published by Elsevier Inc.

  19. The American College of Surgeons: an enduring commitment to quality and patient care.

    PubMed

    Hoyt, David B; Schneidman, Diane S

    2015-03-01

    This paper describes the American College of Surgeons' 100-plus-year commitment to improving quality and patient care. It summarizes programs that the College established a century ago to improve patient care, including the Hospital Standardization Program, and new initiatives, such as the ACS National Surgical Quality Improvement Program. The College's longstanding experience with quality improvement programs is enabling the organization to play a critical and influential role in helping to ensure that health care reforms, including those in the Affordable Care Act, are implemented in a way that best serves that interests of the surgical patient. Through a combination of these data analysis systems and the application of a finely tuned set of values, the College has become a respected voice in quality and patient safety. The ultimate goal is to create an environment where high value and high reliability take precedence over high volume and where all health care professionals play an active leadership role in delivering optimal, coordinated care. This article further describes how the surgical culture can be reshaped to meet these evolving needs and demands. The American College of Surgeons (ACS) has a longstanding commitment to improving the quality of surgical care through outcome measurement, standards setting, accreditation, and educational activities. This legacy has enabled the ACS to play an influential role in recent developments related to implementation of the Affordable Care Act (ACA) and Medicare physician payment reform. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. High-mix insulins

    PubMed Central

    Kalra, Sanjay; Farooqi, Mohammad Hamed; El-Houni, Ali E.

    2015-01-01

    Premix insulins are commonly used insulin preparations, which are available in varying ratios of different molecules. These drugs contain one short- or rapid-acting, and one intermediate- or long-acting insulin. High-mix insulins are mixtures of insulins that contain 50% or more than 50% of short-acting insulin. This review describes the clinical pharmacology of high-mix insulins, including data from randomized controlled trials. It suggests various ways, in which high-mix insulin can be used, including once daily, twice daily, thrice daily, hetero-mix, and reverse regimes. The authors provide a rational framework to help diabetes care professionals, identify indications for pragmatic high-mix use. PMID:26425485

  1. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

    PubMed Central

    Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

    2016-01-01

    Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423

  2. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs.

    PubMed

    Eibner, Christine; Krull, Heather; Brown, Kristine M; Cefalu, Matthew; Mulcahy, Andrew W; Pollard, Michael; Shetty, Kanaka; Adamson, David M; Amaral, Ernesto F L; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M; Weinick, Robin M; Woods, Dulani; Hosek, Susan D; Farmer, Carrie M

    2016-05-09

    The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.

  3. Mental health care for irregular migrants in Europe: Barriers and how they are overcome

    PubMed Central

    2012-01-01

    Background Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice. Methods Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis. Results Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation. Conclusions Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources. PMID:22607386

  4. 21 CFR 874.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  5. 21 CFR 874.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  6. 21 CFR 874.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  7. 21 CFR 874.9 - Limitations of exemptions from section 510(k) of the Federal Food, Drug, and Cosmetic Act (the act).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES... for lay use where the former intended use was by health care professionals only; (b) The modified... use in screening or diagnosis of familial or acquired genetic disorders, including inborn errors of...

  8. Promoting physical activity among older people in primary care using peer mentors.

    PubMed

    Stevens, Zoe; Barlow, Cate; Iliffe, Steve

    2015-04-01

    The home-based Otago Exercise Programme has been shown to increase sustained physical-activity levels in older people recruited through primary care, when supported by health professionals. The ProAct65+ trial is testing this programme using volunteer peer mentors to support behaviour change. This qualitative study explored how these peer mentors experienced their role. Ten peer mentors from the ProAct65+ trial were interviewed. Semi-structured interviews were audio-recorded, transcribed verbatim and thematically analysed. Peer mentors reported positive experiences including meeting new people, watching mentees progress, developing friendships and being shown gratitude for their support. Key barriers and facilitators to the mentoring process included the home and telephone as settings for support, geography and making contact with mentees. Findings from this study can help the development of peer mentor programmes in primary care for older people. Future programmes should recruit peer mentors who are local to where mentoring is needed to reduce travel difficulties.

  9. Food labeling; nutrition labeling of standard menu items in restaurants and similar retail food establishments. Final rule.

    PubMed

    2014-12-01

    To implement the nutrition labeling provisions of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA), the Food and Drug Administration (FDA or we) is requiring disclosure of certain nutrition information for standard menu items in certain restaurants and retail food establishments. The ACA, in part, amended the Federal Food, Drug, and Cosmetic Act (the FD&C Act), among other things, to require restaurants and similar retail food establishments that are part of a chain with 20 or more locations doing business under the same name and offering for sale substantially the same menu items to provide calorie and other nutrition information for standard menu items, including food on display and self-service food. Under provisions of the ACA, restaurants and similar retail food establishments not otherwise covered by the law may elect to become subject to these Federal requirements by registering every other year with FDA. Providing accurate, clear, and consistent nutrition information, including the calorie content of foods, in restaurants and similar retail food establishments will make such nutrition information available to consumers in a direct and accessible manner to enable consumers to make informed and healthful dietary choices.

  10. Medicaid program; state plan home and community-based services, 5-year period for waivers, provider payment reassignment, and home and community-based setting requirements for Community First Choice and home and community-based services (HCBS) waivers. Final rule.

    PubMed

    2014-01-16

    This final rule amends the Medicaid regulations to define and describe state plan section 1915(i) home and community-based services (HCBS) under the Social Security Act (the Act) amended by the Affordable Care Act. This rule offers states new flexibilities in providing necessary and appropriate services to elderly and disabled populations. This rule describes Medicaid coverage of the optional state plan benefit to furnish home and community based-services and draw federal matching funds. This rule also provides for a 5-year duration for certain demonstration projects or waivers at the discretion of the Secretary, when they provide medical assistance for individuals dually eligible for Medicaid and Medicare benefits, includes payment reassignment provisions because state Medicaid programs often operate as the primary or only payer for the class of practitioners that includes HCBS providers, and amends Medicaid regulations to provide home and community-based setting requirements related to the Affordable Care Act for Community First Choice State plan option. This final rule also makes several important changes to the regulations implementing Medicaid 1915(c) HCBS waivers.

  11. 45 CFR 155.20 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT... Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of.... Catastrophic plan means a health plan described in section 1302(e) of the Affordable Care Act. Code means the...

  12. 75 FR 70160 - Affordable Care Act; Federal External Review Process; Request for Information

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ...-9986-NC] DEPARTMENT OF LABOR Employee Benefits Security Administration 29 CFR Part 2590 Affordable Care... Affordable Care Act, and its implementing regulations. DATES: Submit written or electronic comments by... processes under the Affordable Care Act; those comments are being collected and evaluated on a separate...

  13. Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients.

    PubMed

    Gajewski, James L; McClellan, Mark B; Majhail, Navneet S; Hari, Parameswaran N; Bredeson, Christopher N; Maziarz, Richard T; LeMaistre, Charles F; Lill, Michael C; Farnia, Stephanie H; Komanduri, Krishna V; Boo, Michael J

    2018-01-01

    Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for the Accreditation of Cell Therapy. Payers have built on these community-established programs and use public outcomes and program accreditation as standards necessary for inclusion in specialty care networks and contracts. Although HCT centers have not been described as medical homes, most HCT providers have already developed the structures that address critical requirements of MACRA for medical homes. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  14. The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.

    PubMed

    Quast, Troy

    2013-01-01

    The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies. I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects. Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative. Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.

  15. The Patient Protection and Affordable Care Act of 2010: impact on otolaryngology practice and research.

    PubMed

    Sun, Gordon H; Davis, Matthew M

    2012-05-01

    The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. Since its passage, the PPACA has led to increased health insurance coverage for millions more Americans, and it includes provisions leading to new avenues for clinical and health services research funding. The legislation also favors development of the primary care specialties and general surgery, increased training of midlevel health care providers, and medical training and service in underserved areas of the United States. However, the PPACA does not effectively engage otolaryngologists in quality improvement, despite modifications to the Physician Quality Reporting System. The legislation also levies a tax on cosmetic procedures, affecting both clinicians and patients. This article reviews the sections of the PPACA that are most pertinent to otolaryngologists and explains how these components of the bill will affect otolaryngologic practice and research over the coming decade.

  16. Child Care and Development Fund: Report of State Plans FY 2002-2003.

    ERIC Educational Resources Information Center

    Administration on Children, Youth, and Families (DHHS), Washington, DC. Child Care Bureau.

    The Personal Responsibility and Work Opportunity Reconciliation Act requires each state to submit a biennial plan to implement the Child Care and Development Fund (CCDF). This report summarizes information in the biennial plans submitted for the period October 1, 2001 to September 30, 2003. The analysis includes information from 50 states, the…

  17. Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments.

    PubMed

    2010-12-01

    This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).

  18. Medicare program; payment policies under the physician fee schedule, five-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to part B for CY 2012. Final rule with comment period.

    PubMed

    2011-11-28

    This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

  19. The Affordable Care Act's implications for a public health workforce agenda: taxonomy, enumeration, and the Standard Occupational Classification system.

    PubMed

    Montes, J Henry; Webb, Susan C

    2015-01-01

    The Affordable Care Act brings a renewed emphasis on the importance of public health services and those whose occupations are defined by performing the essential public health functions. The Affordable Care Act Prevention and Public Health Fund is a signal to the field that its work is important and critical to the health of the nation. Recent reports by the Institute of Medicine describe the changing dimensions of public health work in primary care integration and the need for enhanced financing of public health as investment. Gaining knowledge about the public health workforce, that is, how many workers there are and what they are doing, is of growing interest and concern for the field. Although enumeration of the public health workforce has been attempted several times by the federal government beginning as early as 1982, it was not until the year 2000 that a major effort was undertaken to obtain more complete information. Limitations that hampered Enumeration 2000 have persisted however. With implementation of the Affordable Care Act and other new ventures, key federal agencies are developing strategies to pursue a systemic and systematic enumeration and consistent taxonomy process. Included in these efforts is use of the Bureau of Labor Statistics, Standard Occupational Classification system. A clear and accurate understanding of the public health workforce and its characteristics is a major challenge. A well-constructed, systematic enumeration process can add to our understanding of the nature and functions of that workforce. In addition, discussion of enumeration must include the need for a consensus within the field that leads to a consistent taxonomy for the public health occupations. This article will provide a stage-setting brief of historical actions regarding enumeration, and it will examine selected enumeration activities taking place currently. It will discuss positive and negative implications facing public health and the potential for enhancing the existing Standard Occupational Classification system to aid enumeration studies.

  20. 75 FR 15441 - Privacy Act of 1974; Report of an Altered System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ..., speech pathologists, health care administration personnel, nurses, allied health personnel, medical technologists, chiropractors, clinical psychologists, and other health personnel may be included. CATEGORIES OF...

  1. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

    PubMed

    Duska, Linda R; Engelhard, Carolyn L

    2013-06-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. How the center for Medicare and Medicaid innovation should test accountable care organizations.

    PubMed

    Shortell, Stephen M; Casalino, Lawrence P; Fisher, Elliott S

    2010-07-01

    The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development.

  3. Republic Act No. 6766, 23 October 1989.

    PubMed

    1989-01-01

    This document contains major provisions of the 1989 Republic Act setting forth the Organic Act for the Cordillera Autonomous Region in the Philippines. Article 2 contains guiding principles and policies which call for 1) ensuring equal access to resources, employment, and services; 2) minimizing inequities and disparities; 3) preventing sex discrimination in the work place; and 4) protecting children from abuse or harmful employment. Article 10 covers personal, family, tribal, and property relations and recognizes customary law in these areas (including marriage) among members of indigenous groups or cultural communities. Article 9 deals with ancestral domain and ancestral lands and directs the Regional Government to protect the same. Article 16 discusses social justice and welfare and provides for a living wage, profit-sharing schemes, and occupational safety. In the area of health care, this article calls for establishment of a primary health care delivery system, health education, training for health care workers, establishment of a food and drug regulatory system, research into traditional medicine, financing schemes to lower health care costs, and protection of vulnerable groups. Housing programs will be instituted where needed, women's status will be enhanced, child care support systems will be established, and women will receive education in regard to their rights and responsibilities to correct stereotypes.

  4. Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

    PubMed

    Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

    2016-02-01

    Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

  5. Care of the family in the surgical intensive care unit.

    PubMed

    Tyrie, Leslie Steele; Mosenthal, Anne Charlotte

    2011-04-01

    In the surgical intensive care unit (SICU), the stress of having a critically ill loved one creates significant bereavement and emotional needs for family members. Surgical palliative care has expanded; clinicians do not just treat the patient, but now include the family within the scope of care. Understanding and treating complicated grief, and the emotional and educational needs of the family improves family outcome, improves the surrogate family's ability to act as decision makers, and ultimately may positively affect patient survivor outcome. Care of families in the SICU requires interdisciplinary teams and palliative care processes to appropriately address their needs. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Bridging the gap in care for children through the clinical nurse leader.

    PubMed

    O'Grady, Erin L; VanGraafeiland, Brigit

    2012-01-01

    Care coordination has been identified as a gap in the nursing care of children and families who experience an encounter within the health care system. The educational preparation of the clinical nurse leader (CNL) enables the CNL to address many gaps found in health care. Current evidence suggests various gaps in care, as reported by patients, families, nurses, and other health care providers. Identified gaps in care include problems with communication, coordination, education, research, advocacy, psychological and social support, and the needs of siblings. The CNL may improve quality of care for children through efficient care coordination by acting as a liaison and advocate between the patient, family, and health care team to bridge gaps in the current practices of care.

  7. Applying the plan-do-study-act model to increase the use of kangaroo care.

    PubMed

    Stikes, Reetta; Barbier, Denise

    2013-01-01

    To increase the rate of participation in kangaroo care within a level III neonatal intensive care unit. Preterm birth typically results in initial separation of mother and infant which may disrupt the bonding process. Nurses within the neonatal intensive care unit can introduce strategies that will assist parents in overcoming fears and developing relationships with their infants. Kangaroo care is a method of skin-to-skin holding that has been shown to enhance the mother-infant relationship while also improving infant outcomes. However, kangaroo care has been used inconsistently within neonatal intensive care unit settings. The Plan-Do-Study-Act Model was used as a framework for this project. Plan-Do-Study-Act Model uses four cyclical steps for continuous quality improvement. Based upon Plan-Do-Study-Act Model, education was planned, surveys were developed and strategies implemented to overcome barriers. Four months post-implementation, the use of kangaroo care increased by 31%. Staff surveys demonstrated a decrease in the perceived barriers to kangaroo care as well as an increase in kangaroo care. Application of Plan-Do-Study-Act Model was successful in meeting the goal of increasing the use of kangaroo care. The use of the Plan-Do-Study-Act Model framework encourages learning, reflection and validation throughout implementation. Plan-Do-Study-Act Model is a strategy that can promote the effective use of innovative practices in nursing. © 2013 Blackwell Publishing Ltd.

  8. The success and repeal of the Medicare Catastrophic Coverage Act: a paradoxical lesson for health care reform.

    PubMed

    Aaronson, W E; Zinn, J S; Rosko, M D

    1994-01-01

    Congress intended the Medicare Catastrophic Coverage Act (MCCA) of 1988 to reduce the risk for illness-related catastrophic financial losses in the elderly. The act was short-lived, facing repeal just one year after passage. Many elderly persons were convinced that the costs of the program outweighed the benefits. However nursing home payment provisions of the MCCA may have affected out-of-pocket expenses paid by the elderly for long-term care more than consumers realized at the time of repeal. A transmittal memorandum, issued by the Health Care Financing Administration independent of Congressional action, enhanced consumers' ability to qualify for Medicare nursing home benefits. We investigated the effects of the Medicare policy change on nursing home payer mix and out-of-pocket expenses in 489 Pennsylvania nursing homes. We found that substantial shifts in payer mix from self-pay to Medicare payment sources occurred, reducing out-of-pocket expenses. Unfortunately the debate over the MCCA's repeal did not include discussion of the improved nursing home benefit structure. These findings, and the fate of the MCCA legislation, reinforce the importance of comprehensive information and clear communication in promoting health care reform.

  9. Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013: its impact in the Northern Rivers, NSW.

    PubMed

    Fraser, Alice C; Williams, Sarah E; Kong, Sarah X; Wells, Lucy E; Goodall, Louise S; Pit, Sabrina; Hansen, Vibeke; Trent, Marianne

    2016-04-15

    The objective of the study was to explore the impact of implementation of the Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013 on child-care centres in the Northern Rivers region of New South Wales (NSW), from the perspective of child-care centre directors. Importance of study: Immunisation is an effective public health intervention, but more than 75 000 Australian children are not fully vaccinated. A recent amendment to the NSW Public Health Act 2010 asks child-care facilities to collect evidence of complete vaccination or approved exemption before allowing enrolment. Ten child-care centre directors participated in a semiscripted interview. Interviews were recorded, transcribed and analysed. Common themes included misinterpretation of the amendment before implementation, the importance of adequate notice for implementation, lack of understanding of assessment of compliance, increased administrative requirements, the importance of other public health efforts, and limited change in vaccination rates. Child-care centres differed in their experience of the resources provided by the government, interactions with Medicare, and ease of integration with existing record-keeping methods. Participants felt that the amendment was successfully implemented. The amendment was felt to have fulfilled its aim of prompting parents who had forgotten to vaccinate, but failed to significantly affect conscientious objectors. Overall, the amendment was perceived to be a positive step in improving vaccination rates, but its impact was largely complementary to other components of the multifaceted vaccination policy.

