Medicaid provider reimbursement policy for adult immunizations☆

PubMed Central

Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

2015-01-01

Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

Medicaid provider reimbursement policy for adult immunizations.

PubMed

Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

2015-10-26

State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

20 CFR 10.718 - Are payments to a beneficiary as a result of an insurance policy which the beneficiary has...

Code of Federal Regulations, 2010 CFR

2010-04-01

... OWCP or SOL? 10.718 Section 10.718 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... reported to OWCP or SOL? Since payments received by a FECA beneficiary pursuant to an insurance policy...

78 FR 48995 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-12

...This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on November 16, 2012, entitled ``Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013.''

Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule & other revisions to Part B for CY 2014. Final rule with comment period.

PubMed

2013-12-10

This major final rule with comment period addresses changes to the physician fee schedule, clinical laboratory 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. This final rule with comment period also includes a discussion in the Supplementary Information regarding various programs. (See the Table of Contents for a listing of the specific issues addressed in the final rule with comment period.)

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.

Medicaid payment policies for nursing home care: A national survey

PubMed Central

Buchanan, Robert J.; Madel, R. Peter; Persons, Dan

1991-01-01

This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935

Measure in the ESRD QIP for PY 2020. Final rule.

PubMed

2017-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.

Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

PubMed

2007-11-27

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. 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, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

California safety-net hospitals likely to be penalized by ACA value, readmission, and meaningful-use programs.

PubMed

Gilman, Matlin; Adams, E Kathleen; Hockenberry, Jason M; Wilson, Ira B; Milstein, Arnold S; Becker, Edmund R

2014-08-01

The Affordable Care Act includes provisions to increase the value obtained from health care spending. A growing concern among health policy experts is that new Medicare policies designed to improve the quality and efficiency of hospital care, such as value-based purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), and electronic health record (EHR) meaningful-use criteria, will disproportionately affect safety-net hospitals, which are already facing reduced disproportionate-share hospital (DSH) payments under both Medicare and Medicaid. We examined hospitals in California to determine whether safety-net institutions were more likely than others to incur penalties under these programs. To assess quality, we also examined whether mortality outcomes were different at these hospitals. Our study found that compared to non-safety-net hospitals, safety-net institutions had lower thirty-day risk-adjusted mortality rates in the period 2009-11 for acute myocardial infarction, heart failure, and pneumonia and marginally lower adjusted Medicare costs. Nonetheless, safety-net hospitals were more likely than others to be penalized under the VBP program and the HRRP and more likely not to meet EHR meaningful-use criteria. The combined effects of Medicare value-based payment policies on the financial viability of safety-net hospitals need to be considered along with DSH payment cuts as national policy makers further incorporate performance measures into the overall payment system. Project HOPE—The People-to-People Health Foundation, Inc.

7 CFR 1400.301 - Eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Cash Rent Tenants § 1400.301 Eligibility. (a) Any tenant that is...

7 CFR 1400.9 - Appeals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS General Provisions § 1400.9 Appeals. (a) A person or legal entity...

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements. Final rule.

PubMed

2016-11-15

This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.

7 CFR 1400.401 - Eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE GENERAL REGULATIONS AND POLICIES PAYMENT LIMITATION AND PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Foreign Persons § 1400.401 Eligibility. (a) Any person who is not a...

48 CFR 2825.302 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 2825.302 Section 2825.302 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 2825.302 Policy. The HCA, or designee at a level not lower than the...

48 CFR 2825.302 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 2825.302 Section 2825.302 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 2825.302 Policy. The HCA, or designee at a level not lower than the...

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.

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

PubMed

2015-11-13

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

Who Picks up the Tab? Reducing Payment Errors in School Nutrition Programs. Trends in Nutrition Policy. Issue Brief. Number 3

ERIC Educational Resources Information Center

Ponza, Michael; Gleason, Philip; Hulsey, Lara; Moore, Quinn

2009-01-01

Although the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) help ensure that many low-income children have enough nutritious food to eat, some studies have suggested that the programs could be more efficient and cost-effective. In particular, concerns have been raised about erroneous payments that reimburse schools for…

12 CFR 370.12 - Payment on the guarantee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Payment on the guarantee. 370.12 Section 370.12 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY TEMPORARY LIQUIDITY GUARANTEE PROGRAM § 370.12 Payment on the guarantee. (a) Claims for Deposits in...

Ecological and socioeconomic effects of China's policies for ecosystem services.

PubMed

Liu, Jianguo; Li, Shuxin; Ouyang, Zhiyun; Tam, Christine; Chen, Xiaodong

2008-07-15

To address devastating environmental crises and to improve human well-being, China has been implementing a number of national policies on payments for ecosystem services. Two of them, the Natural Forest Conservation Program (NFCP) and the Grain to Green Program (GTGP), are among the biggest programs in the world because of their ambitious goals, massive scales, huge payments, and potentially enormous impacts. The NFCP conserves natural forests through logging bans and afforestation with incentives to forest enterprises, whereas the GTGP converts cropland on steep slopes to forest and grassland by providing farmers with grain and cash subsidies. Overall ecological effects are beneficial, and socioeconomic effects are mostly positive. Whereas there are time lags in ecological effects, socioeconomic effects are more immediate. Both the NFCP and the GTGP also have global implications because they increase vegetative cover, enhance carbon sequestration, and reduce dust to other countries by controlling soil erosion. The future impacts of these programs may be even bigger. Extended payments for the GTGP have recently been approved by the central government for up to 8 years. The NFCP is likely to follow suit and receive renewed payments. To make these programs more effective, we recommend systematic planning, diversified funding, effective compensation, integrated research, and comprehensive monitoring. Effective implementation of these programs can also provide important experiences and lessons for other ecosystem service payment programs in China and many other parts of the world.

Payment policy and the growth of Medicare Advantage.

PubMed

Zarabozo, Carlos; Harrison, Scott

2009-01-01

This paper reviews recent trends in Medicare Advantage, examining program costs, access to plans, enrollment, plan bids, and benchmarks. We find that current policy has favored the growth of particular types of plans. Bid data show that plans are paid, on average, 113 percent of what expenditures would have been under the traditional Medicare program. Although some of the plan payments are used to finance extra benefits for enrollees, paying plans at higher than fee-for-service levels could affect the sustainability of the Medicare program and result in increased costs for all taxpayers and beneficiaries.

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.

Payments To Informal vs. Formal Home Care Providers: Policy Divergence Affects the Elderly and Their Families in Michigan and Illinois. Revised.

ERIC Educational Resources Information Center

Keigher, Sharon M.; And Others

States' policies vary widely on paying friends and family rather than home care agencies to care for the elderly. This analysis explored two state programs which exemplify different payment options: Michigan, which pays clients' informal caregivers, and Illinois, which generally pays agencies to provide services. It asked how different payment…

7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Will FAS make advance payments to a Cooperator? 1484... DEVELOP FOREIGN MARKETS FOR AGRICULTURAL COMMODITIES Contributions and Reimbursements § 1484.57 Will FAS make advance payments to a Cooperator? (a) Policy. In general, FAS operates the Cooperator program on a...

7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Will FAS make advance payments to a Cooperator? 1484... DEVELOP FOREIGN MARKETS FOR AGRICULTURAL COMMODITIES Contributions and Reimbursements § 1484.57 Will FAS make advance payments to a Cooperator? (a) Policy. In general, FAS operates the Cooperator program on a...

7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Will FAS make advance payments to a Cooperator? 1484... FOR AGRICULTURAL COMMODITIES Contributions and Reimbursements § 1484.57 Will FAS make advance payments to a Cooperator? (a) Policy. In general, FAS operates the Cooperator program on a reimbursable basis...

7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Will FAS make advance payments to a Cooperator? 1484... FOR AGRICULTURAL COMMODITIES Contributions and Reimbursements § 1484.57 Will FAS make advance payments to a Cooperator? (a) Policy. In general, FAS operates the Cooperator program on a reimbursable basis...

7 CFR 1484.57 - Will FAS make advance payments to a Cooperator?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Will FAS make advance payments to a Cooperator? 1484... FOR AGRICULTURAL COMMODITIES Contributions and Reimbursements § 1484.57 Will FAS make advance payments to a Cooperator? (a) Policy. In general, FAS operates the Cooperator program on a reimbursable basis...

7 CFR 1486.406 - Will CCC make advance payments to Recipients?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Will CCC make advance payments to Recipients? 1486... PROGRAM Contributions and Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a) Policy. In general, CCC operates the EMP on a cost reimbursable basis. (b) Exception. Upon request, CCC...

7 CFR 1486.406 - Will CCC make advance payments to Recipients?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Will CCC make advance payments to Recipients? 1486... PROGRAM Contributions and Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a) Policy. In general, CCC operates the EMP on a cost reimbursable basis. (b) Exception. Upon request, CCC...

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.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

PubMed

2014-08-22

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. 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 Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. 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) 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 discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare. We 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. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

Hospice Value-Based Purchasing Program: A Model Design.

PubMed

Nowak, Bryan P

2016-12-01

With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Medicare program; revisions to payment policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, access to identifiable data for the Center for Medicare and Medicaid Innovation Models & other revisions to Part B for CY 2015. Final rule with comment period.

PubMed

2014-11-13

This major 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, as well as changes in the statute. See the Table of Contents for a listing of the specific issues addressed in this rule.

Payments for carbon sequestration to alleviate development pressure in a rapidly urbanizing region

USGS Publications Warehouse

Smith, Jordan W.; Dorning, Monica; Shoemaker, Douglas A.; Méley, Andréanne; Dupey, Lauren; Meentemeyer, Ross K.

2017-01-01

The purpose of this study was to determine individuals' willingness to enroll in voluntary payments for carbon sequestration programs through the use of a discrete choice experiment delivered to forest owners living in the rapidly urbanizing region surrounding Charlotte, North Carolina. We examined forest owners' willingness to enroll in payments for carbon sequestration policies under different levels of financial incentives (annual revenue), different contract lengths, and different program administrators (e.g., private companies versus a state or federal agency). We also examined the influence forest owners' sense of place had on their willingness to enroll in hypothetical programs. Our results showed a high level of ambivalence toward participating in payments for carbon sequestration programs. However, both financial incentives and contract lengths significantly influenced forest owners' intent to enroll. Neither program administration nor forest owners' sense of place influenced intent to enroll. Although our analyses indicated that payments from carbon sequestration programs are not currently competitive with the monetary returns expected from timber harvest or property sales, certain forest owners might see payments for carbon sequestration programs as a viable option for offsetting increasing tax costs as development encroaches and property values rise.

US hospital payment adjustments for innovative technology lag behind those in Germany, France, and Japan.

PubMed

Hernandez, John; Machacz, Susanne F; Robinson, James C

2015-02-01

Medicare pioneered add-on payments to facilitate the adoption of innovative technologies under its hospital prospective payment system. US policy makers are now experimenting with broader value-based payment initiatives, but these have not been adjusted for innovation. This article examines the structure, processes, and experience with Medicare's hospital new technology add-on payment program since its inception in 2001 and compares it with analogous payment systems in Germany, France, and Japan. Between 2001 and 2015 CMS approved nineteen of fifty-three applications for the new technology add-on payment program. We found that the program resulted in $201.7 million in Medicare payments in fiscal years 2002-13-less than half the level anticipated by Congress and only 34 percent of the amount projected by CMS. The US program approved considerably fewer innovative technologies, compared to analogous technology payment mechanisms in Germany, France and Japan. We conclude that it is important to adjust payments for new medical innovations within prospective and value-based payment systems explicitly as well as implicitly. The most straightforward method to use in adjusting value-based payments is for the insurer to retrospectively adjust spending targets to account for the cost of new technologies. If CMS made such retrospective adjustments, it would not financially penalize hospitals for adopting beneficial innovations. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.

PubMed

2017-12-01

This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

48 CFR 2104.703 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 2104.703 Section 2104.703 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Retention 2104.703 Policy. In view of the unique payment schedules of FEGLI Program contracts and the...

48 CFR 2104.703 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policy. 2104.703 Section 2104.703 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Retention 2104.703 Policy. In view of the unique payment schedules of FEGLI Program contracts and the...

48 CFR 2104.703 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 2104.703 Section 2104.703 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Retention 2104.703 Policy. In view of the unique payment schedules of FEGLI Program contracts and the...

Payment policy and inefficient benefits in the Medicare+Choice program.

PubMed

Pizer, Steven D; Frakt, Austin B; Feldman, Roger

2003-06-01

We investigated whether constraints on premium rebates by health plans in the Medicare+Choice program result in inefficient benefits. Since relationships between revenue and benefits could be confounded by unobserved variation in the cost of coverage, we took advantage of natural experiment that occurred following passage of the Benefits Improvement and Protection Act of 2000. Our findings indicate that benefits in zero premium plans were more sensitive to changes in payment rates than were benefits in plans that charged nonzero premiums. These results strongly suggest that current Medicare policy induces plans to offer benefits that are not valued by enrollees at or above their cost.

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.

77 FR 44721 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face to...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-30

... Classification of Diseases IMRT Intensity Modulated Radiation Therapy IOM Internet-only Manual IPCI Indirect... RIA Regulatory impact analysis RVU Relative value unit SBRT Stereotactic body radiation therapy SGR... adjust the payment rates for two common radiation oncology treatment delivery methods, intensity...

77 FR 217 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

... Donald Howard, (410) 786-6764, Hospital Value-Based Purchasing (VBP) Program Issues. SUPPLEMENTARY... analyses performed by Brandeis University and Mathematica Policy Research together despite their slightly...