  10. Analysis of State Laws and Policies Following the Implementation of the Fostering Connections to Success and Increasing Adoptions Act

    ERIC Educational Resources Information Center

    Perfect, Michelle M.; Stoll, Katherine A.; Thompson, Kristin C.; Scott, Roxanne E.

    2013-01-01

    The Fostering Connections to Success and Increasing Adoptions Act was implemented in 2008 (P.L. 110-351) in an effort to meet the needs of youth in foster care, including issues related to educational stability, educational services to support stability, and transition into higher education or the workforce. This article examines the written laws,…

  11. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Nonquantitative Treatment Limits for Specialty Behavioral Health Care.

    PubMed

    Thalmayer, Amber Gayle; Harwood, Jessica M; Friedman, Sarah; Azocar, Francisca; Watson, L Amy; Xu, Haiyong; Ettner, Susan L

    2018-05-08

    To assess frequency, type, and extent of behavioral health (BH) nonquantitative treatment limits (NQTLs) before and after implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Secondary administrative data for Optum carve-out and carve-in plans. Cross-tabulations and "two-part" regression models were estimated to assess associations of parity period with NQTLs. Optum provided four proprietary BH databases, including 2008-2013 data for 40 carve-out and 385 carve-in employers from Optum's claims processing databases and 2010 data from interviews conducted by Optum's parity compliance team with 49 carve-out employers. Preparity, carve-out plans required preauthorization for in-network inpatient/intermediate care; otherwise coverage was denied. Postparity, 73 percent would review later by request and half charged no penalty for late authorization. Outpatient visit authorization requirements virtually disappeared. For carve-out out-of-network inpatient/intermediate care, and for carve-ins, plans changed penalties to match medical service policies, but this did not necessarily lead to fewer requirements or lower penalties. After 2011, MHPAEA was associated with the transformation of BH care management, including much less restrictive preauthorization requirements, especially for in-network care provided by carve-out plans. © Health Research and Educational Trust.

  12. 77 FR 48550 - Technicolor Creative Services, Post Production Feature Mastering Division Including On-Site...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-14

    ... Services, Post Production Feature Mastering Division Including On-Site Leased Workers From Ajilon... Services, Post Production Feature Mastering Division, Hollywood, California (subject firm). The worker... the workers meet the eligibility requirements of the Trade Act of 1974. Conclusion After careful...

  13. The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

    PubMed

    Kelly, B D

    2017-05-01

    Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

  14. An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act

    PubMed Central

    Kwan, Bethany M.; Valeras, Aimee B.; Levey, Shandra Brown; Nease, Donald E.; Talen, Mary E.

    2015-01-01

    The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability. PMID:29546130

  15. The Patient Protection and Affordable Care Act: the impact on urologic cancer care.

    PubMed

    Keegan, Kirk A; Penson, David F

    2013-10-01

    In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the USA. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urologic cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. Published by Elsevier Inc.

  16. Implications of the 2017 Tax Cuts and Jobs Act for Public Health.

    PubMed

    Glied, Sherry

    2018-06-01

    The recently passed Tax Cuts and Jobs Act will reduce total federal revenues by about 4% between 2018 and 2027. The law makes multiple changes to the taxation of individuals and corporations. It also repeals the Affordable Care Act's (ACA's) individual mandate penalties, which will erase some of the gains in insurance coverage achieved since implementation of the ACA's coverage expansions. The resulting increases in rates of uninsurance will likely lead to increased uncompensated care and deflect hospitals and health departments from addressing other prevention and public health needs. In addition, the law is expected to lead to substantial increases in the federal debt and, consequently, to calls for reductions in spending on entitlement programs, particularly Medicare, and on discretionary programs, including public health. Many other provisions of the law could also have second-order effects on public health.

  17. Young adults' health care utilization and expenditures prior to the Affordable Care Act.

    PubMed

    Lau, Josephine S; Adams, Sally H; Boscardin, W John; Irwin, Charles E

    2014-06-01

    To examine young adults' health care utilization and expenditures prior to the Affordable Care Act. We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income. Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex. Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  18. Finally, fixing health care: what's different now?

    PubMed

    Wyden, Ron; Bennett, Bob

    2008-01-01

    Is now the time to fix the U.S. health care system? Those who remember the failed attempts of the past would say no. We see it differently. Our optimism is rooted in new developments that didn't exist the last time Congress addressed health care. These include bipartisan support for our Healthy Americans Act; an ideological truce over the role of government in health care; common ground between business and labor; the realization that states can't go it alone on health care; the plight of employers in a global marketplace; and the need for coverage that is affordable, accessible, and portable.

  19. Case management.

    PubMed

    Woodward, Judy; Rice, Eve

    2015-03-01

    Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. A Critical Analysis of Foster Youth Advisory Boards in the United States

    ERIC Educational Resources Information Center

    Forenza, Brad; Happonen, Robin G.

    2016-01-01

    Background: The enactment of the John H. Chafee Foster Care Independence Act brought welcome attention to young people aging out of foster care, and sought to include them in both case planning and policy dialog. Foster Youth Advisory Boards help to promote such inclusion, though the implementation of those boards has not been formally analyzed.…

  1. 42 CFR 476.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT... under section 1154(a)(4) of the Act, a QIO must determine whether the quality of services (including... 42 Public Health 4 2010-10-01 2010-10-01 false Review of the quality of care of risk-basis health...

  2. The Care Manager's Dilemma: Balancing Human Rights with Risk Management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

    ERIC Educational Resources Information Center

    Prebble, Kate; Diesfeld, Kate; Frey, Rosemary; Sutton, Daniel; Honey, Michelle; Vickery, Russell; McKenna, Brian

    2013-01-01

    In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such "care recipients" from the criminal justice system to a disability…

  3. 24 CFR 5.306 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... identified by HUD through notice; or (C) For which preference in tenant selection is given for all units in... programs identified by HUD through notice. (ii) This term does not include health and care facilities that have mortgage insurance under the National Housing Act. This term also does not include any of the...

  4. 24 CFR 5.306 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... identified by HUD through notice; or (C) For which preference in tenant selection is given for all units in... programs identified by HUD through notice. (ii) This term does not include health and care facilities that have mortgage insurance under the National Housing Act. This term also does not include any of the...

  5. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

  6. 76 FR 41261 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1003

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. The ACA...

  7. 76 FR 54773 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-02

    ... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. REACH...

  8. The financial impacts of the nursing shortage.

    PubMed

    Rivers, Patrick A; Tsai, Kai-Li; Munchus, George

    2005-01-01

    This article examines the multiple factors leading to the nursing shortage and the financial impact of the nursing shortage on hospitals and health care providers, the government, society and educational institutions. Nursing shortages have occurred in this country throughout history, however, the current shortage is especially grappling due to the financial condition of the health care system, Health Insurance Portability and Accountability Act, the Balanced Budget Act, the compounding conditions that have led up to the shortage and the forecasted health care needs. Many solutions have been proposed to improve the nursing shortage. This article provides recommendations to problem solving methods and discusses some current policy alternatives, including recently enacted "nurse-patient ratio" regulation, demonstrated by California state policy and the "Magnet Certification" program developed by American Nursing Credential Center (ANCC). This article further examines the financial impacts on nursing shortage problem.

  9. Health insurance exchanges under the Patient Protection and Affordable Care Act: regulatory and design challenges.

    PubMed

    Hoffmann, Stephanie M

    2012-12-01

    Under the Patient Protection and Affordable Care Act, all states are required to establish health insurance exchanges, marketplaces where individuals and small businesses can purchase health care coverage. In establishing these exchanges, states must address a range of regulatory and design issues to ensure that their exchanges are sustainable and meet the needs of their populations. The issues include the degree of federal involvement in the management of the exchanges, the overall structure and governance of the exchanges, the requirements for insurance plans to be offered on the exchanges, and the design of the exchanges themselves. Each of these issues will play a crucial role in determining the quality of coverage offered to consumers and how effectively they can access that coverage. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. Adaptation of neurological practice and policy to a changing US health-care landscape.

    PubMed

    Gorelick, Philip B

    2016-04-01

    Health care in the USA is undergoing a drastic transformation under the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act is driving major health-care policy changes by connecting payment for traditional health-care services to value-based care initiatives and emphasising population health and innovative mechanisms to deliver care. Under the Patient Protection and Affordable Care Act, neurological practice will need to adapt and transform. Therefore, neurological policy should consider employing a new framework for neurological residency training, developing interdisciplinary team approaches to neurological subspecialty care, and strengthening the primary care-neurological specialty care interface to avoid redundancies and other medical waste. Additionally, neurological policy will need to support a more robust review of diagnostic and care pathway use to reduce avoidable expenditures, and test and implement bundled payments for key neurological diagnoses. In view of an anticipated 19% shortage of US neurologists in the next 10 years, development of new neurological policy under the Patient Protection and Affordable Care Act is paramount. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. 75 FR 56601 - Privacy Act of 1974: New System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-16

    ...The Patient Protection and Affordable Care Act (the Affordable Care Act), Public Law 111-148, was enacted on March 23, 2010; the Health Care and Education Reconciliation Act (the Reconciliation Act), Public Law 111-152, was enacted on March 30, 2010. The Affordable Care Act and implementing regulations (codified in HHS interim final rules (IFR) at 45 CFR Part 147) require that non-grandfathered health insurance plans and issuers offering group and individual coverage have effective internal claims and appeals and external review processes. The effective date for these requirements is plan or policy years beginning on or after September 23, 2010. Regarding external review, the statute requires that health plans and issuers must comply with either a state external review process or a process meeting standards issued by the Secretary of Health and Human Services (HHS) that is ``similar to'' a state process meeting requirements in section 2719 (a ``federal external review process''). The IFR includes a transition period prior to July 1, 2011, during which time HHS will work with states to assist in making any necessary changes so that the state process will meet the minimum consumer protections identified in 45 CFR 147.136 that must be met in order for the state process to apply. During this interim period, health insurance issuers in states with external review laws in effect prior to September 23, 2010 will follow that state's external review law to the extent applicable. In states that have not passed an external review law that is in effect on September 23, 2010, a health insurance issuer must follow an interim federal external review process that will be administered by the Office of Personnel Management (OPM). The system of records will be created as OPM assists HHS by providing external reviews of adverse benefit determinations and final internal adverse benefit determinations as requested by eligible claimants and their authorized representatives (``claimants''). The system of records will include any data relevant to these external reviews, and OPM proposes to add this new system of records to its inventory of records systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. This action is necessary to meet the requirements of the Privacy Act to publish in the Federal Register notice of the existence and character of records maintained by the agency (5 U.S.C. 552a(e)(4)).

  12. Working with the Mental Capacity Act: findings from specialist palliative and neurological care settings.

    PubMed

    Wilson, Eleanor; Seymour, Jane E; Perkins, Paul

    2010-06-01

    Since October 2007 staff across health and social care services in England and Wales have been guided by the Mental Capacity Act (2005) in the provision of care for those who may lack capacity to make some decisions for themselves. This paper reports on the findings from a study with 26 staff members working in three palliative and three neurological care centres. Semistructured interviews were used to gain an understanding of their knowledge of the Mental Capacity Act, the issue of capacity itself and the documentation processes associated with the introduction of the Act and in line with advance care planning. Within this setting advance care planning is a key part of care provision and the mental capacity of service users is a regular issue. Findings show that staff generally had a good understanding of issues around capacity but felt unclear about some of the terminology related to the Mental Capacity Act, impacting on their confidence to discuss issues with service users and complete the documentation. Many felt the Act and its associated documentation had aided record-keeping in an area staff already delivered well in practice. Advance care planning in the context of the Mental Capacity Act is not as well embedded in practice as providers would like and consideration needs to be given to how and when staff should approach these issues with service users.

  13. Medicare's chronic care improvement pilot program: what is its potential?

    PubMed

    Super, Nora

    2004-05-10

    This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician's role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

  14. 77 FR 26046 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-02

    ... for OMB Review; Comment Request; Affordable Care Act Internal Claims and Appeals and External Review...) titled, ``Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non... provisions of the Affordable Care Act pertaining to internal claims and appeals, and the external review...

  15. 76 FR 20352 - Notice of Intent To Award Affordable Care Act (ACA) Funding

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-12

    ... Intent To Award Affordable Care Act (ACA) Funding Notice of Intent to award Affordable Care Act (ACA) funding to two Emerging Infections Program (EIP) grantees, the Connecticut Department of Public Health and... grantees' Fiscal Year (FY) 2011 non-competitive continuation applications under funding opportunity CI05...

  16. 76 FR 20354 - Notice of Intent To Award Supplemental Affordable Care Act Funding

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-12

    ... Intent To Award Supplemental Affordable Care Act Funding Notice of Intent to award supplemental Affordable Care Act funding to support enhancement of an existing laboratory fellowship training program through funding opportunity CDC-RFA-HM10-1001, ``APHL--CDC Partnership for Quality Laboratory Practice...

  17. Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals. Final rule.

    PubMed

    2013-08-30

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change.

  18. GAO audit not apt to find pervasive fraud in CARE Act.

    PubMed

    1999-12-24

    After hearing a series of news reports suggesting financial improprieties in programs run by Ryan White CARE Act recipients, a General Accounting Office (GAO) review of the program was made. A preliminary GAO report found only a few cases of fraud in the administration of funding stemming from the CARE Act, but that the potential for fraud is very real because of the lack of safeguards. These findings are considered important since the House Commerce Committee is expected to conduct oversight hearings into further authorization of the CARE Act early in 2000.

  19. Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; Small Business Health Options Program. Final rule.

    PubMed

    2013-06-04

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) related to the Small Business Health Options Program (SHOP). Specifically, this final rule amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP.

  20. 76 FR 81366 - TRICARE: Changes Included in the National Defense Authorization Act for Fiscal Year 2010...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ...; Enhancement of Transitional Dental Care for Members of the Reserve Component on Active Duty for More Than 30... health care dental benefits for Reserve Component members on active duty for more than 30 days in support... in the same manner as a member of the uniformed services on active duty for more than 30 days, thus...

  1. Child Care and Development Fund: Report of State Plans for the Period 10/01/99 to 9/30/01.

    ERIC Educational Resources Information Center

    Stoney, Louise; Stanton, Nina

    The Personal Responsibility and Work Opportunity Reconciliation Act requires each state to submit a biennial plan to implement the Child Care and Development Fund (CCDF). This report is based on the approved State Plans for the period October 1, 1999 to September 30, 2001. The analysis includes information from 48 states, the District of Columbia,…

  2. Willingness and ability to pay for artemisinin-based combination therapy in rural Tanzania

    PubMed Central

    Saulo, Eleonor C; Forsberg, Birger C; Premji, Zul; Montgomery, Scott M; Björkman, Anders

    2008-01-01

    Background The aim of this study was to analyse willingness to pay (WTP) and ability to pay (ATP) for ACT for children below five years of age in a rural setting in Tanzania before the introduction of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. Socio-economic factors associated with WTP and expectations on anti-malaria drugs, including ACT, were also explored. Methods Structured interviews and focus group discussions were held with mothers, household heads, health-care workers and village leaders in Ishozi, Gera and Ishunju wards in north-west Tanzania in 2004. Contingent valuation method (CVM) was used with "take-it-or-leave-it" as the eliciting method, expressed as WTP for a full course of ACT for a child and households' opportunity cost of ACT was used to assess ATP. The study included descriptive analyses with multivariate adjustment for potential confounding factors. Results Among 265 mothers and household heads, 244 (92%, CI = 88%–95%) were willing to pay Tanzanian Shillings (TSh) 500 (US$ 0.46) for a child's dose of ACT, but only 55% (49%–61%) were willing to pay more than TSh 500. Mothers were more often willing to pay than male household heads (adjusted odds ratio = 2.1, CI = 1.2–3.6). Socio-economic status had no significant effect on WTP. The median annual non-subsidized ACT cost for clinical malaria episodes in an average household was calculated as US$ 6.0, which would represent 0.9% of the average total consumption expenditures as estimated from official data in 2001. The cost of non-subsidized ACT represented 7.0% of reported total annual expenditure on food and 33.0% of total annual expenditure on health care. "Rapid effect," "no adverse effect" and "inexpensive" were the most desired features of an anti-malarial drug. Conclusion WTP for ACT in this study was less than its real cost and a subsidy is, therefore, needed to enable its equitable affordability. The decision taken in Tanzania to subsidize Coartem® fully at governmental health care facilities and at a consumer price of TSh 300–500 (US$ 0.28–0.46) at special designated shops through the programme of Accredited Drug Dispensing Outlets (ADDOs) appears to be well founded. PMID:18976453

  3. Willingness and ability to pay for artemisinin-based combination therapy in rural Tanzania.

    PubMed

    Saulo, Eleonor C; Forsberg, Birger C; Premji, Zul; Montgomery, Scott M; Björkman, Anders

    2008-10-31

    The aim of this study was to analyse willingness to pay (WTP) and ability to pay (ATP) for ACT for children below five years of age in a rural setting in Tanzania before the introduction of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria. Socio-economic factors associated with WTP and expectations on anti-malaria drugs, including ACT, were also explored. Structured interviews and focus group discussions were held with mothers, household heads, health-care workers and village leaders in Ishozi, Gera and Ishunju wards in north-west Tanzania in 2004. Contingent valuation method (CVM) was used with "take-it-or-leave-it" as the eliciting method, expressed as WTP for a full course of ACT for a child and households' opportunity cost of ACT was used to assess ATP. The study included descriptive analyses with multivariate adjustment for potential confounding factors. Among 265 mothers and household heads, 244 (92%, CI = 88%-95%) were willing to pay Tanzanian Shillings (TSh) 500 (US$ 0.46) for a child's dose of ACT, but only 55% (49%-61%) were willing to pay more than TSh 500. Mothers were more often willing to pay than male household heads (adjusted odds ratio = 2.1, CI = 1.2-3.6). Socio-economic status had no significant effect on WTP. The median annual non-subsidized ACT cost for clinical malaria episodes in an average household was calculated as US$ 6.0, which would represent 0.9% of the average total consumption expenditures as estimated from official data in 2001. The cost of non-subsidized ACT represented 7.0% of reported total annual expenditure on food and 33.0% of total annual expenditure on health care."Rapid effect," "no adverse effect" and "inexpensive" were the most desired features of an anti-malarial drug. WTP for ACT in this study was less than its real cost and a subsidy is, therefore, needed to enable its equitable affordability. The decision taken in Tanzania to subsidize Coartem fully at governmental health care facilities and at a consumer price of TSh 300-500 (US$ 0.28-0.46) at special designated shops through the programme of Accredited Drug Dispensing Outlets (ADDOs) appears to be well founded.

  4. Health care reform: preparing the psychology workforce.

    PubMed

    Rozensky, Ronald H

    2012-03-01

    This article is based on the opening presentation by the author to the Association of Psychologists in Academic Health Centers' 5th National Conference, "Preparing Psychologists for a Rapidly Changing Healthcare Environment" held in March, 2011. Reviewing the patient protection and affordable care act (ACA), that presentation was designed to set the stage for several days of symposia and discussions anticipating upcoming changes to the healthcare system. This article reviews the ACA; general trends that have impacted healthcare reform; the implications of the Act for psychology's workforce including the growing focus on interprofessional education, training, and practice, challenges to address in order to prepare for psychology's future; and recommendations for advocating for psychology's future as a healthcare profession.

  5. A primer for health care managers: data sanitization, equipment disposal, and electronic waste.

    PubMed

    Andersen, Cathy M

    2011-01-01

    In this article, security regulations under the Health Insurance Portability and Accountability Act concerning data sanitization and the disposal of media containing stored electronic protected health information are discussed, and methods for effective sanitization and media disposal are presented. When disposing of electronic media, electronic waste-or e-waste-is produced. Electronic waste can harm human health and the environment. Responsible equipment disposal methods can minimize the impact of e-waste. Examples of how health care organizations can meet the Health Insurance Portability and Accountability Act regulations while also behaving responsibly toward the environment are provided. Examples include the environmental stewardship activities of reduce, reuse, reeducate, recover, and recycle.

  6. The new follow-on-biologics law: a section by section analysis of the patent litigation provisions in the Biologics Price Competition and Innovation Act of 2009.

    PubMed

    Dougherty, Michael P

    2010-01-01

    An abbreviated pathway for the approval of biosimilar biological products, often called "follow-on biologics," has been enacted into law as part of the health care legislation recently passed by Congress and signed by the President. The subtitle of the health care bill establishing this approval pathway, the Biologics Price Competition and Innovation Act of 2009, includes many provisions governing the identification of patents relevant to a given biosimilar biological product and the assertion of those patents in infringement suits. This article provides a section-by-section analysis of the patent-related provisions of the new approval pathway for biosimilar biological products, and points out several ways in which the new law differs fundamentally from the Hatch-Waxman Act, which provides the approval pathway for generic versions of small molecule drugs.

  7. As roughly 700,000 prisoners are released annually, about half will gain health coverage and care under federal laws.

    PubMed

    Cuellar, Alison Evans; Cheema, Jehanzeb

    2012-05-01

    During 2009, 730,000 prisoners were released from federal and state prisons--a 21 percent increase from the number of prisoners released in 2000. Poor health and poor health coverage have been major challenges for former prisoners trying to reintegrate into the community and find work. We discuss these challenges and the likely effect of recent federal legislation, including the Second Chance Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act. We estimated that with the implementation of health reform, up to 33.6 percent of inmates released annually--more than 245,000 people in 2009--could enroll in Medicaid. Similarly, we estimated that up to 23.5 percent of prisoners released annually-more than 172,000 people in 2009-could be eligible for federal tax credits to defray the cost of purchasing insurance from state health exchanges. This health insurance, combined with new substance abuse services and patient-centered medical home models, could dramatically improve the health and success of former inmates as they return to the community. States should consider several policy changes to ease prisoners' transitions, including suspending rather than terminating Medicaid benefits for offenders; incorporating corrections information into eligibility determination systems; aiming Medicaid outreach and enrollment efforts at prison inmates; and designing comprehensive approaches to meeting former prisoners' health care needs.

  8. 20 CFR 662.240 - What are a program's applicable core services?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... under the Carl D. Perkins Vocational and Applied Technology Education Act (20 U.S.C. 2301 et seq.); and... availability of supportive services, including, at a minimum, child care and transportation, available in the...

  9. 20 CFR 662.240 - What are a program's applicable core services?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... under the Carl D. Perkins Vocational and Applied Technology Education Act (20 U.S.C. 2301 et seq.); and... availability of supportive services, including, at a minimum, child care and transportation, available in the...

  10. 20 CFR 662.240 - What are a program's applicable core services?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... under the Carl D. Perkins Vocational and Applied Technology Education Act (20 U.S.C. 2301 et seq.); and... availability of supportive services, including, at a minimum, child care and transportation, available in the...

  11. 20 CFR 662.240 - What are a program's applicable core services?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... under the Carl D. Perkins Vocational and Applied Technology Education Act (20 U.S.C. 2301 et seq.); and... availability of supportive services, including, at a minimum, child care and transportation, available in the...

  12. 20 CFR 662.240 - What are a program's applicable core services?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... under the Carl D. Perkins Vocational and Applied Technology Education Act (20 U.S.C. 2301 et seq.); and... availability of supportive services, including, at a minimum, child care and transportation, available in the...

  13. 76 FR 53921 - Privacy Act of 1974; Department of Homeland Security ALL-034 Emergency Care Medical Records...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ..., and others performing or working on a contract, service, grant, cooperative agreement, or other... medical records, including psychological records, the decision to release directly to the individual, or...

  14. The cost of cancer care: Part II.

    PubMed

    Eagle, David

    2012-11-01

    The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancer care in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend.

  15. Small businesses and the Affordable Care Act of 2010.

    PubMed

    Collins, Sara R; Davis, Karen; Nicholson, Jennifer L; Stremikis, Kristof

    2010-09-01

    The Patient Protection and Affordable Care Act (ACA) includes several short- and long-term provisions designed to help small businesses pay for and maintain health insurance for their workers, and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers. Analysis shows that up to 16.6 million workers are in firms that would be eligible for the tax credit in 2010 to 2013. Over the next 10 years, small businesses and organizations could receive an estimated $40 billion in federal support through the premium credit program.

  16. Long-acting injectables and risk for rehospitalization among patients with schizophrenia in the home care program in Taiwan.

    PubMed

    Ju, Po-Chung; Chou, Frank Huang-Chih; Lai, Te-Jen; Chuang, Po-Ya; Lin, Yung-Jung; Yang, Ching-Wen Wendy; Tang, Chao-Hsiun

    2014-02-01

    We aimed at evaluating the relationship between medication and treatment effectiveness in a home care setting among patients with schizophrenia. Patients with schizophrenia hospitalized between 2004 and 2009 with a primary International Classification of Diseases, Ninth Revision, Clinical Modification code of 295 were identified from Psychiatric Inpatient Medical Claims Data released by the National Health Research Institute in Taiwan. Patients who joined the home care program after discharge and were prescribed long-acting injection (LAI) (the LAI group) or oral antipsychotic medications (the oral group) were included as study subjects. The final sample for the study included 810 participants in the LAI group and 945 in the oral group. Logistic regression was performed to examine the independent effect of LAI medication on the risk for rehospitalization within the 12-month observation window after controlling for patient and hospital characteristics and propensity score quintile adjustment. The unadjusted odds ratio for rehospitalization risk was 0.80 (confidence interval, 0.65-0.98) for the LAI group compared to the oral group. The adjusted odds ratio was further reduced to 0.78 (confidence interval, 0.63-0.97). Results remained unchanged when the propensity score quintiles were entered into the regression for further adjustment. In a home care setting, patients treated with long-acting antipsychotic agents are at a significantly lower risk for psychiatric rehospitalization than those treated with oral medication. Consequently, LAI home-based treatment for the prevention of schizophrenia relapse may lead to substantial clinical and economic benefits.

  17. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    PubMed

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  18. New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’

    PubMed Central

    Koh, Howard K.; Berwick, Donald M.; Clancy, Carolyn M.; Baur, Cynthia; Brach, Cindy; Harris, Linda M.; Zerhusen, Eileen G.

    2016-01-01

    Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy—a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services’ National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point—that is, poised to make the transition from the margins to the mainstream. If public and private organizations make it a priority to become health literate, the nation’s health literacy can be advanced to the point at which it will play a major role in improving health care and health for all Americans. PMID:22262723

  19. Function assertive community treatment (FACT) and psychiatric service use in patients diagnosed with severe mental illness.

    PubMed

    Drukker, M; van Os, J; Sytema, S; Driessen, G; Visser, E; Delespaul, P

    2011-09-01

    Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU). South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis. FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess. Implementation of FACT results in measurable changes in mental health care use.

  20. Providing Health Information to Latino Farmworkers: The Case of the Affordable Care Act.

    PubMed

    Arcury, Thomas A; Jensen, Anna; Mann, Mackenzie; Sandberg, Joanne C; Wiggins, Melinda F; Talton, Jennifer W; Hall, Mark A; Quandt, Sara A

    2017-01-01

    Providing health program information to vulnerable communities, such as Latino farmworkers, is difficult. This analysis describes the manner in which farmworkers receive information about the Affordable Care Act, comparing farmworkers with other Latinos. Interviews were conducted with 100 Latino farmworkers and 100 urban Latino North Carolina residents in 2015. Most farmworkers had received health information from a community organization. Trusted sources for health information were health care providers and community organizations. Sources that would influence decisions to enroll were Latino nurses and doctors, religious leaders, and family members. Traditional media, including oral presentation and printed material at the doctor's office, were preferred by the majority of farmworkers and non-farmworkers. Farmworkers used traditional electronic media: radio, television, and telephone. More non-farmworkers used current electronic media: e-mail and Internet. Latino farmworkers and non-farmworkers prefer traditional media in the context of a health care setting. They are willing to try contemporary electronic media for this information.

  1. 76 FR 41263 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1004

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... Intent To Award Affordable Care Act (ACA) Funding, EH10-1004 Notice of Intent to award Affordable Care Act (ACA) funding to National Association for Public Health Statistics and Information Systems... under funding opportunity EH10-1004, ``National Environmental Public Health Tracking Program.'' AGENCY...

  2. 76 FR 59703 - Notice of Intent To Award Affordable Care Act (ACA) Funding, RFA-TP-08-001

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... Intent To Award Affordable Care Act (ACA) Funding, RFA- TP-08-001 AGENCY: Centers for Disease Control and... of Intent to award Affordable Care Act (ACA) funding to Preparedness and Emergency Response Research... continuation application under Funding Opportunity Announcement RFA-TP- 08-001, ``Preparedness and Emergency...

  3. 76 FR 41929 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-15

    ... 153 Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Proposed Rule #0;#0;Federal Register / Vol. 76 , No. 136 / Friday, July 15, 2011...] RIN 0938-AR07 Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk...

  4. 78 FR 33233 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... would affect the ability of employers to offer stand-alone pediatric dental coverage in the FF- SHOP... Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Small... rule. SUMMARY: This final rule implements provisions of the Patient Protection and Affordable Care Act...

  5. 78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-28

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 54 [REG-120391-10] RIN 1545-BJ60 Coverage of Certain Preventive Services Under the Affordable Care Act; Correction AGENCY: Internal Revenue... Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security...

  6. 45 CFR 147.140 - Preservation of right to maintain existing coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

  7. 45 CFR 147.140 - Preservation of right to maintain existing coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

  8. 45 CFR 147.140 - Preservation of right to maintain existing coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... grandfathered health plan within the meaning of section 1251 of the Patient Protection and Affordable Care Act... Affordable Care Act, do not apply to grandfathered health plans. In addition, the provisions of PHS Act...

  9. 78 FR 19917 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-02

    ... 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the... Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30, 2010), and... Care Act that expand access to health coverage through improvements in Medicaid and the Children's...

  10. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-27

    ...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  11. Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

    PubMed

    2013-02-27

    This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  12. 75 FR 5325 - Implementation of Section 5001 of the American Recovery and Reinvestment Act of 2009 for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-02

    ... for which the increased FMAP is not available under title XIX include expenditures for...), and expenditures that are paid at an enhanced FMAP rate. The increased FMAP is available for expenditures under part E of title IV (including Foster Care, Adoption Assistance and Guardianship Assistance...

  13. 77 FR 16244 - Request for Comments on the Update of the Scholarships for Disadvantaged Students Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-20

    ... backgrounds, including students who are members of racial and ethnic minority groups. (PHS Act, Sec. 737(d)(1... social work, professional counseling, marriage and family therapy); and physician assistant training..., including students who are members of racial and ethnic minority groups. Also, the primary care weights are...

  14. Patient Protection and Affordable Care Act; exchange and insurance market standards for 2015 and beyond. Final rule.

    PubMed

    2014-05-27

    This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges (``Exchanges''), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed.

  15. Case studies from three states: breaking down silos between health care and criminal justice.

    PubMed

    Bechelli, Matthew J; Caudy, Michael; Gardner, Tracie M; Huber, Alice; Mancuso, David; Samuels, Paul; Shah, Tanya; Venters, Homer D

    2014-03-01

    The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.

  16. Telemedicine and its transformation of emergency care: a case study of one of the largest US integrated healthcare delivery systems.

    PubMed

    Sharma, Rahul; Fleischut, Peter; Barchi, Daniel

    2017-12-01

    Innovative methods for delivering healthcare via the use of technology are rapidly growing. Despite the passage of the Affordable Care Act, emergency department visits have continued to rise nationally. Healthcare systems must devise solutions to face these increasing volumes and also deliver high quality care. In response to the changing healthcare landscape, New York Presbyterian Hospital has implemented a comprehensive enterprise wide digital health portfolio which includes the first mobile stroke treatment unit on the east coast and the first emergency department-based digital emergency care program in New York City.

  17. Facading in transcultural interactions: examples from pediatric cancer care in Sweden.

    PubMed

    Pergert, Pernilla

    2017-07-01

    The aims of the study were to generate a grounded theory explaining the latent pattern of behavior in transcultural care interactions in the context of pediatric cancer care and to unify previously performed studies. The basic tenets of classic grounded theory were applied on a theoretical sample of data from previous studies that included 5 focus group interviews with health care professionals (n = 35) and individual interviews with nurses (n = 12) and foreign-born parents (n = 11). Facading emerged as the core category and is the act of showing an outer appearance that will influence other people's interpretations. In transcultural interactions, facading might be misinterpreted related to different obstacles. Examples are given of different facades explored in pediatric cancer care including strength facading. Facading is a strategy aiming to protect oneself and others emotionally in care and includes: emotional facading and facading-sensitive issues. This grounded theory could help make health care professionals aware of different meanings of facading across cultures in health care. Also, awareness is needed of different views on emotional facading and facading-sensitive issues to provide a congruent care. Copyright © 2016 John Wiley & Sons, Ltd.

  18. The paradox of the Aged Care Act 1997: the marginalisation of nursing discourse.

    PubMed

    Angus, Jocelyn; Nay, Rhonda

    2003-06-01

    This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.

  19. 45 CFR 1386.19 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON DEVELOPMENTAL DISABILITIES, DEVELOPMENTAL... such acts as: Verbal, nonverbal, mental and emotional harassment; rape or sexual assault; striking; the... treatment plan (including a discharge plan); provide adequate nutrition, clothing, or health care to an...

  20. Impact of Patient Protection and Affordable Care Act on academic radiology departments' clinical, research, and education missions.

    PubMed

    Mansoori, Bahar; Vidal, Lorenna L; Applegate, Kimberly; Rawson, James V; Novak, Ronald D; Ros, Pablo R

    2013-10-01

    The Patient Protection and Affordable Care Act (ACA) generated significant media attention since its inception. When the law was approved in 2010, the U.S. health care system began facing multiple changes to adapt and to incorporate measures to meet the new requirements. These mandatory changes will be challenging for academic radiology departments (ARDs) since they will need to promote a shift from a volume-focused to a value-focused practice. This will affect all components of the mission of ARDs, including clinical practice, education, and research. A unique key element to success in this transition is to focus on both quality and safety, thus improving the value of radiology in the post-ACA era. Given the changes ARDs will face during the implementation of ACA, suggestions are provided on how to adapt ARDs to this new environment. Copyright © 2013. Published by Elsevier Inc.

  1. The patient protection and affordable care act: what does it mean for mental health services for older adults?

    PubMed

    Sorrell, Jeanne M

    2012-11-01

    The U.S. Supreme Court recently upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). It is important to think about how this act will affect mental health services for older adults. The act has the potential to improve health outcomes across all income and age groups. There are specific provisions that are expected to improve care for individuals with mental illness, but there is little information about how these provisions will affect older adults with mental illness. As we move toward implementation of the PPACA, psychiatric nurses need to be aware of myths surrounding the act and to think about changes in the health care system, such as collaborative models of care, that may help identify and overcome barriers to treatment of older adults with mental illness. Copyright 2012, SLACK Incorporated.

  2. Medicare program; participation in CHAMPUS and CHAMPVA, hospital admissions for veterans, discharge rights notice, and hospital responsibility for emergency care--HCFA and OIG. Interim final rule with comment period.