Rural Household Preferences for Active Participation in “Payment for Ecosystem Service” Programs: A Case in the Miyun Reservoir Catchment, China

PubMed Central

Jiang, Xuemei; Zhang, Kebin; Yang, Xiaohui

2017-01-01

Many payment for ecosystem services (PES) programs, such as the Slope Land Conversion Program (SLCP), are passive and require full participation by impacted households. In contrast, this study considers the alternative of “active and incomplete” participation in PES programs, in which participants are not obliged to contract their own land, and have the right to select into the program or not. This type of program has been popular over the last decade in China; however, there have been few studies on the characteristics of willingness to participate and implementation. As such, this paper uses the Choice Experiment (CE) method to explore ways for inducing effective program participation, by analyzing the effects of different regime attributes. The case study used to analyze participation utility was the Jing-Ji Afforestation Program for Ecological and Water Protection (JAPEWP), a typical active-participation forestry PES program, and a key source of water near Beijing in the Miyun Reservoir Catchment (MRC). Analyzing rural household survey data indicated that the program faces a variety of challenges, including long-term maintenance, implementation performance, cost-effectiveness, and monitoring approaches. There are also challenges with one-size-fits-all payment strategies, due to ineffective program participation or imperfect implementation regimes. In response, this study proposes several policies, including providing secure and complete land tenure to the participants, creating more local off-farm employment opportunities, designing performance-based monitoring systems that are integrated with financial incentives, applying differentiated payment strategies, providing capacity building to support forestation activities, and establishing a comprehensive implementation regime that would address these challenges. These policy conclusions provide valuable lessons for other active-participation PES programs as well. PMID:28046106

Rural Household Preferences for Active Participation in "Payment for Ecosystem Service" Programs: A Case in the Miyun Reservoir Catchment, China.

PubMed

Li, Hao; Bennett, Michael T; Jiang, Xuemei; Zhang, Kebin; Yang, Xiaohui

2017-01-01

Many payment for ecosystem services (PES) programs, such as the Slope Land Conversion Program (SLCP), are passive and require full participation by impacted households. In contrast, this study considers the alternative of "active and incomplete" participation in PES programs, in which participants are not obliged to contract their own land, and have the right to select into the program or not. This type of program has been popular over the last decade in China; however, there have been few studies on the characteristics of willingness to participate and implementation. As such, this paper uses the Choice Experiment (CE) method to explore ways for inducing effective program participation, by analyzing the effects of different regime attributes. The case study used to analyze participation utility was the Jing-Ji Afforestation Program for Ecological and Water Protection (JAPEWP), a typical active-participation forestry PES program, and a key source of water near Beijing in the Miyun Reservoir Catchment (MRC). Analyzing rural household survey data indicated that the program faces a variety of challenges, including long-term maintenance, implementation performance, cost-effectiveness, and monitoring approaches. There are also challenges with one-size-fits-all payment strategies, due to ineffective program participation or imperfect implementation regimes. In response, this study proposes several policies, including providing secure and complete land tenure to the participants, creating more local off-farm employment opportunities, designing performance-based monitoring systems that are integrated with financial incentives, applying differentiated payment strategies, providing capacity building to support forestation activities, and establishing a comprehensive implementation regime that would address these challenges. These policy conclusions provide valuable lessons for other active-participation PES programs as well.

Do heart failure disease management programs make financial sense under a bundled payment system?

PubMed

Eapen, Zubin J; Reed, Shelby D; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D

2011-05-01

Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown. Our study determined the cost-neutral point for the typical DM program and examined whether published HF DM programs can be cost saving under bundled payment programs. We used a decision analytic model using data from retrospective cohort studies, meta-analyses, 5 randomized trials evaluating DM programs, and inpatient claims for all Medicare beneficiaries discharged with an HF diagnosis from 2001 to 2004. We determined the costs of DM programs and inpatient care over 30 and 180 days. With a baseline readmission rate of 22.9%, the average cost for readmissions over 30 days was $2,272 per patient. Under base-case assumptions, a DM program that reduced readmissions by 21% would need to cost $477 per patient to be cost neutral. Among evaluated published DM programs, 2 of the 5 would increase provider costs (+$15 to $283 per patient), whereas 3 programs would be cost saving (-$241 to $347 per patient). If bundled payments were broadened to include care over 180 days, then program saving estimates would increase, ranging from $419 to $1,706 per patient. Proposed bundled payments for HF admissions provide hospitals with a potential financial incentive to implement DM programs that efficiently reduce readmissions. Copyright © 2011 Mosby, Inc. All rights reserved.

[Provide comprehensive service for state policy].

PubMed

Wu, X

1991-04-01

In recent years, Chinese insurance companies introduced family planning (FP) insurance series. These schemes originated from the "one child" and life insurance and accident insurance of the early 1980s, which were established in response to the need that came with the "one child" policy. In order to help relieve the difficulties of rural FP work, the People's Insurance Corporation extended these programs to a series of schemes. These schemes included e.g., and old age security program for the families with 1 daughter only, old age security for families with an only child, and the program for FP workers' personal safety. The purpose of these schemes was to guarantee security in old age for families with few children, to ensure compensation if accident occurs during delivery or as a result of birth control operations; and compensation for FP workers for physical assaults they encountered. As FP organizations have been directly involved in advertising the insurance programs, there has been support from local governments with human and financial resources, and these insurance programs have been expanding every year. The payment of the policy has been either entirely or partially borne by the employers of the insured. In the process of the development of the insurance program, some problems have occurred. 1st, competition between FP organizations and insurance companies have evolved in sponsoring the program for its profit. 2nd, some media reports have confused the payment of premiums with the compulsory levy of undue fees, which in a way, hindered the expansion of program enrollment. 3rd, some local administrations are short of funds to pay for the insurance premiums. 4th, the accrued income from the premiums is lower than the expected sum of the principle and interest if the same funds were deposited in a bank at current interest rate. Therefore, some schemes lack appeal. FP series insurance is a longer term program which will have an important impact on the realization of the aim of population policy, and on the welfare of the population. The government should give adequate emphasis to the management of the program. The fund from the policy premiums could be used in high return and low risk investment in order to increase the appeal of the insurance schemes. Besides the current resources for the payment of premiums, funds from government allocation, penalty payment from those who have birth above the quota, one-child allowance, donations from communities or individuals, and income from special lotteries could also be used to pay the premiums.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

PubMed

2016-11-04

This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

Costs, payments, and incentives in family planning programs: a review for developing countries.

PubMed

Ross, J A; Isaacs, S L

1988-01-01

Anxieties about financing health and family planning programs have grown in recent years, leading to discussions of cost-recovery measures that would raise charges to the consumer. Yet some governments wish to lower cost to encourage contraceptive use, and a few use incentives and disincentives. Data from numerous developing countries are presented on contraceptive cost topics: charges for contraceptive supplies and services, in both public and private sectors, and conversely, payments made to clients and providers to offset costs and to increase contraceptive use. The data show great diversity, and much inconsistency within countries, indicating that the structures of charges, payments, and incentives in many programs could be improved. Ethical considerations are discussed, and guidelines are suggested for developing effective financial policies.

Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms

PubMed Central

Jack, B. Kelsey; Kousky, Carolyn; Sims, Katharine R. E.

2008-01-01

Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation. PMID:18621696

Designing payments for ecosystem services: Lessons from previous experience with incentive-based mechanisms.

PubMed

Jack, B Kelsey; Kousky, Carolyn; Sims, Katharine R E

2008-07-15

Payments for ecosystem services (PES) policies compensate individuals or communities for undertaking actions that increase the provision of ecosystem services such as water purification, flood mitigation, or carbon sequestration. PES schemes rely on incentives to induce behavioral change and can thus be considered part of the broader class of incentive- or market-based mechanisms for environmental policy. By recognizing that PES programs are incentive-based, policymakers can draw on insights from the substantial body of accumulated knowledge about this class of instruments. In particular, this article offers a set of lessons about how the environmental, socioeconomic, political, and dynamic context of a PES policy is likely to interact with policy design to produce policy outcomes, including environmental effectiveness, cost-effectiveness, and poverty alleviation.