    PubMed

    1994-06-22

    We are revising requirements for Medicare participating hospitals by adding the following: A hospital must provide inpatient hospital services to individuals who have health coverage provided by either the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA), subject to limitations provided by regulations that require the hospital to collect the beneficiary's cost-share and accept payment from the CHAMPUS/CHAMPVA programs as payment in full. A hospital must provide inpatient hospital services to military veterans (subject to the limitations provided in 38 CFR 17.50 ff.) and accept payment from the Department of Veterans Affairs as payment in full. A hospital must give each Medicare beneficiary (or his or her representative) at or about the time of admission, a written statement of his or her rights concerning discharge from the hospital. A hospital (including a rural primary care hospital) with an emergency department must provide, upon request and within the capabilities of the hospital or rural primary care hospital, an appropriate medical screening examination, stabilizing treatment and/or an appropriate transfer to another medical facility to any individual with an emergency medical condition, regardless of the individual's eligibility for Medicare. The statute provides for the termination of a provider's agreement for violation of any of these provisions. These revisions implement sections 9121 and 9122 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (as amended by section 4009 of the Omnibus Budget Reconciliation Act of 1987), section 233 of the Veteran's Benefit Improvement and Health Care Authorization Act of 1986, sections 9305(b)(1) and 9307 of the Omnibus Budget Reconciliation Act of 1986, sections 6003(g)(3)(D)(xiv), 6018 and 6211 of the Omnibus Budget Reconciliation Act of 1989, and sections 4008(b), 4027(a), and 4027(k)(3) of the Omnibus Budget Reconciliation Act of 1990.

  3. Procedures for the handling of retaliation complaints under section 1558 of the Affordable Care Act. Interim final rule; request for comments.

    PubMed

    2013-02-27

    This document provides the interim final regulations governing the employee protection (whistleblower) provision of section 1558 of the Affordable Care Act, which added section 18C of the Fair Labor Standards Act, to provide protections to employees of health insurance issuers or other employers who may have been subject to retaliation for reporting potential violations of the law's consumer protections (e.g., the prohibition on denials of insurance due to pre-existing conditions) or affordability assistance provisions (e.g., access to health insurance premium tax credits). This interim rule establishes procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary's final decision.

  4. 76 FR 56767 - Request for Information Regarding State Flexibility To Establish a Basic Health Program Under the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... essential health benefits described in section 1302(b) of the Affordable Care Act to eligible individuals in... Affordable Care Act; (2) covers at least the essential health benefits described in section 1302(b) of the Affordable Care Act; and (3) in the case of a plan that provides health insurance coverage offered by a...

  5. Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

    PubMed

    2014-02-24

    The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

  6. Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

    PubMed

    2013-02-25

    This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

  7. A study of occupational stress, scope of practice, and collaboration in nurse anesthetists practicing in anesthesia care team settings.

    PubMed

    Alves, Steve L

    2005-12-01

    This study examined occupational stress in Certified Registered Nurse Anesthetists (CRNAs) practicing with anesthesiologists in anesthesia care team (ACT) settings. The focus was to examine the relationships among CRNA scope of practice (SOP) in ACTs, collaboration, and role-related occupational stress. A survey questionnaire was mailed to CRNAs from the 6 New England states, with a return rate of 30.87% (n = 347). Data analysis included practice characteristics and demographics of the sample, and the research questions were examined applying correlational analysis, t test, and analysis of variance addressing relationships among the study measures. Data analyses revealed that limited, restricted CRNA practice scope was particularly evident in respondents employed by anesthesiology groups, compared with hospital-employed CRNAs. Few CRNA respondents perceived their practice as collaborative, and many used compromise as a conflict-resolution style. Respondents with a broader SOP reported higher collaboration than those with restrictions. Respondents reporting a broader SOP also experienced increased job stress in relation to role overload but used coping resources effectively. Implications for future studies include exploring strategies that achieve consensus between CRNAs and anesthesiologists in ACTs, emphasizing clearly defined roles and optimizing productivity.

  8. US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

    PubMed

    Axelrod, D A; Millman, D; Abecassis, M M

    2010-10-01

    The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

  9. The Affordable Care Act, Insurance Coverage, and Health Care Utilization of Previously Incarcerated Young Men: 2008-2015.

    PubMed

    Winkelman, Tyler N A; Choi, HwaJung; Davis, Matthew M

    2017-05-01

    To estimate health insurance and health care utilization patterns among previously incarcerated men following implementation of the Affordable Care Act's (ACA's) Medicaid expansion and Marketplace plans in 2014. We performed serial cross-sectional analyses using data from the National Survey of Family Growth between 2008 and 2015. Our sample included men aged 18 to 44 years with (n = 3476) and without (n = 8702) a history of incarceration. Uninsurance declined significantly among previously incarcerated men after ACA implementation (-5.9 percentage points; 95% confidence interval [CI] = -11.5, -0.4), primarily because of an increase in private insurance (6.8 percentage points; 95% CI = 0.1, 13.3). Previously incarcerated men accounted for a large proportion of the remaining uninsured (38.6%) in 2014 to 2015. Following ACA implementation, previously incarcerated men continued to be significantly less likely to report a regular source of primary care and more likely to report emergency department use than were never-incarcerated peers. Health insurance coverage improved among previously incarcerated men following ACA implementation. However, these men account for a substantial proportion of the remaining uninsured. Previously incarcerated men continue to lack primary care and frequently utilize acute care services.

  10. Community health centers at the crossroads: growth and staffing needs.

    PubMed

    Proser, Michelle; Bysshe, Tyler; Weaver, Donald; Yee, Ronald

    2015-04-01

    In response to increased demand for primary care services under the Affordable Care Act, the national network of community health centers (CHCs) will play an increasingly prominent role. CHCs have a broad staffing model that includes extensive use of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs). Between 2007 and 2012, the number of PAs, NPs, and CNMs at CHCs increased by 61%, compared with 31% for physicians. However, several policy and payment issues jeopardize CHCs' ability to expand their workforce and meet the current and rising demand for care.

  11. Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management

    PubMed Central

    Chabot, Elizabeth; Nirula, Ram

    2017-01-01

    The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen. PMID:29766080

  12. Making the case for a model mental health advance directive statute.

    PubMed

    Clausen, Judy A

    2014-01-01

    Acute episodes of mental illness temporarily destroy the capacity required to give informed consent and often prevent people from realizing they are sick, causing them to refuse intervention. Once a person refuses treatment, the only way to obtain care is as an involuntary patient. Even in the midst of acute episodes, many people do not meet commitment criteria because they are not likely to injure themselves or others and are still able to care for their basic needs. Left untreated, the episode will likely spiral out of control. By the time the person finally meets strict commitment criteria, devastation has already occurred. This Article argues that an individual should have the right to enter a Ulysses arrangement, a special type of mental health advance directive that authorizes a doctor to administer treatment during a future episode even if the episode causes the individual to refuse care. The Uniform Law Commissioners enacted the Uniform Health-Care Decisions Act as a model statute to address all types of advance health care planning, including planning for mental illness. However, the Act focuses on end-of-life care and fails to address many issues faced by people with mental illness. For example, the Act does not empower people to enter Ulysses arrangements and eliminates writing and witnessing requirements that protect against fraud and coercion. This Article recommends that the Uniform Law Commissioners adopt a model mental health advance directive statute that empowers people to enter Ulysses arrangements and provides safeguards against abuse. Appendix A sets forth model provisions.

  13. Pressures on the dental care system in the United States.

    PubMed Central

    Wotman, S; Goldman, H

    1982-01-01

    A number of significant pressures are creating tensions in the dental profession and the dental care delivery system. These pressures may be categorized in five major areas: 1) regulation and deregulation pressures involve changes in the state dental practice acts, court decisions concerning antitrust and advertising, and the inclusion of consumers on State professional regulatory boards; 2) cost of services includes factors involving the out-of-pocket cost of dental care and the growth of dental insurance; 3) dentist-related factors include the increased number of dentists and the indebtedness of dental graduates; 4) the pressures of changes in the American populations include the decline in population growth and the increase in proportion of elderly people; 5) changes in the distribution of dental care are based on new epidemiologic data concerning dental caries and progress in the prevention of periodontal disease. Many of these pressures are inducing competition in the dental care system. It is clear that the dental care system is in the process of change as it responds to these complex pressures. PMID:7091458

  14. Pressures on the dental care system in the United States.

    PubMed

    Wotman, S; Goldman, H

    1982-07-01

    A number of significant pressures are creating tensions in the dental profession and the dental care delivery system. These pressures may be categorized in five major areas: 1) regulation and deregulation pressures involve changes in the state dental practice acts, court decisions concerning antitrust and advertising, and the inclusion of consumers on State professional regulatory boards; 2) cost of services includes factors involving the out-of-pocket cost of dental care and the growth of dental insurance; 3) dentist-related factors include the increased number of dentists and the indebtedness of dental graduates; 4) the pressures of changes in the American populations include the decline in population growth and the increase in proportion of elderly people; 5) changes in the distribution of dental care are based on new epidemiologic data concerning dental caries and progress in the prevention of periodontal disease. Many of these pressures are inducing competition in the dental care system. It is clear that the dental care system is in the process of change as it responds to these complex pressures.

  15. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... health care expenditures. The ADLSs were first announced in the May 19, 2011 Federal Register (76 FR... Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010... Medicaid Innovation (Innovation Center) for the purpose of examining new ways of delivering health care and...

  16. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  17. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  18. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  19. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  20. 48 CFR 852.222-70 - Contract Work Hours and Safety Standards Act-nursing home care contract supplement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Safety Standards Act-nursing home care contract supplement. 852.222-70 Section 852.222-70 Federal...—nursing home care contract supplement. As prescribed in 822.305, for nursing home care requirements, insert the following clause: Contract Work Hours and Safety Standards Act—Nursing Home Care Contract...

  1. Assessment of variation in the alberta context tool: the contribution of unit level contextual factors and specialty in Canadian pediatric acute care settings

    PubMed Central

    2011-01-01

    Background There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify variables that significantly contribute to between-unit variation for each of the 10 concepts. Methods 859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT's ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1). In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care) to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3). Results The null model (unadjusted baseline HLM model) established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units). When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the contribution of specialty to between-unit variation enabled us to explain more variance (1.19% to 16.73%) in 6 of the 10 ACT concepts. Finally, when we assessed the unique contribution of the unit level variables available to us, we were able to explain additional variance (15.91% to 73.25%) in 7 of the 10 ACT concepts. Conclusion The findings reported here represent the third published argument for validity of the ACT and adds to the evidence supporting its use to discriminate patient care units by all 10 contextual factors. We found evidence of relationships between a variety of individual and unit-level variables that explained much of this between-unit variation for each of the 10 ACT concepts. Future research will include examination of the relationships between the ACT's contextual factors and research utilization by nurses and ultimately the relationships between context, research utilization, and outcomes for patients. PMID:21970404

  2. 42 CFR 600.5 - Definitions and use of terms.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Care Act of 2010 (Pub. L. 111-148) as amended by the Health Care and Education Reconciliation Act of... care providers means an entity capable of meeting the provision and administration of standard health... not limited to: Accountable Care Organizations, Independent Physician Associations, or a large health...

  3. Art, science, or both? Keeping the care in nursing.

    PubMed

    Jasmine, Tayray

    2009-12-01

    Nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is ongoing as professional nurses strive to maintain the concept, art, and act of caring as the moral center of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviors during each nurse-patient interaction. This article discusses the profession of nursing as an art and a science, and it explores the challenges associated with keeping the care in nursing.

  4. The Affordable Care Act: the ethical call to transform the organizational culture.

    PubMed

    Piper, Llewellyn E

    2014-01-01

    The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.

  5. 76 FR 1366 - Medicare Program; Amendment to Payment Policies Under the Physician Fee Schedule and Other...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... (including members of Congress and those who were involved with this provision during the debate on the... with this provision during the debate on the Affordable Care Act). Because we believe it is in the...

  6. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules.

    PubMed

    2011-08-18

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. In addition, we are finalizing an interim final rule with comment period that implements section 203 of the Medicare and Medicaid Extenders Act of 2010 relating to the treatment of teaching hospitals that are members of the same Medicare graduate medical education affiliated groups for the purpose of determining possible full-time equivalent (FTE) resident cap reductions.

  7. Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.

    PubMed

    Belperio, Pamela S; Chartier, Maggie; Gonzalez, Rachel I; Park, Angela M; Ross, David B; Morgan, Tim R; Backus, Lisa I

    2018-06-01

    The Department of Veterans Affairs (VA) has made significant progress in treating hepatitis C virus, experiencing more than a 75% reduction in veterans remaining to be treated since the availability of oral direct-acting antivirals. Hepatitis C Innovation Teams use lean process improvement and system redesign, resulting in practice models that address gaps in care. The key to success is creative improvements in veteran access to providers, including expanded use of nonphysician providers, video telehealth, and electronic technologies. Population health management tools monitor and identify trends in care, helping the VA tailor care and address barriers. Published by Elsevier Inc.

  8. Impact of the Affordable Care Act on stem cell transplantation.

    PubMed

    Farnia, Stephanie; Gedan, Alicia; Boo, Michael

    2014-03-01

    The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

  9. Flying beneath the Radar of Health Reform: The Community Living Assistance Services and Supports (CLASS) Act

    ERIC Educational Resources Information Center

    Miller, Edward Alan

    2011-01-01

    The Patient Protection and Affordable Care Act attempts to address prevailing deficiencies in long-term care (LTC) financing through the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary LTC insurance program administered by the Federal government. The CLASS Act is intended to supplement rather than supplant…

  10. 77 FR 18309 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-27

    ...This final rule will implement the new Affordable Insurance Exchanges (``Exchanges''), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

  11. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

    PubMed

    Bartels, Stephen J; Gill, Lydia; Naslund, John A

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.

  12. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

    PubMed Central

    Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

    2015-01-01

    Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

  13. Minimum essential coverage and other rules regarding the shared responsibility payment for individuals. Final regulations.

    PubMed

    2014-11-26

    This document contains final regulations relating to the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173 (collectively, the Affordable Care Act). These final regulations provide individual taxpayers with guidance under section 5000A of the Internal Revenue Code on the requirement to maintain minimum essential coverage and rules governing certain types of exemptions from that requirement.

  14. Let's Get Real About Health Care Reform.

    PubMed

    Karpf, Michael

    2017-09-01

    In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.

  15. Harnessing the Affordable Care Act to catalyze delivery system reform and strengthen emergency care in America.

    PubMed

    Maa, John

    2015-01-01

    As health care reform in the US evolves beyond insurance reform to encompass delivery system reform, the opportunity arises to harness the Affordable Care Act to strengthen patient care in America. One area for dedicated individuals to lead this effort is by improving transitions in patient care across the continuum of team members, specialties, settings, and systems. This article will describe innovations of the surgicalist and acute care surgeon that have emerged in response to the challenges facing surgery in specialization, geography, and the need to comply with health care reform mandates. Three ways will be described to integrate these innovations with pilot programs in the Affordable Care Act: to promote teamwork, to reduce readmissions, and to strengthen emergency care because the key location where the joint efforts intersect most acutely with patient need is in our nation's Emergency Departments.

  16. Harnessing the Affordable Care Act to Catalyze Delivery System Reform and Strengthen Emergency Care in America

    PubMed Central

    Maa, John

    2015-01-01

    As health care reform in the US evolves beyond insurance reform to encompass delivery system reform, the opportunity arises to harness the Affordable Care Act to strengthen patient care in America. One area for dedicated individuals to lead this effort is by improving transitions in patient care across the continuum of team members, specialties, settings, and systems. This article will describe innovations of the surgicalist and acute care surgeon that have emerged in response to the challenges facing surgery in specialization, geography, and the need to comply with health care reform mandates. Three ways will be described to integrate these innovations with pilot programs in the Affordable Care Act: to promote teamwork, to reduce readmissions, and to strengthen emergency care because the key location where the joint efforts intersect most acutely with patient need is in our nation’s Emergency Departments. PMID:25663212

  17. [Duties of institutions and heads of health care centers in the area of infection control, information, assessment, registration and financing of benefits provided to TB patients].

    PubMed

    Zielonka, Tadeusz M

    2015-01-01

    The Act on preventing and counteracting infections and infectious diseases in humans effective in Poland requires the heads of health care outlets and institutions to counteract spreading of TB in units under their management. They are, by all means, responsible for monitoring infections in their respective units, including development, implementation and monitoring of the implementation of procedures into practice, aiming at limiting the dissemination of TB in hospitals and outpatient clinics. Medical service unit managers are also responsible for providing members of their staff with means of individual protection against infection with Mycobacterium tuberculosis bacillus. Their duties also include reporting all of the recognized TB cases in their respective units. TB is an infectious diseases included in the occupational disease list. Assessment of TB as an occupational disease is the responsibility of provincial TB prevention clinics. The Act also provides principles of financing of individual benefits available for the insured TB patients as well as those not insured.

  18. State health policy for terrorism preparedness.

    PubMed

    Ziskin, Leah Z; Harris, Drew A

    2007-09-01

    State health policy for terrorism preparedness began before the terrorist attacks on September 11, 2001, but was accelerated after that day. In a crisis atmosphere after September 11, the states found their policies changing rapidly, greatly influenced by federal policies and federal dollars. In the 5 years since September 11, these state health policies have been refined. This refinement has included a restatement of the goals and objectives of state programs, the modernization of emergency powers statutes, the education and training of the public health workforce, and a preparation of the health care system to better care for victims of disasters, including acts of terrorism.

  19. Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings.

    PubMed

    Zolna, Mia R; Kavanaugh, Megan L; Hasstedt, Kinsey

    Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings

    PubMed Central

    Zolna, Mia R.; Kavanaugh, Megan L.; Hasstedt, Kinsey

    2018-01-01

    Introduction Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states’ Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. Methods We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Results Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Conclusions Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. PMID:29108987

  1. The Impact of Foster Care and Temporary Assistance for Needy Families (TANF) on Women's Drug Treatment Outcomes

    PubMed Central

    Lewandowski, Cathleen A.; Hill, Twyla J.

    2008-01-01

    This study assesses the impact of having a child in foster care and receiving cash benefits through Temporary Assistance for Needy Families (TANF) on women's completion of a residential drug treatment program. The study's hypothesis was that drug treatment completion rates for women who had children in foster care and/or who were receiving TANF would differ from women who did not receive these services. The sample included 117 women age 19 to 54, in a Midwestern state. Findings suggest that women with a child or children in foster care were less likely to complete treatment. Women receiving cash benefits were also somewhat less likely to complete treatment than women not receiving these services. Women with children in foster care had similar levels of psychological, employment, and drug and alcohol concerns as other women, as measured by the Addiction Severity Index. Future research should focus on identifying strategies that enhance retention rates of these vulnerable women. Implications for improving treatment retention are discussed in light of the Adoption and Safe Families Act of 1997 and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. PMID:19122866

  2. Mental health services in South Africa: taking stock.

    PubMed

    Lund, C; Petersen, I; Kleintjes, S; Bhana, A

    2012-11-01

    There is new policy commitment to mental health in South Africa, demonstrated in the national mental health summit of April 2012. This provides an opportunity to take stock of our mental health services. At primary care level key challenges include- training and supervision of staff in the detection and management of common mental disorders, and the development of community-based psychosocial rehabilitation programmes for people with severe mental illness (in collaboration with existing non-governmental organizations). At secondary level, resources need to be invested in 72-hour observation facilities at designated district and regional hospitals, in keeping with the Mental Health Care Act. At tertiary level, greater continuity of care with primary and secondary levels is required to prevent "revolving door" patterns of care. There are major challenges and also opportunities related to the high level of comorbidity between mental illness and a range of other public health priorities, notably HIV/AIDS, cardiovascular disease and diabetes. The agenda for mental health services research needs to shift to a focus on evaluating interventions. With current policy commitment, the time to act and invest in evidence-based mental health services is now.

  3. Absence and leave; sick leave. Final rule.

    PubMed

    2010-12-03

    The U.S. Office of Personnel Management is issuing final regulations on the use of sick leave and advanced sick leave for serious communicable diseases, including pandemic influenza when appropriate. We are also permitting employees to substitute up to 26 weeks of accrued or accumulated sick leave for unpaid Family and Medical Leave Act (FMLA) leave to care for a seriously injured or ill covered servicemember, as authorized under the National Defense Authorization Act for Fiscal Year 2008, including up to 30 days of advanced sick leave for this purpose. Finally, we are reorganizing the existing sick leave regulations to enhance reader understanding and administration of the program.

  4. The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes

    PubMed Central

    Ängerud, Karin Hellström; Brulin, Christine; Eliasson, Mats; Näslund, Ulf; Hörnsten, Åsa

    2015-01-01

    Background: People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis. Objective: The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care. Methods: We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory. Results: The core category that emerged, “becoming ready to act,” incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes. Conclusions: Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur. PMID:25325370

  5. U.S. health care: a conundrum and a challenge.

    PubMed

    Ciric, Ivan S

    2013-12-01

    This report was conceived as a contribution to the national debate regarding U.S. health care (HC) and as a means of explaining the challenges facing U.S. HC to the international readers of WORLD NEUROSURGERY. The basic economic concepts pertinent to health care, including fundamentals of economic theories, gross domestic product (GDP), U.S. revenues and expenditures and the U.S. federal deficit and national debt, are discussed at the outset of this study. This is followed by a review of the U.S. health insurance paradigms and a detailed analysis of the escalating cost of U.S. health care. Finally, the efforts designed to reverse the paradigm of escalating health care costs will be discussed. This study reveals that should the U.S. HC cost continue to escalate at the same rate, HC would consume the entire gross domestic product by 2070. The root causes for this trend are overutilization of HC, inappropriate allocation of HC costs at the end of life, defensive medicine, high-end technology and prescription drugs, failure of competitive market forces, and administrative costs, inefficiency, and waste. The proposed means of reversing this paradigm, including the Patient Protection and Affordable Care Act, are discussed in light of their economic and social impact. The reversal of the current paradigm of escalating cost of U.S. HC will require extraordinary leadership across the entire spectrum of HC delivery. It is concluded that neither the Affordable Care Act nor the Path to Prosperity will succeed unless the escalating cost of U.S. HC is reversed. It is hoped that this report contributes to that end. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Patient Protection and Affordable Care Act of 2010: a primer for neurointerventionalists.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2012-03-01

    The Patient Protection and Affordable Care Act (the ACA, for short) became law on 23 March 2010. It represents the most significant transformation of the American healthcare system since Medicare and Medicaid. Essentials of ACA include: (1) a mandate for individuals and businesses requiring as a matter of law that nearly every American has an approved level of health insurance or pay a penalty; (2) a system of federal subsidies to completely or partially pay for the now required health insurance for ∼34 million Americans who are currently uninsured-subsidized through Medicaid and Exchanges; (3) extensive new requirements on the health insurance industry and (4) changes in the practice of medicine. The Act is divided into 10 titles. It contains provisions that went into effect starting on 21 June 2010 with many of the provisions going into effect in 2014 and later. The ACA goes well beyond insurance and payment reform. Practicing physicians will potentially be impacted by the Independent Payment Advisory Board and the Patient Centered Outcomes Research Institute.

  7. "All who nurse for hire": nursing and the mixed legacy of legislative victories.

    PubMed

    Whelan, Jean C

    2013-01-01

    Sustained support of policy initiatives by nursing has resulted in significant legislative victories. One victory, the passage of the 1938 New York State Todd-Feld Act, which underwent legislative debate at a time when the nurse labor market was in disarray, during an economic depression, and before U.S. entry into World War II, reinforces our understanding that nursing must be a strong shepherd for policies beneficial for health care delivery. Designed to correct serious deficiencies in the nursing workforce, the act successfully required licensing for those working as registered and practical nurses. Yet, its provisions failed to stop all unlicensed nurse workers from practicing. Rapid changes occurring in the nurse labor market against the backdrop of growing hospital power over the employment of all nurse workers minimized the act's effectiveness. Policy implications include the need to focus on the complex nature of health care policy initiatives, flexibility in the face of changing circumstances, and acceptance of political realities. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Care homes and the Mental Capacity Act 2005: Changes in understanding and practice over time.

    PubMed

    Manthorpe, Jill; Samsi, Kritika

    2016-07-01

    The Mental Capacity Act 2005 provides the legal framework in England and Wales for the making of decisions in respect of people who have never had or have lost decision-making capacity. As part of a 5-year research program investigating the implementation and adoption of the Mental Capacity Act in dementia practice, we interviewed staff working in different care homes at two time points (32 staff at Time 1 in 2008 and 27 staff at Time 2 in 2012) in South East England. At baseline Time 1, daily practice seemed to resonate with Mental Capacity Act principles of respecting decisions and trying to act in a person's best interests. This paper reports Time 2 findings. We found that few care home staff interviewed specifically reported finding the Mental Capacity Act helpful in crystallizing the legal basis of their work. Most continued to offer illustrations of day-to-day practice in which they paid attention to individual choices, took account of the wishes of residents' families, and tried to act in residents' best interests but referred major decisions to their seniors. This study highlights the potential of referring to specific day-to-day practice in care homes when offering training or scrutinizing practice in dementia care more generally so that the work is set in its legal as well as moral framework. Care home staff in this study reported that advanced planning and pre-specifying preferences were more common among new care home residents, especially those with dementia, indicating that greater understanding of these is required by staff. © The Author(s) 2014.

  9. Increased Public Accountability for Hospital Nonprofit Status: Potential Impacts on Residency Positions.

    PubMed

    Raffoul, Melanie C; Phillips, Robert L

    2017-01-01

    The Institute of Medicine recently called for greater graduate medical education (GME) accountability for meeting the workforce needs of the nation. The Affordable Care Act expanded community health needs assessment (CHNA) requirements for nonprofit and tax-exempt hospitals to include community assessment, intervention, and evaluation every 3 years but did not specify details about workforce. Texas receives relatively little federal GME funding but has used Medicaid waivers to support GME expansion. The objective of this article was to examine Texas CHNAs and regional health partnership (RHP) plans to determine to what extent they identify community workforce need or include targeted GME changes or expansion since the enactment of the Affordable Care Act and the revised Internal Revenue Service requirements for CHNAs. Texas hospitals (n = 61) received federal GME dollars during the study period. Most of these hospitals completed a CHNA; nearly all hospitals receiving federal GME dollars but not mandated to complete a CHNA participated in similar state-based RHP plans. The 20 RHPs included assessments and intervention proposals under a 1115 Medicaid waiver. Every CHNA and RHP was reviewed for any mention of GME-related needs or interventions. The latest available CHNAs and RHPs were reviewed in 2015. All CHNA and RHP plans were dated 2011 to 2015. Of the 38 hospital CHNAs, 26 identified a workforce need in primary care, 34 in mental health, and 17 in subspecialty care. A total of 36 CHNAs included implementation plans, of which 3 planned to address the primary care workforce need through an increase in GME funding, 1 planned to do so for psychiatry training, and 1 for subspecialty training. Of the 20 RHPs, 18 identified workforce needs in primary care, 20 in mental health, and 15 in subspecialty training. Five RHPs proposed to increase GME funding for primary care, 3 for psychiatry, and 1 for subspecialty care. Hospital CHNAs and other regional health assessments could be potentially strategic mechanisms to assess community needs as well as GME accountability in light of community needs and to guide GME expansion more strategically. Internal Revenue Service guidance regarding CHNAs could include workforce needs assessment and intervention requirements. Preference for future Medicaid or Medicare GME funding expansion could potentially favor states that use CHNAs or RHPs to identify workforce needs and track outcomes of related interventions. © Copyright 2017 by the American Board of Family Medicine.

  10. Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act.

    PubMed

    Grace, Aimee M; Horn, Ivor; Hall, Robert; Cheng, Tina L

    2015-10-01

    The Affordable Care Act has caused and continues to cause sweeping changes throughout the health system in the United States. Poorly explained, complex, controversial, confusing, and subject to continuous legal and regulatory definition, the law stands as a hallmark piece of legislation that will change the health sector in America forever. This article summarizes the Affordable Care Act with a focus on children, families, and disparities. Also provided is the context of the current system of health care coverage in the United States. Published by Elsevier Inc.

  11. [Terrorism and mental health (problem's scale, population tolerance, management of care)].

    PubMed

    Iastrebov, V S

    2004-01-01

    The consequences of terrorist threat and terrorist acts for mental health of the individual, groups of individuals and community in general are analyzed. Mental disorders emerging in the victims of terrorism is described. The problem of terrorist threats use as a psychic weapon is discussed. Tolerance of population to terrorism can be divided into two types--psychophysiological and socio-psychological. The ways for elevating tolerability to terrorist threat and terrorist acts are suggested. Help in the centers of terrorist act must be of the complex character, being provided by different specialists including psychologists and psychiatrists. The importance of state structures and community support in this work is emphasized.

  12. 41 CFR 105-8.103 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... specific learning disabilities. The term “Physical or mental impairment” includes, but is not limited to... caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning... Disabilities Amendments of 1978 (Pub. L. 95-602, 92 Stat. 2955); and the Rehabilitation Act Amendments of 1986...

  13. How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.

    PubMed

    Gunja, Munira Z; Collins, Sara R; Doty, Michelle M; Beautel, Sophie

    2017-08-01

    ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid. GOALS: To examine the effects of ACA health reforms on women’s coverage and access to care. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2016. FINDINGS AND CONCLUSIONS: Women ages 19 to 64 who shopped for new coverage on their own found it significantly easier to find affordable plans in 2016 compared to 2010. The percentage of women who reported delaying or skipping needed care because of costs fell to an all-time low. Insured women were more likely than uninsured women to receive preventive screenings, including Pap tests and mammograms.

  14. 78 FR 70958 - 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... Foreclosures and Enhance became Public Law 111-22; Division B of this law is the HEARTH Act. As amended by the HEARTH Act, Subpart C of the McKinney-Vento Homeless Assistance Act establishes the Continuum of Care... et seq.). The HEARTH Act was designed to improve administrative efficiency and enhance response...

  15. [Duties of institutions and heads of health care centers in the area of infection control, information, assessment, registration and financing of benefits provided to TB patients].

    PubMed

    Zielonka, Tadeusz M

    2011-01-01

    The Act on preventing and counteracting infections and infectious diseases in humans effective in Poland provides for the duty of the heads of health care outlets and institutions to counteract spreading of TB in units under their management. They are, by all means, responsible for monitoring infections in their respective units, involving development, implementation and monitoring of practical implementation of procedures aiming at limiting dissemination of TB in hospitals and outpatient clinics. Medical service unit managers are also responsible for providing members of their staffs with means of individual protection against infection with Mycobacterium tuberculosis bacillus. Their duties also include notification of all recognized TB cases in their respective units. TB is an infectious diseases included in the occupational disease list. Assessment of TB as occupational disease is the responsibility of provincial TB prevention clinics. The Act also provides for principles of financing of individual benefits available for the insured TB patients and those not insured.

  16. Source Materials for the Healthy Communities Toolkit: A Resource Guide for Community and Faith-Based Organizations.

    PubMed

    Acosta, Joie; Chandra, Anita; Williams, Malcolm; Davis, Lois M

    2011-01-01

    The Patient Protection and Affordable Care Act places significant emphasis on the role of community-based health promotion initiatives; within this focus, community and faith-based organizations (CFBOs) are seen as critical partners for improving community well-being. This article describes a report that provides the content for a toolkit that will prepare community and faith-based organizations to take advantage of opportunities presented in the Patient Protection and Affordable Care Act and engage faith and community leaders in promoting health in their communities. This includes key facts and figures about health topics, handouts for community groups, and web links for resources and other information in the following areas: healthcare reform; community health centers and development of the community health workforce; promotion of healthy families; mental health; violence and trauma; prevention of teen and unintended pregnancy and HIV/AIDS; and chronic disease prevention. The report also includes recommendations for testing the content of the toolkit with communities and considerations for its implementation.

  17. Tribal child welfare. Interim final rule.

    PubMed

    2012-01-06

    The Administration for Children and Families (ACF) is issuing this interim final rule to implement statutory provisions related to the Tribal title IV-E program. Effective October 1, 2009, section 479B(b) of the Social Security Act (the Act) authorizes direct Federal funding of Indian Tribes, Tribal organizations, and Tribal consortia that choose to operate a foster care, adoption assistance and, at Tribal option, a kinship guardianship assistance program under title IV-E of the Act. The Fostering Connections to Success and Increasing Adoptions Act of 2008 requires that ACF issue interim final regulations which address procedures to ensure that a transfer of responsibility for the placement and care of a child under a State title IV-E plan to a Tribal title IV-E plan occurs in a manner that does not affect the child's eligibility for title IV-E benefits or medical assistance under title XIX of the Act (Medicaid) and such services or payments; in-kind expenditures from third-party sources for the Tribal share of administration and training expenditures under title IV-E; and other provisions to carry out the Tribal-related amendments to title IV-E. This interim final rule includes these provisions and technical amendments necessary to implement a Tribal title IV-E program.

  18. United States Health Care Reform Progress to Date and Next Steps

    PubMed Central

    Obama, Barack

    2016-01-01

    IMPORTANCE The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. EVIDENCE Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. FINDINGS The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. CONCLUSIONS AND RELEVANCE Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges. PMID:27400401

  19. United States Health Care Reform: Progress to Date and Next Steps.

    PubMed

    Obama, Barack

    2016-08-02

    The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation's most complex challenges.

  20. 45 CFR 144.200 - Basis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE Qualified State Long-Term Care Insurance Partnerships: Reporting Requirements... Social Security Act, (Act) which requires the issuer of a long-term care insurance policy issued under a...

  1. 45 CFR 144.200 - Basis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE Qualified State Long-Term Care Insurance Partnerships: Reporting Requirements... Social Security Act, (Act) which requires the issuer of a long-term care insurance policy issued under a...

  2. 45 CFR 144.200 - Basis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE Qualified State Long-Term Care Insurance Partnerships: Reporting Requirements... Social Security Act, (Act) which requires the issuer of a long-term care insurance policy issued under a...

  3. 45 CFR 144.200 - Basis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE Qualified State Long-Term Care Insurance Partnerships: Reporting Requirements... Social Security Act, (Act) which requires the issuer of a long-term care insurance policy issued under a...

  4. Why the affordable care act needs a better name: 'Americare'.

    PubMed

    Sage, William M

    2010-08-01

    The culmination of a century's effort to enact universal coverage in the United States is a law with an uninspiring title, the Patient Protection and Affordable Care Act, and an even more awkward acronym, PPACA. The Obama administration has decided to call the legislation the Affordable Care Act, but the expansion of health coverage that the law sets in motion has no name, and therefore no identity. It badly needs one.

  5. NAPWA prefers no CARE act to one laden with new restrictions.

    PubMed

    1999-11-26

    The National Association for People With AIDS would prefer no reauthorization of the Ryan White CARE Act from Congress to a bad bill. The group fears candidates will attempt to communicate their social policy views through the CARE Act during an election year. Policy advocates say that issues like mandatory testing, name-based reporting, and criminalizing HIV exposure through sex are not sound public health, and NAPWA is opposed to seeing these policies become law. Failure to reauthorize the CARE act would not necessarily mean programs are canceled because funding can be renewed through the process of appropriations. However the strategy of pulling the bill may be risky if the next Congress is not as hospitable to the advocacy community as the current one.