Impact of Medicare's prospective payment system on hospitals, skilled nursing facilities, and home health agencies: how the Balanced Budget Act of 1997 may have altered service patterns for Medicare providers.

PubMed

Kulesher, Robert R

2006-01-01

The prospective payment system is one of many changes in reimbursement that has affected the delivery of health care. Originally developed for the payment of inpatient hospital services, it has become a major factor in how all health insurance is reimbursed. The policy implications extend beyond the Medicare program and affect the entire health care delivery system. Initially implemented in 1982 for payments to hospitals, prospective payment system was extended to payments for skilled nursing facility and home health agency services by the Balanced Budget Act of 1997. The intent of the Balanced Budget Act was to bring into balance the federal budget through reductions in spending. The decisions that providers have made to mitigate the impact are a function of ownership type, organizational mission, and current level of Medicare participation. This article summarizes the findings of several initial studies on the Balanced Budget Act's impact and discusses how changes in Medicare reimbursement policy have influenced the delivery of health care for the general public and for Medicare beneficiaries.

Medicare and Medicaid Physician Payment Incentives

PubMed Central

Burney, Ira L.; Schieber, George J.; Blaxall, Martha O.; Gabel, Jon R.

1979-01-01

The incentives in the Medicare and Medicaid physician payment systems and their effects on six interrelated aspects of health care costs and beneficiary access to care were analyzed. Research results and data presented indicate that Medicare and Medicaid physician payment incentives are inconsistent with current public policy goals of (1) containing inflation in fees and expenditures, (2) encouraging physician participation in public programs, (3) improving the geographic and specialty distributions of physicians, (4) encouraging primary care instead of surgery, and also outpatient rather than inpatient treatment. PMID:10309053

78 FR 26437 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-06

...This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2014, would revise and rebase the SNF market basket, and would make certain technical and conforming revisions in the regulations text. This proposed rule also includes a proposed policy for reporting the SNF market basket forecast error correction in certain limited circumstances and a proposed new item for the Minimum Data Set (MDS), Version 3.0.

Texas Medicaid Payment Reform: Fewer Early Elective Deliveries And Increased Gestational Age And Birthweight.

PubMed

Dahlen, Heather M; McCullough, J Mac; Fertig, Angela R; Dowd, Bryan E; Riley, William J

2017-03-01

Infants born at full term have better health outcomes. However, one in ten babies in the United States are born via a medically unnecessary early elective delivery: induction of labor, a cesarean section, or both before thirty-nine weeks gestation. In 2011 the Texas Medicaid program sought to reduce the rate of early elective deliveries by denying payment to providers for the procedure. We examined the impact of this policy on clinical care practice and perinatal outcomes by comparing the changes in Texas relative to comparison states. We found that early elective delivery rates fell by as much as 14 percent in Texas after this payment policy change, which led to gains of almost five days in gestational age and six ounces in birthweight among births affected by the policy. The impact on early elective delivery was larger in magnitude for minority patients. Other states may look to this Medicaid payment reform as a model for reducing early elective deliveries and disparities in infant health. Project HOPE—The People-to-People Health Foundation, Inc.

Opportunities and Challenges for Payment Reform: Observations from Massachusetts.

PubMed

Mechanic, Robert E

2016-08-01

Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts than in any other state. The reasons include a major effort by Blue Cross Blue Shield of Massachusetts to implement global payment, the presence of large integrated systems willing to take on financial risk, and a supportive state policy environment. By 2014, thirty-seven percent of Massachusetts's residents enrolled in health plans were covered under risk-based payment models tied to global budgets. But the expansion of payment reform in Massachusetts slowed between 2012 and 2015 because some commercial enrollment shifted from risk-based health maintenance organization products to fee-for-service preferred provider organization (PPO) plans, and the state Medicaid program fell short of its payment reform goals. Provider groups will not fully commit to population-based clinical models if they believe it will result in large reductions in fee-for-service revenue. The use of alternative payment models will accelerate in 2016 when Blue Cross begins implementing PPO payment reforms, but it is unknown how quickly other payers will follow. Massachusetts's experience illustrates the complexity of payment reform in pluralistic health care markets and the need for complementary efforts by public and private stakeholders. Copyright © 2016 by Duke University Press.

Current State of Value-Based Purchasing Programs.

PubMed

Chee, Tingyin T; Ryan, Andrew M; Wasfy, Jason H; Borden, William B

2016-05-31

The US healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, solidified the role of value-based payment in Medicare. Many private insurers are following Medicare's lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in Medicare Access and CHIP Reauthorization Act and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated; the impact of those programs has been marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care. © 2016 American Heart Association, Inc.

Current State of Value-Based Purchasing Programs

PubMed Central

Chee, Tingyin T.; Ryan, Andrew M.; Wasfy, Jason H.; Borden, William B.

2016-01-01

The United States healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act (MACRA), solidified the role of value-based payment in Medicare. Many private insurers are following Medicare’s lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in MACRA and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated, with the impact of those programs being marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care. PMID:27245648

77 FR 24215 - Section 8 Housing Assistance Payments Program-Fiscal Year (FY) 2012 Inflation Factors for Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-23

... AGENCY: Office of the Assistant Secretary for Policy Development and Research, HUD. ACTION: Notice... Division, Office of Policy Development and Research, telephone number 202-402- 6058, for technical... economic variables from the Administration's economic assumptions. For reference, these economic...

20 CFR 408.601 - What is this subpart about?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What is this subpart about? 408.601 Section 408.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... payment policies and procedures we use for the title VIII program closely parallel our title II policies...

20 CFR 408.601 - What is this subpart about?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What is this subpart about? 408.601 Section 408.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... payment policies and procedures we use for the title VIII program closely parallel our title II policies...

20 CFR 408.601 - What is this subpart about?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What is this subpart about? 408.601 Section 408.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... payment policies and procedures we use for the title VIII program closely parallel our title II policies...

20 CFR 408.601 - What is this subpart about?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What is this subpart about? 408.601 Section 408.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... payment policies and procedures we use for the title VIII program closely parallel our title II policies...

20 CFR 408.601 - What is this subpart about?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What is this subpart about? 408.601 Section 408.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II... payment policies and procedures we use for the title VIII program closely parallel our title II policies...

Mitigating greenhouse gases: the importance of land base interactions between forests, agriculture, and residential development in the face of changes in bioenergy and carbon prices

Treesearch

Ralph Alig; Greg Latta; Darius Adams; Bruce McCarl

2009-01-01

The forest sector can contribute to atmospheric greenhouse gas reduction, while also providing other environmental, economic, and social benefits. Policy tools for climate change mitigation include carbon-related payment programs as well as laws and programs to impede the loss of agricultural and forest lands to development. Policy makers will base their expectations...

Exploring interactions between payment for hydrologic service policies, landowner decisions, and ecohydrology in a Mexican cloud forest watershed: Is there a disconnect between the policy and the resource?

NASA Astrophysics Data System (ADS)

Asbjornsen, H.; Geissert, D.; Gomez-Tagle, A.; Holwerda, F.; Manson, R.; Perez-Maqueo, O.; Munoz-Villers, L.; Scullion, J.

2013-05-01

Payment for hydrologic service (PHS) programs are increasingly being used as a means to incentivize watershed protection by compensating upstream 'water producers' with payments made by downstream 'water consumers'. However, the effectiveness of PHS programs in achieving their target goals is often poorly understood. Here, we draw from insights obtained from socioeconomic and ecohydrological research in Veracruz, Mexico to explore interactions between PHS policies, landowner decisions, and hydrologic services. GIS analysis of land-cover changes during 2003-2009 combined with interviews of PHS participants indicated that despite lower deforestation rates on properties receiving PES payments, other factors were likely to have a greater influence on land use decisions than PHS payments per se, including opportunity costs and personal conservation ethic. The interviews also highlighted a general lack of trust and cooperation between the citizen participants and government administrators, which was reflected in the relatively low level of knowledge of the PHS programs' regulations and goals, the role of forests in protecting water resources, and a low level of co-financing by the private sector. An important premise of PHS programs is that protecting existing forest cover (and planting trees) will enhance water supply, especially in upland cloud forests that are due to their perceived role as water producers. Measurements of climate, steamflow, canopy fog interception, plant transpiration, soil water dynamics, and hydrologic flow paths were collected over a 3-year period to assess stand water balance and streamflow response under four different land covers: mature cloud forest, pasture, regenerating cloud forest, pine reforestation. Results suggested relatively minor additional inputs of fog to increasing streamflow in cloud forest watersheds, while conversion of forest to pasture did not markedly decrease dry season flows, but did increase annual flows due to lower pasture evapotranspiration. Nevertheless, the pasture showed higher surface runoff for the most intense storms, indicating a diminished infiltration capacity. Young pine plantations and regenerating cloud forest had higher evapotranspiration and therefore higher water yield relative to mature cloud forest. Our analysis suggests a disconnect between PHS policies and the hydrological services provided through forest conservation and tree planting. The implications of this apparent disconnect are discussed within the context of designing effective policies for enhancing hydrologic services, and the importance of site-based research and monitoring to improve understanding of coupled social-ecohydrological systems.

76 FR 26431 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

...This final rule updates the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for discharges occurring during the rate year (RY) beginning July 1, 2011 through September 30, 2012. The final rule also changes the IPF prospective payment system (PPS) payment rate update period to a RY that coincides with a fiscal year (FY). In addition, the rule implements policy changes affecting the IPF PPS teaching adjustment. It also rebases and revises the Rehabilitation, Psychiatric, and Long-Term Care (RPL) market basket, and makes some clarifications and corrections to terminology and regulations text.

34 CFR 303.20 - Policies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH DISABILITIES... system of payments is provided for under Federal or State law. (4) A State's standards for personnel who...

34 CFR 303.20 - Policies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH..., except where a system of payments is provided for under Federal or State law. (4) A State's standards for...

7 CFR 1485.18 - Advances.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MARKETS FOR AGRICULTURAL COMMODITIES Market Access Program § 1485.18 Advances. (a) Policy. In general, CCC... payments to an MAP participant for generic promotion activities. Prior to making an advance, CCC may...

7 CFR 1485.18 - Advances.

Code of Federal Regulations, 2011 CFR

2011-01-01

... MARKETS FOR AGRICULTURAL COMMODITIES Market Access Program § 1485.18 Advances. (a) Policy. In general, CCC... payments to an MAP participant for generic promotion activities. Prior to making an advance, CCC may...

The impact of health reform on the Medicare Advantage program: realigning payment with performance.

PubMed

Biles, Brian; Casillas, Giselle; Arnold, Grace; Guterman, Stuart

2012-10-01

The Affordable Care Act enacts a new payment system for private health plans available to Medicare beneficiaries through the Medicare Advantage (MA) program. The system, which is being phased in through 2017, aims to (1) reduce the excess pay­ments received by private plans relative to per capita spending in traditional Medicare, and (2) reward plans that earn high performance ratings. Using 2009 data, this issue brief pres­ents analysis of the distributional impact on MA plan payments of these new policies as if they had been fully implemented in that year. We find that, when the polices [sic] are in place, they will bring overall MA plan payments nationwide down from 114 percent to 102 per­cent of what spending would have been for the same enrollees if they had been enrolled in traditional Medicare. While payments will vary across the nation, high-performing MA plans stand to benefit from this new arrangement.

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.

MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

PubMed Central

ROBBINS, JACOB A.

2015-01-01

The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

Medicare program; clarification of Medicare's accrual basis of accounting policy--HCFA. Final rule.

PubMed

1995-06-27

This final rule revises the Medicare regulations to clarify the concept of "accrual basis of accounting" to indicate that expenses must be incurred by a provider of health care services before Medicare will pay its share of those expenses. This rule does not signify a change in policy but, rather, incorporates into the regulations Medicare's longstanding policy regarding the circumstances under which we recognize, for the purposes of program payment, a provider's claim for costs for which it has not actually expended funds during the current cost reporting period.

7 CFR 1735.41 - Notes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GENERAL POLICIES, TYPES OF LOANS, LOAN REQUIREMENTS-TELECOMMUNICATIONS PROGRAM Terms of Loans § 1735.41... supersedes those portions of RUS Bulletin 320-12 “Loan Payments and Statements” with which it is in conflict. ...

Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

PubMed

Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

2016-06-01

Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care.

From politics to policy: a new payment approach in Medicare Advantage.

PubMed

Berenson, Robert A

2008-01-01

While the Medicare Advantage program's future remains contentious politically, the Medicare Payment Advisory Commission's (MedPAC's) recommended policy of financial neutrality at the local level between private plans and traditional Medicare ignores local market dynamics in important ways. An analysis correlating plan bids against traditional Medicare's local spending levels likely would provide an alternative method of setting benchmarks, by producing a blend of local and national rates. A result would be that the rural and lower-cost urban "floor counties" would have benchmarks below currently inflated levels but above what financial neutrality at the local level--MedPAC's approach--would produce.

No hospital left behind? Education policy lessons for value-based payment in healthcare.

PubMed

Maurer, Kristin A; Ryan, Andrew M

2016-01-01

Value-based payment systems have been widely implemented in healthcare in an effort to improve the quality of care. However, these programs have not broadly improved quality, and some evidence suggests that they may increase inequities in care. No Child Left Behind is a parallel effort in education to address uneven achievement and inequalities. Yet, by penalizing the lowest performers, No Child Left Behind's approach to accountability has led to a number of unintended consequences. This article draws lessons from education policy, arguing that financial incentives should be designed to support the lowest performers to improve quality. © 2015 Society of Hospital Medicine.

Evaluating Payments for Environmental Services: Methodological Challenges

PubMed Central

2016-01-01

Over the last fifteen years, Payments for Environmental Services (PES) schemes have become very popular environmental policy instruments, but the academic literature has begun to question their additionality. The literature attempts to estimate the causal effect of these programs by applying impact evaluation (IE) techniques. However, PES programs are complex instruments and IE methods cannot be directly applied without adjustments. Based on a systematic review of the literature, this article proposes a framework for the methodological process of designing an IE for PES schemes. It revises and discusses the methodological choices at each step of the process and proposes guidelines for practitioners. PMID:26910850

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2016. Final rule.