  6. Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; exchange standards for employers. Final rule, Interim final rule.

    PubMed

    2012-03-27

    This final rule will implement the new Affordable Insurance Exchanges ("Exchanges"), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

  7. Catching up: Latino health coverage gains and challenges under the Affordable Care Act: results from the Commonwealth Fund Affordable Care Act Tracking Survey.

    PubMed

    Doty, Michelle M; Rasmussen, Petra W; Collins, Sara R

    2014-09-01

    For decades, Latinos have had the highest uninsured rates of any racial or ethnic group in the United States. Less than one year after the Affordable Care Act's health insurance marketplaces opened for enrollment, the overall Latino uninsured rate dropped from 36 percent to 23 percent, according to the Commonwealth Fund Affordable Care Act Tracking Survey, conducted April 9 to June 2, 2014. However, the high uninsured rate among Latinos in states that had not expanded their Medicaid program at the time of the survey--33 percent--remained statistically unchanged. These states are home to about 20 million Latinos, the majority of whom live in Texas and Florida.

  8. Is quality of cardiac hospital care a public or private good?

    PubMed

    Chen, Hsueh-Fen; Bazzoli, Gloria J; Harless, David W; Clement, Jan P

    2010-11-01

    There are many studies examining the effects of financial pressure from different payment sources on hospital quality of care, but most have assumed that quality of care is a public good in that payment changes from one payer will affect all hospital patients rather than just those directly associated with the payer. Although quality of hospital care can be either a public or private good, few studies have tested which of these scenarios are more likely to hold. To examine whether the change in the magnitude of in-hospital mortality for Medicare and managed care patients is different based on financial pressure resulting from the Balanced Budget Act and growing managed care market penetration; and to examine what role hospital competition may play in affecting these changes. The unit of analysis for the study was the hospital. Multiple data sources were used including the Agency for Healthcare Research and Quality State Inpatient Databases, American Hospital Association Annual Surveys, Area Resource File, and health maintenance organization data from InterStudy. A difference-in-difference-in-difference model was applied for a 2-period panel design. In general, Balanced Budget Act financial pressure and managed care market share did not magnify the difference in in-hospital mortality rates between Medicare and managed care patients. The results suggest that quality of cardiac care in the hospital setting is more likely to be a public good; however, more investigation using other quality indicators and the role of hospital competition under different payment systems is recommended.

  9. 78 FR 49525 - Privacy Act of 1974; CMS Computer Match No. 2013-06; HHS Computer Match No. 1308

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-14

    ... Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of..., 2009). INCLUSIVE DATES OF THE MATCH: The CMP will become effective no sooner than 40 days after the...

  10. Transitional Child Care: State Experiences and Emerging Policies under the Family Support Act.

    ERIC Educational Resources Information Center

    Ebb, Nancy; And Others

    This guide is designed to provide information about transitional child care (TCC) program policies and operations and to offer recommendations to policymakers and advocates. Transitional child care is a new federal child care program that every state must implement by April 1, 1990. Established by the Family Support Act (FSA) of 1988, TCC is…

  11. 76 FR 60084 - Extension Request for Collection of Baseline Information for Green Jobs and Health Care Impact...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-28

    ... Baseline Information for Green Jobs and Health Care Impact Evaluation of ARRA-Funded Grants AGENCY... the Green Jobs and Health Care American Recovery and Reinvestment Act of 2009 (ARRA or Recovery Act... supports an evaluation of the impacts of the Green Jobs and Health Care (GJHC) training grants. This...

  12. Nursing homes and the affordable care act: a cease fire in the ongoing struggle over quality reform.

    PubMed

    Hawes, Catherine; Moudouni, Darcy M; Edwards, Rachel B; Phillips, Charles D

    2012-01-01

    Most provisions in the Affordable Care Act that affect nursing homes originated in two earlier attempts at reform, both of which failed multiple times in prior Congressional sessions: the Elder Justice Act and the Nursing Home Transparency and Improvement Act. Both of these earlier efforts focused on improving quality and reducing elder abuse in nursing homes by strengthening oversight and enforcement penalties, expanding staff training, and increasing the information on nursing home quality available to consumers and regulators. Each bill addressed problems that were serious, widespread, and had persisted for years, but each failed to pass on its own. The Affordable Care Act, with its own momentum, became the vehicle for their passage. However, the reasons the bills failed in these earlier efforts suggest implementation challenges now that they have ridden into law on the coattails of the more general effort to reform the health care sector.

  13. Forensic Assertive Community Treatment in a Continuum of Care for Male Internees in Belgium: Results After 33 Months.

    PubMed

    Marquant, Thomas; Sabbe, Bernard; Van Nuffel, Meike; Verelst, Rudy; Goethals, Kris

    2018-01-01

    Non-forensic or regular assertive community treatment (ACT) has positive effects on non-forensic outcomes but has poor effects on forensic outcome measures. In this study, we examined non-forensic and forensic outcome measures of a forensic adaptation of ACT (ForACT) within a continuum of care for internees. Data were collected retrospectively from files of 70 participants in the ForACT group who had been released from a forensic hospital. The control group comprised internees who had left prison and entered community-based care (n = 56). The ForACT group demonstrated significantly better outcomes on forensic measures, such as arrests and incarcerations, and had better community tenure. However, this group showed high hospitalization rates. The findings indicate that this type of community-based care can be beneficial for such internees; however, internees continue to experience difficulties reintegrating into society.

  14. 75 FR 30917 - Medicare Program; Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-02

    ...This proposed rule is a supplement to the fiscal year (FY) 2011 hospital inpatient prospective payment systems (IPPS) and long- term care prospective payment system (LTCH PPS) proposed rule published in the May 4, 2010 Federal Register. This supplemental proposed rule would implement certain statutory provisions relating to Medicare payments to hospitals for inpatient services that are contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act). It would also specify statutorily required changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs, and for long-term care hospital costs.

  15. Iranian nurses' perception of spirituality and spiritual care: a qualitative content analysis study.

    PubMed

    Mahmoodishan, Gholamreza; Alhani, Fatemeh; Ahmadi, Fazlollah; Kazemnejad, Anoshirvan

    2010-01-01

    The purpose of the present study was to explore nurses' perception about spirituality and spiritual care. A qualitative content analysis approach was conducted on 20 registered nurses interviewed using unstructured strategy in 2009. Three themes emerged from the data analysis: 1) "meaning and purpose of work and life" including 'spiritualistic view to profession', 'commitment and professional responsibility', and 'positive attitude'; 2) "religious attitude" including 'God approval', 'spiritual reward', 'taking advice', 'inner belief in the Supreme Being', 'faith-based interactions and altruism'; 3) "transcendence-seeking" including 'need for respect' and 'personal-professional transcendence'. Therefore, the spirituality produces maintenance, harmony and balance in nurses in relation to God. Spiritual care focuses on respecting patients, friendly and sympathetic interactions, sharing in rituals and strengthening patients and nurses' inner energy. This type of spirituality gives a positive perspective to life and profession, peaceful interactions, a harmonious state of mind, and acts as a motivator among nurses to promote nursing care and spirituality.

  16. Health care reform and care at the behavioral health--primary care interface.

    PubMed

    Druss, Benjamin G; Mauer, Barbara J

    2010-11-01

    The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

  17. Medicare's post-acute care payment: a review of the issues and policy proposals.

    PubMed

    Linehan, Kathryn

    2012-12-07

    Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.

  18. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    PubMed

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  19. From acute care to home care: the evolution of hospital responsibility and rationale for increased vertical integration.

    PubMed

    Dilwali, Prashant K

    2013-01-01

    The responsibility of hospitals is changing. Those activities that were once confined within the walls of the medical facility have largely shifted outside them, yet the requirements for hospitals have only grown in scope. With the passage of the Patient Protection and Affordable Care Act (ACA) and the development of accountable care organizations, financial incentives are focused on care coordination, and a hospital's responsibility now includes postdischarge outcomes. As a result, hospitals need to adjust their business model to accommodate their increased need to impact post-acute care settings. A home care service line can fulfill this role for hospitals, serving as an effective conduit to the postdischarge realm-serving as both a potential profit center and a risk mitigation offering. An alliance between home care agencies and hospitals can help improve clinical outcomes, provide the necessary care for communities, and establish a potentially profitable product line.

  20. Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

    PubMed

    King, Marjorie L

    2013-01-01

    Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

  1. What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision-making for frail and older people? A systematic literature review.

    PubMed

    Hinsliff-Smith, Kathryn; Feakes, Ruth; Whitworth, Gillian; Seymour, Jane; Moghaddam, Nima; Dening, Tom; Cox, Karen

    2017-03-01

    In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. Our aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care. © 2015 John Wiley & Sons Ltd.

  2. Dateline Child Care: Child Care Debated in Congress.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1989

    1989-01-01

    Discusses a revision of the Act for Better Child Care (ABC) bill cosponsored by Senators Christopher Dodd and Orrin Hatch. Major opponents of the ABC bill remain unmoved. The Child Development and Education Act of 1989 and Smart Start legislation are also discussed. (RJC)

  3. Faith-based organizations and the Affordable Care Act: Reducing Latino mental health care disparities.

    PubMed

    Villatoro, Alice P; Dixon, Elizabeth; Mays, Vickie M

    2016-02-01

    The Patient Protection and Affordable Care Act (ACA; 2010) is expected to increase access to mental health care through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental health care disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental health care of Latinos by increasing help seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental health care disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered health homes may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and primary care providers need to overcome to be partners in integrated care efforts. (c) 2016 APA, all rights reserved).

  4. Gap analysis: transition of health care from Department of Defense to Department of Veterans Affairs.

    PubMed

    Randall, Marjorie J

    2012-01-01

    This study examined the effectiveness of Public Law 110-181, "National Defense Authorization Act of Fiscal Year 2008, Title XVI-Wounded Warriors Matter," as it relates to health care for returning Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Specifically, it examined the gap between the time an OEF/OIF combat service member left active service and subsequently obtained health care within the Veteran Affairs (VA) Healthcare System, and which factors influenced or impeded the veteran from obtaining health care sooner. Data were collected from 376 OEF/OIF combat veterans who sought health care at the Nashville or Murfreesboro VA Medical Centers. A questionnaire was designed exclusively for this study. The average time gap for an OEF/OIF combat veteran to transition from Department of Defense to VA health care was 3.83 months (SD 7.17). Twenty-six percent of respondents reported there were factors that impeded them from coming to the VA sooner. Factors included lack of knowledge about VA benefits, transportation/distance, perceptions of losing military career, seeking help as sign of weakness, and VA reputation. The study provided some evidence to support that Department of Defense and VA are meeting mandates for providing seamless transition of health care set forth by "Public Law 110-181, National Defense Authorization Act of Fiscal Year 2008."

  5. Emerging Issues and Opportunities in Health Information Technology.

    PubMed

    Nardi, Elizabeth A; Lentz, Lisa Korin; Winckworth-Prejsnar, Katherine; Abernethy, Amy P; Carlson, Robert W

    2016-10-01

    When used effectively, health information technology (HIT) can transform clinical care and contribute to new research discoveries. Despite advances in HIT and increased electronic health record adoption, many challenges to optimal use, interoperability, and data sharing exist. Data standardization across systems is limited, and scanned medical note documents result in unstructured data that make reporting on quality measures for reimbursement burdensome. Different policies and initiatives, including the Health Information Technology for Economic and Clinical Health Act, the Medicare Access and CHIP Reauthorization Act, and the National Cancer Moonshot initiative, among others, all recognize the impact that HIT can have on cancer care. Given the growing role HIT plays in health care, it is vital to have effective and efficient HIT systems that can exchange information, collect credible data that is analyzable at the point of care, and improves the patient-provider relationship. In June 2016, NCCN hosted the Emerging Issues and Opportunities in Health Information Technology Policy Summit. The summit addressed challenges, issues, and opportunities in HIT as they relate to cancer care. Keynote presentations and panelists discussed moving beyond Meaningful Use, HIT readiness to support and report on quality care, the role of HIT in precision medicine, the role of HIT in the National Cancer Moonshot initiative, and leveraging HIT to improve quality of clinical care. Copyright © 2016 by the National Comprehensive Cancer Network.

  6. 75 FR 70371 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ...This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the ``skilled services'' section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

  7. Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care.

    PubMed

    Graves, John A; Swartz, Katherine

    The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries' access to cancer treatments. Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials. Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance-not only the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.

  8. 42 CFR 412.500 - Basis and scope of subpart.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... appropriate adjustments to that system, including adjustments to DRG weights, area wage adjustments... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long... payment system for long-term care hospitals described in section 1886(d)(1)(B)(iv) of the Act. (2) Section...

  9. 42 CFR § 512.210 - Included and excluded services.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Scope of Episodes...) Certain PBPM payments under models tested under section 1115A of the Act that CMS determines to be... PBPM model payments funded from the Innovation Center appropriation. (c) Updating the exclusion lists...

  10. 78 FR 66806 - Privacy Act of 1974

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-06

    ... efforts to expand its technology into the mobile and Web-based application domain as well as facilitate.... The data may be used for such purposes as scheduling patient treatment services, including nursing... health care profession, when requested in writing by an investigator or supervisory official of the...

  11. 76 FR 30942 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-27

    ... the Patient Protection and Affordable Care Act, Public Law 111-148 (the Affordable Care Act), provides... comply with certain consumer protection provisions contained in the Act. It also will provide important contact information for participants to find out which protections apply and which protections do not...

  12. Patients as consumers of health care in South Africa: the ethical and legal implications.

    PubMed

    Rowe, Kirsten; Moodley, Keymanthri

    2013-03-21

    South Africa currently has a pluralistic health care system with separate public and private sectors. It is, however, moving towards a socialised model with the introduction of National Health Insurance. The South African legislative environment has changed recently with the promulgation of the Consumer Protection Act and proposed amendments to the National Health Act. Patients can now be viewed as consumers from a legal perspective. This has various implications for health care systems, health care providers and the doctor-patient relationship. Calling a recipient of health care a 'consumer' as opposed to a 'patient' has distinct connotations and may result in differential behaviour. Labels reflect the ideals of the context in which they are used. Various models of the doctor-patient relationship exist and different metaphors have been used to describe it. Increasingly there are third parties involved within the doctor-patient relationship making it more difficult for the doctor to play the fiduciary role. In certain parts of the world, there has been a shift from a traditional paternalistic model to a consumerist model. The ethical implications of the commodification of health care are complex. As health care becomes a 'product' supplied by the health care 'provider', there is the risk that doctors will replace professional ethics with those of the marketplace. Health care is a universal human need and cannot be considered a mere commodity. In modern medical ethics, great emphasis is placed on the principle of respect for patient autonomy. Patients are now the ultimate decision-makers. The new Consumer Protection Act in South Africa applies to consumers and patients alike. It enforces strict liability for harm caused by goods and services. Everyone in the supply chain, including the doctor, can be held jointly and severally liable. This may lead to enormous challenges in health care delivery. Viewing patients as consumers may be detrimental to the doctor-patient relationship. While it facilitates an emphasis on respect for patient autonomy, it inadvertently results in the commodification of health care. The new legislative environment in South Africa promotes the protection of patient rights. It may, however, contribute to increased medical litigation.

  13. Patients as consumers of health care in South Africa: the ethical and legal implications

    PubMed Central

    2013-01-01

    Background South Africa currently has a pluralistic health care system with separate public and private sectors. It is, however, moving towards a socialised model with the introduction of National Health Insurance. The South African legislative environment has changed recently with the promulgation of the Consumer Protection Act and proposed amendments to the National Health Act. Patients can now be viewed as consumers from a legal perspective. This has various implications for health care systems, health care providers and the doctor-patient relationship. Discussion Calling a recipient of health care a ‘consumer’ as opposed to a ‘patient’ has distinct connotations and may result in differential behaviour. Labels reflect the ideals of the context in which they are used. Various models of the doctor-patient relationship exist and different metaphors have been used to describe it. Increasingly there are third parties involved within the doctor-patient relationship making it more difficult for the doctor to play the fiduciary role. In certain parts of the world, there has been a shift from a traditional paternalistic model to a consumerist model. The ethical implications of the commodification of health care are complex. As health care becomes a ‘product’ supplied by the health care ‘provider’, there is the risk that doctors will replace professional ethics with those of the marketplace. Health care is a universal human need and cannot be considered a mere commodity. In modern medical ethics, great emphasis is placed on the principle of respect for patient autonomy. Patients are now the ultimate decision-makers. The new Consumer Protection Act in South Africa applies to consumers and patients alike. It enforces strict liability for harm caused by goods and services. Everyone in the supply chain, including the doctor, can be held jointly and severally liable. This may lead to enormous challenges in health care delivery. Summary Viewing patients as consumers may be detrimental to the doctor-patient relationship. While it facilitates an emphasis on respect for patient autonomy, it inadvertently results in the commodification of health care. The new legislative environment in South Africa promotes the protection of patient rights. It may, however, contribute to increased medical litigation. PMID:23514130

  14. Affordable Care Act and Diabetes Mellitus.

    PubMed

    Shi, Qian; Nellans, Frank P; Shi, Lizheng

    2015-12-01

    The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

  15. Meeting the religious needs of residents with dementia.

    PubMed

    Higgins, Patricia

    2013-11-01

    This article considers practical strategies to help nurses working in care homes meet the religious needs of people with dementia, including attending services in homes or churches, supporting them in private prayer and at the end of life. It also considers the characteristics of person-centred care for such residents and how the Mental Capacity Act 2005 may be called on to support religious needs as dementia advances. To achieve good practice in all these aspects, staff in care homes should work in partnership with local faith communities and ensure they are aware of residents' life histories and preferences, including their faith practices. The focus of the article is on meeting the needs of Christian residents. For residents from other faith groups living in care homes not affiliated to their faith, the same general approach to meeting religious needs could be adopted as a starting point.