PubMed

2015-08-06

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2016 as required by the statute. As required by section 1886(j)(5) of the Act, this rule includes the classification and weighting factors for the IRF PPS's case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2016. This final rule also finalizes policy changes, including the adoption of an IRF-specific market basket that reflects the cost structures of only IRF providers, a 1-year phase-in of the revised wage index changes, a 3-year phase-out of the rural adjustment for certain IRFs, and revisions and updates to the quality reporting program (QRP).

Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance.

PubMed

Guerrero, Erick G; Garner, Bryan R; Cook, Benjamin; Kong, Yinfei; Vega, William A; Gelberg, Lillian

2017-05-25

Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs' acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.

Studies in Public Welfare. Paper No. 12 (Part I): The Family, Poverty, and Welfare Programs; Factors Influencing Family Instability. A Volume of Studies Prepared for the Use of the Subcommittee on Fiscal Policy of the Joint Economic Committee, Congress of the United States.

ERIC Educational Resources Information Center

Joint Economic Committee, Washington, DC.

Contents of this volume of studies analyzing the causes of the alarming growth in illegitimacy, families lacking a father, and welfare caseloads, include the following studies: "The Family, Poverty, and Welfare Programs: An Introductory Essay on Problems of Analysis and Policy," Robert I. Lerman; "The Impact of Welfare Payment Levels on Family…

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…

78 FR 43281 - Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

..., Independent Laboratory, Pathology, Radiation Oncology, and Radiation Therapy Centers are projected to have a... Mass immunization roster biller. 74 Radiation therapy centers. 87 All other suppliers (e.g., drug and...

A Report On Eight Early-Stage State And Regional Projects Testing Value-Based Payment

PubMed Central

Conrad, Douglas; Grembowski, David; Gibbons, Claire; Marcus-Smith, Miriam; Hernandez, Susan E.; Chang, Judy; Renz, Anne; Lau, Bernard; Cruz, Erin dela

2014-01-01

To help contain health care spending and improve the quality of care, practitioners and policy makers are trying to move away from fee-for-service toward value-based payment, which links providers’ reimbursement to the value, rather than the volume, of services delivered. With funding from the Robert Wood Johnson Foundation, eight grantees across the country are designing and implementing value-based payment reform projects. For example, in Salem, Oregon, the Physicians Choice Foundation is testing “Program Oriented Payments,” which include incentives for providers who follow a condition-specific program of care designed to meet goals set jointly by patient and provider. In this article we describe the funding rationale and the specific objectives, strategies, progress, and early stages of implementation of the eight projects. We also share some early lessons and identify prerequisites for success, such as ensuring that providers have broad and timely access to data so they can meet patients’ needs in cost-effective ways. PMID:23650332

75 FR 52487 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-26

... practice reporting option I (GPRO I) measures, we inadvertently omitted hypertension from the list of... preventive care services.'' is corrected to read ``heart failure; hypertension; and preventive care services...

Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

PubMed

2017-08-14

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 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will 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 2018. 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 2018. In addition, we are 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). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We 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. We also are making changes relating to transparency of accrediting organization survey reports and plans of correction of providers and suppliers; electronic signature and electronic submission of the Certification and Settlement Summary page of the Medicare cost reports; and clarification of provider disposal of assets.

Looking at CER from Medicare's perspective.

PubMed

Mohr, Penny

2012-05-01

Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly enhance CMS's ability to make decisions regarding coverage and payment that will benefit both the agency and their patient population.

75 FR 60749 - Policy on Payment System Risk

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... FEDERAL RESERVE SYSTEM [Docket No. OP-1345] Policy on Payment System Risk AGENCY: Board of... of its Policy on Payment System Risk (PSR). The revisions explicitly recognize the role of the central bank in providing intraday credit to healthy depository institutions, and establish a zero fee for...

Implementing the water framework directive: contract design and the cost of measures to reduce nitrogen pollution from agriculture.

PubMed

Bartolini, Fabio; Gallerani, Vittorio; Raggi, Meri; Viaggi, Davide

2007-10-01

The performance of different policy design strategies is a key issue in evaluating programmes for water quality improvement under the Water Framework Directive (60/2000). This issue is emphasised by information asymmetries between regulator and agents. Using an economic model under asymmetric information, the aim of this paper is to compare the cost-effectiveness of selected methods of designing payments to farmers in order to reduce nitrogen pollution in agriculture. A principal-agent model is used, based on profit functions generated through farm-level linear programming. This allows a comparison of flat rate payments and a menu of contracts developed through mechanism design. The model is tested in an area of Emilia Romagna (Italy) in two policy contexts: Agenda 2000 and the 2003 Common Agricultural Policy (CAP) reform. The results show that different policy design options lead to differences in policy costs as great as 200-400%, with clear advantages for the menu of contracts. However, different policy scenarios may strongly affect such differences. Hence, the paper calls for greater attention to the interplay between CAP scenarios and water quality measures.

Implementing the Water Framework Directive: Contract Design and the Cost of Measures to Reduce Nitrogen Pollution from Agriculture

NASA Astrophysics Data System (ADS)

Bartolini, Fabio; Gallerani, Vittorio; Raggi, Meri; Viaggi, Davide

2007-10-01

The performance of different policy design strategies is a key issue in evaluating programmes for water quality improvement under the Water Framework Directive (60/2000). This issue is emphasised by information asymmetries between regulator and agents. Using an economic model under asymmetric information, the aim of this paper is to compare the cost-effectiveness of selected methods of designing payments to farmers in order to reduce nitrogen pollution in agriculture. A principal-agent model is used, based on profit functions generated through farm-level linear programming. This allows a comparison of flat rate payments and a menu of contracts developed through mechanism design. The model is tested in an area of Emilia Romagna (Italy) in two policy contexts: Agenda 2000 and the 2003 Common Agricultural Policy (CAP) reform. The results show that different policy design options lead to differences in policy costs as great as 200-400%, with clear advantages for the menu of contracts. However, different policy scenarios may strongly affect such differences. Hence, the paper calls for greater attention to the interplay between CAP scenarios and water quality measures.

Financial Management Regulation. Volume 13. Nonappropriated Funds Policy and Procedures.

DTIC Science & Technology

1994-08-22

located in the continental United States, Alaska, territory made pursuant to the Act of 17 July and Hawaii are subject to the following 1952 (66 Stat...17 0404 D ISCO U N TS ....................................................... 17 0405 PROMPT PAYMENT ACT ...PROGRAM ............................. B-10 B0410 RANDOLPH SHEPPARD ACT -VENDING FACILITY PROGRAM FOR THE BL IN D

75 FR 33651 - Sunshine Act; Notice of Agency Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-14

... for Insurance, Interest Rate Risk Policy and Program. 4. Insurance Fund Report. 5. Temporary Corporate Credit Union Stabilization Fund Accounting Standard. 6. Temporary Corporate Credit Union Stabilization Fund Payment of Insured Shares. 7. Temporary Corporate Credit Union Stabilization Fund Assessment...

The formal-informal patient payment mix in European countries. Governance, economics, culture or all of these?