  16. The Affordable Care Act: the ethical call for value-based leadership to transform quality.

    PubMed

    Piper, Llewellyn E

    2013-01-01

    Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.

  17. Young Children in Wales: An Evaluation of the Implementation of the Children Act 1989 for Day Care Services.

    ERIC Educational Resources Information Center

    Statham, June

    This 3-year study examined the implementation of the Children Act in Wales, which deals with providing, coordinating, and regulating day care and related services for children under 8 years. Data were collected through interviews with key officers and representatives of child care organizations, a national survey of day care providers, and an…

  18. AB 9: California bill would end county mandate for last-resort care, including communicable diseases.

    PubMed

    1996-02-16

    The California Assembly passed a bill to end the current requirement that counties provide general assistance and medical care as last resort care to persons who do not have access to Medi-Cal or private insurance. There is concern that all counties will close the facilities and reduce or eliminate last resort care, leaving people with no access to treatment when they become ill. The bill is now in the California State Senate. AIDS organizations are urging Californians to call their state senator and urge them to oppose the bill. More information is available by contacting AIDS Project Los Angeles, Life AIDS Lobby (916)444-0424, or ACT UP/Golden Gate.

  19. Access to Accredited Cancer Hospitals Within Federal Exchange Plans Under the Affordable Care Act

    PubMed Central

    Liao, Kai-Ping; Krause, Trudy M.; Giordano, Sharon H.

    2017-01-01

    Purpose The Affordable Care Act expanded access to health insurance in the United States, but concerns have arisen about access to specialized cancer care within narrow provider networks. To characterize the scope and potential impact of this problem, we assessed rates of inclusion of Commission on Cancer (CoC) –accredited hospitals and National Cancer Institute (NCI) –designated cancer centers within federal exchange networks. Methods We downloaded publicly available machine-readable network data and public use files for individual federal exchange plans from the Centers for Medicare and Medicaid Services for the 2016 enrollment year. We linked this information to National Provider Identifier data, identified a set of distinct provider networks, and assessed the rates of inclusion of CoC-accredited hospitals and NCI-designated centers. We measured variation in these rates according to geography, plan type, and metal level. Results Of 4,058 unique individual plans, network data were available for 3,637 (90%); hospital information was available for 3,531 (87%). Provider lists for these plans reduced into 295 unique networks for analysis. Ninety-five percent of networks included at least one CoC-accredited hospital, but just 41% of networks included NCI-designated centers. States and counties each varied substantially in the proportion of networks listed that included NCI-designated centers (range, 0% to 100%). The proportion of networks that included NCI-designated centers also varied by plan type (range, 31% for health maintenance organizations to 49% for preferred provider organizations; P = .04) but not by metal level. Conclusion A large majority of federal exchange networks contain CoC-accredited hospitals, but most do not contain NCI-designated cancer centers. These results will inform policy regarding access to cancer care, and they reinforce the importance of promoting access to clinical trials and specialized care through community sites. PMID:28068172

  20. Linguistic validation of the Alberta Context Tool and two measures of research use, for German residential long term care.

    PubMed

    Hoben, Matthias; Bär, Marion; Mahler, Cornelia; Berger, Sarah; Squires, Janet E; Estabrooks, Carole A; Kruse, Andreas; Behrens, Johann

    2014-01-31

    To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks' Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity-an initial stage of validity, necessary before more advanced validity assessment. We included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants' answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants. Cognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups. Cognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores.

  1. Linguistic validation of the Alberta Context Tool and two measures of research use, for German residential long term care

    PubMed Central

    2014-01-01

    Background To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity–an initial stage of validity, necessary before more advanced validity assessment. Methods We included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants’ answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants. Results Cognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups. Conclusion Cognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores. PMID:24479645

  2. Patient engagement--what works?

    PubMed

    Coulter, Angela

    2012-01-01

    The recent focus on patient engagement acknowledges that patients have an important role to play in their own health care. This includes reading, understanding and acting on health information (health literacy), working together with clinicians to select appropriate treatments or management options (shared decision making), and providing feedback on health care processes and outcomes (quality improvement). Various interventions designed to help patients play an effective role have been evaluated in trials and systematic reviews. This article outlines the evidence in support of the most promising interventions.

  3. The physician as perpetrator of abuse.

    PubMed

    Kluft, R P

    1993-06-01

    Although the exploitation and abuse of patients is forbidden by every code of medical ethics, physicians are in a power position vis-a-vis their patients, and this power may be misused. The spectrum of abusive physician behaviors includes doctors functioning as agents of control, exploiting physicianly perogatives, acting out personal problems in the medical setting, allowing subversion of their judgment, deliberately delivering suboptimal care, dehumanizing care, and sexually exploiting patients. Guidelines for the treatment of patients with such prior experiences are offered.

  4. 45 CFR 98.15 - Assurances and certifications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... categories of care or types of providers, pursuant to § 98.30(f). (6) That if expenditures for pre... Child Care and Development Block Grant Act of 1990, as amended, section 418 of the Social Security Act...

  5. 45 CFR 98.15 - Assurances and certifications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... categories of care or types of providers, pursuant to § 98.30(f). (6) That if expenditures for pre... Child Care and Development Block Grant Act of 1990, as amended, section 418 of the Social Security Act...

  6. 45 CFR 98.15 - Assurances and certifications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... categories of care or types of providers, pursuant to § 98.30(f). (6) That if expenditures for pre... Child Care and Development Block Grant Act of 1990, as amended, section 418 of the Social Security Act...

  7. 45 CFR 98.15 - Assurances and certifications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... categories of care or types of providers, pursuant to § 98.30(f). (6) That if expenditures for pre... Child Care and Development Block Grant Act of 1990, as amended, section 418 of the Social Security Act...

  8. 45 CFR 98.15 - Assurances and certifications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT... categories of care or types of providers, pursuant to § 98.30(f). (6) That if expenditures for pre... Child Care and Development Block Grant Act of 1990, as amended, section 418 of the Social Security Act...

  9. 76 FR 41262 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH11-1103

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... Intent To Award Affordable Care Act (ACA) Funding, EH11-1103 Notice of Intent to award Affordable Care... opportunity EH11-1103, ``National Environmental Public Health Tracking Program-Network Implementation... under funding opportunity EH11-1103, ``National Environmental Public Health Tracking Program-Network...

  10. State Health Policy for Terrorism Preparedness

    PubMed Central

    Ziskin, Leah Z.; Harris, Drew A.

    2007-01-01

    State health policy for terrorism preparedness began before the terrorist attacks on September 11, 2001, but was accelerated after that day. In a crisis atmosphere after September 11, the states found their policies changing rapidly, greatly influenced by federal policies and federal dollars. In the 5 years since September 11, these state health policies have been refined. This refinement has included a restatement of the goals and objectives of state programs, the modernization of emergency powers statutes, the education and training of the public health workforce, and a preparation of the health care system to better care for victims of disasters, including acts of terrorism. PMID:17666689

  11. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    PubMed

    2016-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and making technical corrections and changes to regulations relating to costs to related organizations and Medicare cost reports; we are providing notice of the closure of three teaching hospitals and the opportunity to apply for available GME resident slots under section 5506 of the Affordable Care Act. We are finalizing the provisions of interim final rules with comment period that relate to a temporary exception for certain wound care discharges from the application of the site neutral payment rate under the LTCH PPS for certain LTCHs; application of two judicial decisions relating to modifications of limitations on redesignation by the Medicare Geographic Classification Review Board; and legislative extensions of the Medicare-dependent, small rural hospital program and changes to the payment adjustment for low-volume hospitals.

  12. 45 CFR 205.190 - Standard-setting authority for institutions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...(ies) in the development of standards directed toward assuring adequate quality of care; in upgrading... are hazardous to the safety of the patients; and in planning so that institutions may be...(AABD) of the Social Security Act includes aid or assistance to individuals in institutions as defined...

  13. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-06

    ... Hospital IPPS Inpatient prospective payment system MS-DRG Diagnosis-related group NCA National coverage... based on the ``inpatient prospective payment system'' (IPPS) described in section 1886(d) of the Act... and procedures, and payment systems. We reviewed various articles, reports, summaries, and data bases...

  14. 78 FR 54516 - Proposed Collection; Comment Request for Regulation Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-04

    ... provider (including a pediatrician for a child) and of the right to obtain access to obstetrical or... affordable care act notice of patient protection. DATES: Written comments should be received on or before... Notice of Patient Protection. OMB Number: 1545-2181. Regulation Project Number: REG-120399-10 [RIN 1545...

  15. Fact Sheet: Vulnerable Young Children

    ERIC Educational Resources Information Center

    Shaw, Evelyn, Comp.; Goode, Sue, Comp.

    2008-01-01

    This fact sheet provides data on infants, toddlers and young children who are experiencing high stress as a result of a number of risk factors specifically identified in the Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004), including substantiated abuse or neglect, foster care placement, homelessness, exposure to family…

  16. 77 FR 50121 - Office of Direct Service and Contracting Tribes National Indian Health Outreach and Education...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-20

    ... Contracting Tribes National Indian Health Outreach and Education Program Funding Opportunity Announcement Type... Education (NIHOE-III) program funding opportunity that includes outreach and education activities on the... Health Care and Education Reconciliation Act of 2010, Public Law 111- 152, collectively known as the...

  17. 75 FR 82400 - Development of Health Risk Assessment Guidance; Public Forum

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... Care Act (ACA) (Pub. L. 111-148) requires that a Health Risk Assessment be included in the annual... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Development of Health Risk Assessment Guidance; Public Forum AGENCY: Centers for Disease Control and Prevention (CDC...

  18. 77 FR 65938 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-31

    ... social security number, to a state prescription drug monitoring program (PDMP), or similar program, for... organizations in connection with the audit of claims or other review activities to determine quality of care or.... VA may disclose relevant information, including but not limited to, patient name, address, and social...

  19. Childhood Cancer Survivor Study participants' perceptions and understanding of the Affordable Care Act.

    PubMed

    Park, Elyse R; Kirchhoff, Anne C; Perez, Giselle K; Leisenring, Wendy; Weissman, Joel S; Donelan, Karen; Mertens, Ann C; Reschovsky, James D; Armstrong, Gregory T; Robison, Leslie L; Franklin, Mariel; Hyland, Kelly A; Diller, Lisa R; Recklitis, Christopher J; Kuhlthau, Karen A

    2015-03-01

    The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered "very important" are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as "very important" (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. © 2015 by American Society of Clinical Oncology.

  20. Childhood Cancer Survivor Study Participants' Perceptions and Understanding of the Affordable Care Act

    PubMed Central

    Park, Elyse R.; Kirchhoff, Anne C.; Perez, Giselle K.; Leisenring, Wendy; Weissman, Joel S.; Donelan, Karen; Mertens, Ann C.; Reschovsky, James D.; Armstrong, Gregory T.; Robison, Leslie L.; Franklin, Mariel; Hyland, Kelly A.; Diller, Lisa R.; Recklitis, Christopher J.; Kuhlthau, Karen A.

    2015-01-01

    Purpose The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Methods Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Results Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered “very important” are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as “very important” (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Conclusion Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits. PMID:25646189

  1. 75 FR 55402 - Proposed Collection; Comment Request for Regulation Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-10

    ... required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently... Care Act Notice of Patient Protection. DATES: Written comments should be received on or before November...-10-Affordable Care Act Notice of Patient Protection. OMB Number: 1545-2181. Regulation Project Number...

  2. PubMed Central

    1988-01-01

    The delegation of a medical act to persons other than physicians may be appropriate in certain restricted circumstances in the interests of good patient care and efficient use of health care resources. The CMA's Guidelines for the Delegation of a Medical Act were established to help physicians when they decide to delegate a medical act to a person other than a physician. Such delegation does not absolve the physician of responsibility for the care of the patient; it merely widens the circle of responsibility for the safe execution of the procedure.

  3. Financial sustainability of academic health centers: identifying challenges and strategic responses.

    PubMed

    Stimpson, Jim P; Li, Tao; Shiyanbola, Oyewale O; Jacobson, Janelle J

    2014-06-01

    Academic health centers (AHCs) play a vital role in the health care system. The training of health care personnel and delivery of health care services, especially to the most complex and financially challenged patients, has been a responsibility increasingly shouldered by AHCs over the years. Additionally, AHCs play a significant role in researching and developing new treatment protocols, including discovering and validating new health technologies. However, AHCs face unique financial challenges in fulfilling their social mission in the health care system. Reforms being implemented under the Affordable Care Act and shifting economic patterns are threatening the financial sustainability of AHCs.The authors review challenges facing AHCs, including training new health care professionals with fewer funding resources, disproportionate clinical care of complex and costly patients, charity care to uninsured and underinsured, and reduced research funding opportunities. Then, they provide a review of some potential solutions to these challenges, including new reimbursement methods, improvements in operational efficiency, price regulation, subsidization of education, improved decision making and communication, utilization of industrial management tools, and increasing internal and external cooperation. Devising solutions to the evolving problems of AHCs is crucial to improving health care delivery in the United States. Most likely, a combination of market, government, and system reforms will be needed to improve the viability of AHCs and assist them in fulfilling their social and organizational missions.

  4. Health care reform: will quality remodeling affect obstetrician-gynecologists in addition to patients?

    PubMed

    von Gruenigen, Vivian E; Deveny, T Clifford

    2011-05-01

    The Patient Protection and Affordable Care Act is a federal statute that attempts to address many fundamental problems with the current health care system including the uninsured, rising health care costs, and quality care. Quality metrics have been in development for years (by private and governmental sectors), and momentum is growing. The purpose of this commentary is to explore quality changes in the way practicing obstetricians and gynecologists will be held accountable for quality service. Two new options being explored for health care, both focusing on improving quality and physician metrics, include value-based purchasing and accountable-care organizations. Both will likely consist of universal clinical algorithms and cost monitoring as measures. For obstetrics this will probably include physician's rates of cesarean deliveries and elective inductions. For gynecology this may comprise of indications for hysterectomy with documented failed medical management, minor surgical management, or both medical and minor surgical management. It is anticipated patients will no longer be able to request obstetric testing, pregnancy induction, or hysterectomy. It is imperative we, as obstetrician-gynecologists, are involved in health care reform that inevitably involves the care of women. The expectation is that the American Congress of Obstetricians and Gynecologists (ACOG) will further develop evidenced-based opinions and guidelines, as medical communities embrace ACOG documents and reference these in hospital policies and peer review.

  5. Controlling hepatitis C in Rwanda: a framework for a national response.

    PubMed

    Mbituyumuremyi, Aimable; Van Nuil, Jennifer Ilo; Umuhire, Jeanne; Mugabo, Jules; Mwumvaneza, Mutagoma; Makuza, Jean Damascene; Umutesi, Justine; Nsanzimana, Sabin; Gupta, Neil

    2018-01-01

    With the introduction of direct-acting antiviral drugs, treatment of hepatitis C is both highly effective and tolerable. Access to treatment for patients, however, remains limited in low- and middle-income countries due to the lack of supportive health infrastructure and the high cost of treatment. Poorer countries are being encouraged by international bodies to organize public health responses that would facilitate the roll-out of care and treatment on a national scale. Yet few countries have documented formal plans and policies. Here, we outline the approach taken in Rwanda to a public health framework for hepatitis C control and care within the World Health Organization hepatitis health sector strategy. This includes the development and implementation of policies and programmes, prevention efforts, screening capacity, treatment services and strategic information systems. We highlight key successes by the national programme for the control and management of hepatitis C: establishment of national governance and planning; development of diagnostic capacity; approval and introduction of direct-acting antiviral treatments; training of key personnel; generation of political will and leadership; and fostering of key strategic partnerships. Existing challenges and next steps for the programme include developing a detailed monitoring and evaluation framework and tools for monitoring of viral hepatitis. The government needs to further decentralize care and integrate hepatitis C management into routine clinical services to provide better access to diagnosis and treatment for patients. Introducing rapid diagnostic tests to public health-care facilities would help to increase case-finding. Increased public and private financing is essential to support care and treatment services.

  6. The effects of the Balanced Budget Act of 1997 on home health and hospice in older adult cancer patients.

    PubMed

    Kilgore, Meredith L; Grabowski, David C; Morrisey, Michael A; Ritchie, Christine S; Yun, Huifeng; Locher, Julie L

    2009-03-01

    Home health and hospice services can constitute important elements in the continuum of care for older adults diagnosed with cancer. The Balanced Budget Act (BBA) of 1997 included provisions affecting those services. The first objective of this study is to assess the effect of the BBA of 1997 on home health and hospice service utilization in older cancer patients. The second objective is to estimate the effect of the BBA of 1997 on costs associated specifically with home health and hospice services and on total costs of care. The final objective is to evaluate the effect of the BBA of 1997 on mortality in these patients. Longitudinal analysis using the Surveillance, Epidemiology, and End Results-Medicare Database, covering a service area that includes 26% of the US population. Community-dwelling Medicare beneficiaries 65 years of age and older. Utilization rates of home health and hospice services; costs associated with those services, and total costs of care; and mortality. Home health utilization rates dropped substantially and hospice utilization rates increased after the BBA. Medicare costs for home health services declined as did total Medicare costs but hospice costs increased. There was no discernable effect on mortality rates. The BBA was successful in containing the costs of home health services and resulted in savings in overall costs of care for older cancer patients. Reduction in utilization of home health services did not seem to negatively affect outcomes. The BBA may have contributed to the trend of increasing use of hospice care.

  7. Home health care agency staffing patterns before and after the Balanced Budget Act of 1997, by rural and urban location.

    PubMed

    McAuley, William J; Spector, William; Van Nostrand, Joan

    2008-01-01

    The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff.

  8. Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas.

    PubMed

    Soni, Aparna; Hendryx, Michael; Simon, Kosali

    2017-04-01

    To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage. Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses. Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P < .05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P < .01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations. The Medicaid expansion increased the probability of having "any insurance" for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization. © 2017 National Rural Health Association.

  9. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

    PubMed

    LaCoursiere Zucchero, Terri; McDannold, Sarah; McInnes, D Keith

    2016-09-07

    While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

  10. [The Danish Health Act and health-care services to undocumented migrants].

    PubMed

    Aabenhus, Rune; Hallas, Peter

    2012-09-17

    Health-care workers may experience uncertainty regarding legal matters when attending to medical needs of undocumented migrants. This paper applies a pragmatic focus when addressing the legal aspects involved in providing health-care services to undocumented migrants with examples from the Danish Health Act and international conventions. The delivery of medical care to vulnerable groups such as pregnant women and children is described.

  11. mCare: using secure mobile technology to support soldier reintegration and rehabilitation.

    PubMed

    Poropatich, Ronald K; Pavliscsak, Holly H; Tong, James C; Little, Jeanette R; McVeigh, Francis L

    2014-06-01

    The U.S. Army Medical Department conducted a pilot mobile health project to determine the requirements for coordination of care for "Wounded Warriors" using mobile messaging. The primary objective was to determine if a secure mobile health (mhealth) intervention provided to geographically dispersed patients would improve contact rates and positively impact the military healthcare system. Over 21 months, volunteers enrolled in a Health Insurance Portability and Accountability Act-compliant, secure mobile messaging initiative called mCare. The study included males and females, 18-61 years old, with a minimum of 60 days of outpatient recovery. Volunteers were required to have a compatible phone. The mhealth intervention included appointment reminders, health and wellness tips, announcements, and other relevant information to this population exchanged between care teams and patients. Provider respondents reported that 85% would refer patients to mCare, and 56% noted improvement in appointment attendance (n=90). Patient responses also revealed high acceptability of mCare and refined the frequency and delivery times (n=114). The pilot project resulted in over 84,000 outbound messages and improved contact rates by 176%. The mCare pilot project demonstrated the feasibility and administrative effectiveness of a scalable mhealth application using secure mobile messaging and information exchanges, including personalized patient education.

  12. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    PubMed

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  13. Can biosimilars help achieve the goals of US health care reform?

    PubMed

    Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

    2017-01-01

    The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

  14. Developing the Senses Framework to support relationship-centred care for people with advanced dementia until the end of life in care homes.

    PubMed

    Watson, Julie

    2016-12-06

    People with advanced dementia living in care homes can experience social death before their physical death. Social death occurs when a person is no longer recognised as being an active agent within their relationships. A shift is required in how we perceive people with advanced dementia so that the ways they continue to be active in their relationships are noticed. Paying attention to embodied and interembodied selfhood broadens the scope and opportunities for relationships with people with advanced dementia, acting as a counter to social death. This has the potential to improve the quality of care, including end of life care, of people with advanced dementia in care homes. This study examined the role of embodied and interembodied selfhood within care-giving/care-receiving relationships in a specialist dementia care home. Empirical findings and their implications for the development of relationship-centred care and the Senses Framework in care homes are discussed. © The Author(s) 2016.

  15. Participatory Evaluation of a Community Mobilization Effort to Enroll Wyandotte County, Kansas, Residents Through the Affordable Care Act

    PubMed Central

    Sepers, Charles E.; McKain, Wesley

    2015-01-01

    Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas. We describe mobilization activities during the first round of open enrollment in coverage under the ACA (October 1, 2013–March 31, 2014), including the unfolding of community and organizational changes (e.g., new enrollment sites) and services provided to assist enrollment over time. The findings show an association between implementation measures and newly created accounts under the ACA (the primary outcome). PMID:25905820

  16. Massachusetts Substance Use Disorder Treatment Organizations’ Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design

    PubMed Central

    Quinn, Amity E.; Stewart, Maureen T.; Brolin, Mary; Horgan, Constance; Lane, Nancy E.

    2017-01-01

    The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations’ responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in-person June–December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms. PMID:28350232

  17. California's “Bridge to Reform”: Identifying Challenges and Defining Strategies for Providers and Policymakers Implementing the Affordable Care Act in Low-Income HIV/AIDS Care and Treatment Settings

    PubMed Central

    Hazelton, Patrick T.; Steward, Wayne T.; Collins, Shane P.; Gaffney, Stuart; Morin, Stephen F.; Arnold, Emily A.

    2014-01-01

    Background In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved. Methods 30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses. Results Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients. Conclusions California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people living with HIV experiencing these transitions demonstrate the importance of setting effective policies in anticipation of full ACA implementation in 2014. PMID:24599337

  18. California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

    PubMed

    Hazelton, Patrick T; Steward, Wayne T; Collins, Shane P; Gaffney, Stuart; Morin, Stephen F; Arnold, Emily A

    2014-01-01

    In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved. 30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses. Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients. California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people living with HIV experiencing these transitions demonstrate the importance of setting effective policies in anticipation of full ACA implementation in 2014.

  19. [Assessment of the technology of care relations in the health services: perception of the elderly included in the family health strategy in Bambuí, Brazil].

    PubMed

    Santos, Wagner Jorge dos; Giacomin, Karla Cristina; Firmo, Josélia Oliveira Araújo

    2014-08-01

    In the health field, technologies of care relations are in the scope of the worker-user encounter, implying intersubjectivity with the development of relationships between subjects, resulting in action. Evaluation studies synthesize knowledge produced on the consequences of using these technologies for society. This anthropological study aims to understand the perception of the elderly regarding the resolution capability and effectiveness of the acts produced in health care relationships in the context of the Family Health Strategy (ESF). The group studied consisted of 57 elderly residents in Bambui, State of Minas Gerais, Brazil. The model of signs, meanings and actions was used for collecting and analyzing data and the semi-structured interview was applied as a research technique. Elderly individuals assess resolution capability and effectiveness of the acts of care in the ESF as negative, with relation to the quality of user and professional interaction. The ESF is not effective and the desired change in the health care model has not occurred in practice. It repeats the centrality of the medical-drug-procedure model that treats the disease rather than the patient, perceiving old age as a disease and illness as being related to aging.

  20. Minor's rights versus parental rights: review of legal issues in adolescent health care.

    PubMed

    Maradiegue, Ann

    2003-01-01

    The right of adolescents to access confidential health care is sensitive and controversial. Recent challenges in the court system to adolescents' right to access abortion and contraception are eroding current law, including the Roe v Wade decision. The prospect of more than a million pregnancies in individuals under the age of 20 years in the United States with increasingly fewer alternatives to pregnancy is concerning. New regulations under the Health Insurance Portability and Accountability Act are adding yet another layer of complexity to the care of adolescents. Understanding legal issues surrounding adolescent rights to care can help the health care provider make appropriate care available to this age group. Keywords previously identified in CINAHL and MEDLINE were used to perform the literature search. LexisNexis was the search engine used to identify the laws and statutes.

  1. To repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010.

    THOMAS, 113th Congress

    Rep. Bachmann, Michele [R-MN-6

    2013-01-03

    Senate - 05/22/2013 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 78. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

  2. 77 FR 19295 - Privacy Act of 1974; Report of an Altered System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-30

    ... for the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care..., 2010 (75 FR 60763). The Health Care Quality Improvement Act of 1986, as amended, title IV of Public Law... conduct of physicians, dentists, and other health care practitioners. By law, the information is...

  3. 76 FR 28438 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-17

    ... announced below concerns ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity..., discussion, and evaluation of ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity...

  4. Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system.

    PubMed

    Mechanic, David

    2012-02-01

    The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation should work intensively with the states to implement these new programs and other arrangements and begin to fulfill the many unmet promises of community mental health care.

  5. Getting to value in neurological care: a roadmap for academic neurology.

    PubMed

    Holloway, Robert G; Ringel, Steven P

    2011-06-01

    Academic neurology is undergoing transformational changes. The public investment in biomedical research and clinical care is enormous and there is a growing perception that the return on this huge investment is insufficient. Hospitals, departments, and individual neurologists should expect more scrutiny as information about their quality of care and financial relationships with industry are increasingly reported to the public. There are unprecedented changes occurring in the financing and delivery of health care and research that will have profound impact on the mission and operation of academic departments of neurology. With the passage of the Patient Protection and Affordable Care Act (PPACA) there will be increasing emphasis on research that demonstrates value and includes the patient's perspective. Here we review neurological investigations of our clinical and research enterprises that focus on quality of care and comparative effectiveness, including cost-effectiveness. By highlighting progress made and the challenges that lie ahead, we hope to create a clinical, educational, and research roadmap for academic departments of neurology to thrive in today's increasingly regulated environment. Copyright © 2011 American Neurological Association.

  6. 75 FR 17918 - Advisory Board to the Consumer Operated and Oriented Plan (CO-OP) Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-08

    ...: The Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services to... program. The Patient Protection and Affordable Care Act gave the Comptroller General of the United States... described in section 1805(c)(2) of the Social Security Act. Appointments are to be made not later than three...

  7. Veterans Health Care: Improvements Needed in Operationalizing Strategic Goals and Objectives

    DTIC Science & Technology

    2016-10-01

    Congressional Requesters October 2016 GAO-17-50 United States Government Accountability Office United States Government Accountability Office...Abbreviations Choice Act Veterans Access, Choice, and Accountability Act of 2014 FY fiscal year GPRA...health care, among other things, Congress enacted and the President signed into law the Veterans Access, Choice, and Accountability Act of 2014

  8. Recovery approach to the care of people with dementia: decision making and 'best interests' concerns.

    PubMed

    Martin, G

    2009-09-01

    The concept of 'recovery' has been central to the discussion of the care of people with mental health problems in recent years, in this paper these ideas will be applied to the care of people with dementia in an attempt to focus nursing practice on the notion that it is possible to involve this group of patients in their own decision-making processes. It is acknowledged that this is not always possible without support and advocacy by nurses and other carers who must take on board the need to arrive at solutions to problems or change that are in the person's best interests. The provisions of the Mental Capacity Act in 2005 are key to this discussion, and ways forward are recommended, which include a nursing model for change, in an effort to bring together the concepts addressed in this paper. The conclusion reached is that the recovery approach has some difficulties when applied to people with dementia but it remains an essential aspect of the care process which, together with the provisions of the Mental Capacity Act, could bring about radical improvements to the lives of this group of vulnerable people.

  9. The impact of comparative effectiveness research on interventional pain management: evolution from Medicare Modernization Act to Patient Protection and Affordable Care Act and the Patient-Centered Outcomes Research Institute.

    PubMed

    Manchikanti, Laxmaiah; Falco, Frank J E; Benyamin, Ramsin M; Helm, Standiford; Parr, Allan T; Hirsch, Joshua A

    2011-01-01

    The Patient-Centered Outcomes Research Institute (PCORI) was established by the Affordable Care Act of 2010 to promote comparative effectiveness research (CER) to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis. The development of PCORI is vested in the Medicare Modernization Act (MMA) and the American Recovery and Reinvestment Act (ARRA). The framework of CER and PCORI describes multiple elements which are vested in all 3 regulations including stakeholder involvement, public participation, and open transparent decision-making process. Overall, PCORI is much more elaborate with significant involvement of stakeholders, transparency, public participation, and open decision-making. However, there are multiple issues concerning the operation of such agencies in the United States including the predecessor of Agency for Healthcare Research and Quality (AHRQ), the Agency for Healthcare Policy and Research (AHCPR), AHRQ Effectiveness Health Care programs, and others. The CER in the United States may be described at cross-roads or at the beginnings of a scientific era of CER and evidence-based medicine (EBM). However the United States suffers as other countries, including the United Kingdom with its National Health Services (NHS) and National Institute for Health and Clinical Excellence (NICE), with major misunderstandings of methodology, an inordinate focus on methodological assessment, lack of understanding of the study design (placebo versus active control), lack of involvement of clinicians, and misinterpretation of the evidence which continues to be disseminated. Consequently, PCORI and CER have been described as government-driven solutions without following the principles of EBM with an extensive focus on costs rather than quality. It also has been stated that the central planning which has been described for PCORI and CER, a term devised to be acceptable, will be used by third party payors to override the physician's best medical judgement and patient's best interest. Further, stakeholders in PCORI are not scientists, are not balanced, and will set an agenda with an ultimate problem of comparative effectiveness and PCORI that it is not based on medical science, but rather on political science and not even under congressional authority, leading to unprecedented negative changes to health care. Thus, PCORI is operating in an ad hoc manner that is incompatible with the principles of evidence-based practice.This manuscript describes the framework of PCORI, and the role of CER and its impact on interventional pain management.

  10. Thriving and surviving in home care and skilled nursing facilities under the Balanced Budget Act of 1997.

    PubMed

    Turnbull, G B

    2000-03-01

    The Balanced Budget Act of 1997 (BBA 97) contains the most dramatic changes to the Medicare program since its genesis nearly 35 years ago. To remain financially viable under the cost-cutting measures mandated in this Act, hospitals, home health agencies, skilled nursing facilities, and their employees must have a working knowledge of its contents. In addition, the patients served by these health care providers must have well documented and positive health outcomes, and they must be satisfied with the care and service they receive. Nevertheless, merely understanding the changes mandated by BBA 97 is not sufficient for success; clinicians also must develop innovative solutions to the hurdles the Act erects and quickly integrate them into daily practice. Issues of payment and reimbursement have everything to do with the delivery of today's patient care, regardless of the setting where it is delivered. BBA 97 offers special opportunities to wound, ostomy, and continence care clinicians.

  11. Aligning health information technologies with effective service delivery models to improve chronic disease care.

    PubMed

    Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-09-01

    Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Aligning health information technologies with effective service delivery models to improve chronic disease care

    PubMed Central

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-01-01

    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  13. Unique Practice, Unique Place: Exploring Two Assertive Community Treatment Teams in Maine.

    PubMed

    Schroeder, Rebecca A

    2018-06-01

    Assertive Community Treatment (ACT) is a model of care that provides comprehensive community-based psychiatric care for persons with serious mental illness. This model has been widely documented and has shown to be an evidence-based model of care for reducing hospitalizations for this targeted population. Critical ingredients of the ACT model are the holistic nature of their services, a team based approach to treatment and nurses who assist with illness management, medication monitoring, and provider collaboration. Although the model remains strong there are clear differences between urban and rural teams. This article describes present day practice in two disparate ACT programs in urban and rural Maine. It offers a new perspective on the evolving and innovative program of services that treat those with serious mental illness along with a review of literature pertinent to the ACT model and future recommendations for nursing practice. The success and longevity of these two ACT programs are testament to the quality of care and commitment of staff that work with seriously mentally ill consumers. Integrative care models such as these community-based treatment teams and nursing driven interventions are prime elements of this successful model.

  14. The Affordable Care Act and hospital chaplaincy: re-visioning spiritual care, re-valuing institutional wholeness.

    PubMed

    Frierdich, Matthew D

    2015-01-01

    This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care.

  15. Advance decisions and the Mental Capacity Act.

    PubMed

    Halliday, Samantha

    This article considers the requirements set out in the Mental Capacity Act 2005 for valid advance decisions. The Act recognizes that an adult with capacity may refuse treatment, including life-sustaining treatment, in advance of losing capacity. If that advance decision is valid and applicable, it will bind health-care professionals, taking effect as if the patient had contemporaneously refused the treatment. However, in cases where the advance decision does not relate to treatment for a progressive disease, it will be extremely difficult for the patient to meet the dual specificity requirement - specifying the treatment to be refused and the circumstances in which that refusal should operate. Moreover, while a patient may explicitly revoke an advance decision while she retains the capacity to do so, the continuing validity of an advance decision may be called into question by the patient implicitly revoking her advance refusal or by a change of circumstance. This article concludes that the key to enabling patients to exercise precedent autonomy will be full and frank discussion of the scope and intentions underlying advance decisions between patients and their health-care professionals.

  16. A Comparison of Assertive Community Treatment Fidelity Measures and Patient-Centered Medical Home Standards

    PubMed Central

    Vanderlip, Erik R.; Cerimele, Joseph M.; Monroe-DeVita, Maria

    2014-01-01

    Objective This study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation. Methods The authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards. Results PCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy “must-pass” elements of the standards. Conclusions ACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases. PMID:23820753

  17. 75 FR 50843 - 75th Anniversary of the Social Security Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-18

    ... old age.'' Our Nation was entrenched in the Great Depression. Unemployment neared 20 percent, and... new health care law, the Affordable Care Act, helps sustain this commitment and improves the long-term...

  18. 76 FR 28790 - Disease, Disability, and Injury Prevention and Control Special Emphasis Panel (SEP): Initial review.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-18

    ... announced below concerns Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity... ``Affordable Care Act (ACA): Childhood Obesity Research Funding Opportunity Announcement (FOA) DP11-007, Panel...

  19. Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia.

    PubMed

    Chin, May Chien; Sivasampu, Sheamini; Khoo, Ee Ming

    2017-01-01

    Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage. Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA. A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector. Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.

  20. Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

    PubMed Central

    Sivasampu, Sheamini; Khoo, Ee Ming

    2017-01-01

    Objective Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage. Methods Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA. Results A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector. Conclusion Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system. PMID:28662193

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