PubMed

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2013-12-01

Cost-sharing for health care is high on the policy agenda in many European countries that struggle with deficits in their public budget. However, such policy often meets with public opposition, which might delay or even prevent its implementation. Increased reliance on patient payments may also have adverse equity effects, especially in countries where informal patient payments are widespread. The factors which might influence the presence of both, formal and informal payments can be found in economic, governance and cultural differences between countries. The aim of this paper is to review the formal-informal payment mix in Europe and to outline factors associated with this mix. We use quantitative analyses of macro-data for 35 European countries and a qualitative description of selected country experiences. The results suggest that the presence of obligatory cost-sharing for health care services is associated with governance factors, while informal patient payments are a multi-cause phenomenon. A consensus-based policy, supported by evidence and stakeholders' engagement, might contribute to a more sustainable patient payment policy. In some European countries, the implementation of cost-sharing requires policy actions to reduce other patient payment obligations, including measures to eliminate informal payments. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains.

PubMed

Papanicolas, Irene; Figueroa, José F; Orav, E John; Jha, Ashish K

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement. Project HOPE—The People-to-People Health Foundation, Inc.

40 CFR 35.938-6 - Progress payments to contractors.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Progress payments to contractors. 35... § 35.938-6 Progress payments to contractors. (a) Policy. EPA policy is that, except as State law otherwise provides, grantees should make prompt progress payments to prime contractors and prime contractors...

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.

PubMed

Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

2017-06-01

With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

20 CFR 668.370 - What policies govern payments to participants, including wages, training allowances or stipends...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What policies govern payments to participants... What policies govern payments to participants, including wages, training allowances or stipends, or... participants for their successful participation in and completion of education or training services (except...

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...

The US Medicare policy of not reimbursing hospital-acquired conditions: what impact would such a policy have in Victorian hospitals?

PubMed

McNair, Peter D; Jackson, Terri J; Borovnicar, Daniel J

2010-07-05

To model the effect of excluding payment for eight hospital-acquired conditions (HACs) on hospital payments in Victoria, Australia. Retrospective ecological study using the Victorian Admitted Episodes Dataset. The analysis involved all acute inpatient admissions to Victorian public and private hospitals between 1 July 2007 and 30 June 2008. Each admission record includes up to 40 diagnosis and procedure codes from which payments are calculated. The model deleted diagnosis codes for eight HACs from all records, then recalculated payments to estimate the impact of a policy of non-payment for HACs. The effect on hospital payments of excluding diagnosis codes for eight HACs. 2,047,133 cases with total estimated payments of $4902 million were identified; 994 cases (0.05%) had one or more diagnoses meeting the code definition for a definable HAC, representing total payments of $24.1 million. In-hospital falls and pressure ulcers were the most commonly coded HACs. Applying a model that excluded HAC diagnosis codes changed the diagnosis-related group for 134 cases (13.5%), thereby generating a $448,630 reduction in payments. Introducing a non-payment for HACs policy similar to that introduced by Medicare in the United States would have little direct financial impact in the Australian context, although additional savings would accrue if HAC rates were reduced. Such a policy could add further incentive to current initiatives aimed at reducing HACs.

19 CFR 191.92 - Accelerated payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... contain: (i) Company name and address; (ii) Internal Revenue Service (IRS) number (with suffix); (iii... may itself be appealed to CBP Headquarters, Office of International Trade, Trade Policy and Programs... to CBP Headquarters may be extended for good cause, upon written request by the applicant or holder...

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2014. Final rule.

PubMed

2013-08-06

This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year (FY) 2014. In addition, it revises and rebases the SNF market basket, revises and updates the labor related share, and makes certain technical and conforming revisions in the regulations text. This final rule also includes a policy for reporting the SNF market basket forecast error in certain limited circumstances and adds a new item to the Minimum Data Set (MDS), Version 3.0 for reporting the number of distinct therapy days. Finally, this final rule adopts a change to the diagnosis code used to determine which residents will receive the AIDS add-on payment, effective for services provided on or after the October 1, 2014 implementation date for conversion to ICD-10-CM.

Performance and prospects of payments for ecosystem services programs: evidence from China.

PubMed

Yang, Wu; Liu, Wei; Viña, Andrés; Luo, Junyan; He, Guangming; Ouyang, Zhiyun; Zhang, Hemin; Liu, Jianguo

2013-09-30

Systematic evaluation of the environmental and socioeconomic effects of Payments for Ecosystem Services (PES) programs is crucial for guiding policy design and implementation. We evaluated the performance of the Natural Forest Conservation Program (NFCP), a national PES program of China, in the Wolong Nature Reserve for giant pandas. The environmental effects of the NFCP were evaluated through a historical trend (1965-2001) analysis of forest cover to estimate a counter-factual (i.e., without-PES) forest cover baseline for 2007. The socioeconomic effects of the NFCP were evaluated using data collected through household interviews carried out before and after NFCP implementation in 2001. Our results suggest that the NFCP was not only significantly associated with increases in forest cover, but also had both positive (e.g., labor reduction for fuelwood collection) and negative (e.g., economic losses due to crop raiding by wildlife) effects on local households. Results from this study emphasize the importance of integrating local conditions and understanding underlying mechanisms to enhance the performance of PES programs. Our findings are useful for the design and implementation of successful conservation policies not only in our study area but also in similar places around the world. Copyright © 2013 Elsevier Ltd. All rights reserved.

The need for an organized approach for Government Medical Insurance Programs in the Commonwealth of Virginia.

PubMed

Edlich, Richard F

2005-01-01

The Commonwealth of Virginia has a disorganized approach to enrolling their retired faculty in Medicare Supplement Insurance Programs. An organized approach to establishing Medicare Supplemental Insurance for retired University faculty should include the following administrative changes to correct this potential health-care crisis for retired state faculty members. First, the ombudsman for human resources for the state universities must receive educational programs that prepare the retired faculty members over the age of 65 to select the corporate insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. Included in this educational program should be a review of the Advantage 65 Member Handbook. Second, they must point out to the faculty member that they are receiving a CORPORATE insurance policy rather than an individual insurance policy from Anthem Blue Cross/Blue Shield Insurance Company. They must provide the telephone numbers of the Anthem Blue Cross/Blue Shield offices in Roanoke, Virginia. Concomitantly, they must send the name and address of the faculty member to the Commonwealth of Virginia Department of Human Resource Management. They should inform the faculty member that the Commonwealth of Virginia Department of Human Resource Management will be sending them newsletters that outline any changes in the corporate insurance policy that they coordinate with the Anthem Blue Cross/Blue Shield Insurance Company. The Commonwealth of Virginia Department of Human Resource Management must take on some new responsibilities in their efforts to coordinate health-care coverage of the retired faculty over the age of 65. First, they must have a computer registry of all corporate health-care policies of the individual faculty members to ensure that newsletters are being sent to them. Ideally, this agency should have a computerized system that allows it to send out its newsletter update by email to those retired faculty members who have computers. They should urge the faculty members to initiate an automatic check payment withdrawal from their bank so that the premiums from their corporate insurance policy can be paid promptly to Anthem Blue Cross/Blue Shield Insurance Company. Whereas the universities and the Commonwealth of Virginia Department of Human Resource Management are making these responsible changes, Anthem Blue Cross/Blue Shield Insurance Company must undertake innovative changes in their corporate health-care policy to assist the retired faculty member. For instance, they must list on the insurance card that the faculty member has a corporate policy. Like the United Health Insurance Company, it would be advisable to offer a 2-5% reduction in the cost of the corporate insurance policy if the faculty member begins an automatic premium payment agreement through their bank. This insurance discount would be an added incentive for the faculty member to do automatic payments through their bank.

An innovative approach to address homelessness in regional Australia: Participant evaluation of a co-payment model.

PubMed

Jacups, S; Rogerson, B; Kinchin, I

2018-03-01

Homelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program ('Return to Country' [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources. In northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their 'country' leading to rapidly deteriorating health, isolation and separation from family and kin. The R2C program was designed to facilitate travel for persons who were temporarily stranded and were voluntarily seeking to return home. The program provided operational support and funding (participants co-funded AU$99) to participants to return home. Using a descriptive, case series research design, university researchers independently evaluated the R2C program using semi-structured interviews with 37 participants. An investment of AU$970 per participant in the program with partial co-payment was associated with high participant acceptability and satisfaction in-line with harms reduction around substance and criminal abuse, which is suggestive of long-term success for the model. Findings from this study can contribute to the development of best practice guidelines and policies that specifically address the needs of this unique population of stranded persons, who are seeking to return home. The acceptance of the co-payment model can be adopted by policy makers involved in homelessness prevention in other locations in Australia or internationally as an add-on service provision to mainstream housing support. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Medicare program; revisions to payment policies under the Physician Fee Schedule, and other part B payment policies for CY 2008; delay of the date of applicability of the revised anti-markup provisions for certain services furnished in certain locations (Sec. 414.50). Final rule.

PubMed

2008-01-03

This final rule delays until January 1, 2009 the applicability of the anti-markup provisions in Sec. 414.50, as revised at 72 FR 66222, except with respect to the technical component of a purchased diagnostic test and with respect to any anatomic pathology diagnostic testing services furnished in space that: Is utilized by a physician group practice as a "centralized building" (as defined at Sec. 411.351 of this chapter) for purposes of complying with the physician self-referral rules; and does not qualify as a "same building" under Sec. 411.355(b)(2)(i) of this chapter.

Child Poverty Can Be Reduced.

ERIC Educational Resources Information Center

Plotnick, Robert D.

1997-01-01

Reviews programs for increasing earnings of parents with low market skills to prevent pretransfer poverty and discusses three types of income supplementation (public cash transfers, private child support payments, and tax credits) and how successful they are in reducing poverty. Also provides international comparisons of policies to reduce child…

77 FR 227 - Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-04

... professional work with the patient to discover what is important to the patient and the patient's motivation to... and works with the patient to discover what is important to the patient and his or her motivation to...

Statement of the Declaration of Istanbul Custodian Group Regarding Payments to Families of Deceased Organ Donors.

PubMed

Capron, Alexander Morgan; Delmonico, Francis L; Dominguez-Gil, Beatriz; Martin, Dominique Elizabeth; Danovitch, Gabriel M; Chapman, Jeremy

2016-09-01

Governmental and private programs that pay next of kin who give permission for the removal of their deceased relative's organs for transplantation exist in a number of countries. Such payments, which may be given to the relatives or paid directly for funeral expenses or hospital bills unrelated to being a donor, aim to increase the rate of donation. The Declaration of Istanbul Custodian Group-in alignment with the World Health Organization Guiding Principles and the Council of Europe Convention Against Trafficking in Human Organs-has adopted a new policy statement opposing such practices. Payment programs are unwise because they produce a lower rate of donations than in countries with voluntary, unpaid programs; associate deceased donation with being poor and marginal in society; undermine public trust in the determination of death; and raise doubts about fair allocation of organs. Most important, allowing families to receive money for donation from a deceased person, who is at no risk of harm, will make it impossible to sustain prohibitions on paying living donors, who are at risk. Payment programs are also unethical. Tying coverage for funeral expenses or healthcare costs to a family allowing organs to be procured is exploitative, not "charitable." Using payment to overcome reluctance to donate based on cultural or religious beliefs especially offends principles of liberty and dignity. Finally, while it is appropriate to make donation "financially neutral"-by reimbursing the added medical costs of evaluating and maintaining a patient as a potential donor-such reimbursement may never be conditioned on a family agreeing to donate.

Quality measures and pediatric radiology: suggestions for the transition to value-based payment.

PubMed

Heller, Richard E; Coley, Brian D; Simoneaux, Stephen F; Podberesky, Daniel J; Hernanz-Schulman, Marta; Robertson, Richard L; Donnelly, Lane F

2017-06-01

Recent political and economic factors have contributed to a meaningful change in the way that quality in health care, and by extension value, are viewed. While quality is often evaluated on the basis of subjective criteria, pay-for-performance programs that link reimbursement to various measures of quality require use of objective and quantifiable measures. This evolution to value-based payment was accelerated by the 2015 passage of the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). While many of the drivers of these changes are rooted in federal policy and programs such as Medicare and aimed at adult patients, the practice of pediatrics and pediatric radiology will be increasingly impacted. This article addresses issues related to the use of quantitative measures to evaluate the quality of services provided by the pediatric radiology department or sub-specialty section, particularly as seen from the viewpoint of a payer that may be considering ways to link payment to performance. The paper concludes by suggesting a metric categorization strategy to frame future work on the subject.

Factors Related to Medicaid Payment Acceptance at Outpatient Substance Abuse Treatment Programs

PubMed Central

Terry-McElrath, Yvonne M; Chriqui, Jamie F; McBride, Duane C

2011-01-01

Objective To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. Data Sources Secondary analysis of 2003–2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data. Study Design We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage. Data Extraction Methods State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available. Principal Findings Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income. Conclusions SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access. PMID:21105870

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.

Identifying hospitals that may be at most financial risk from Medicaid disproportionate-share hospital payment cuts.

PubMed

Cole, Evan S; Walker, Daniel; Mora, Arthur; Diana, Mark L

2014-11-01

Medicaid disproportionate-share hospital (DSH) payments are expected to decline by $35.1 billion between fiscal years 2017 and 2024, a reduction brought about by the Affordable Care Act (ACA) and recent congressional action. DSH payments have long been a feature of the Medicaid program, intended to partially offset uncompensated care costs incurred by hospitals that treat uninsured and Medicaid populations. The DSH payment cuts were predicated on the expectation that the ACA's expansion of health insurance to millions of Americans would bring about a decline in many hospitals' uncompensated care costs. However, the decision of twenty-five states not to expand their Medicaid programs, combined with residual coverage gaps, may leave as many as thirty million people uninsured, and hospitals will bear the burden of their uncompensated care costs. We sought to identify the hospitals that may be the most financially vulnerable to reductions in Medicaid DSH payments. We found that of the 529 acute care hospitals that will be particularly affected by the cuts, 225 (42.5 percent) are in weak financial condition. Policy makers should recognize that decreases in revenue may affect these hospitals' ability to give vulnerable populations access to care. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 34666 - Section 8 Housing Assistance Payments Program-Fiscal Year (FY) 2013 Inflation Factors for Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-10

... AGENCY: Office of the Assistant Secretary for Policy Development and Research, HUD. ACTION: Notice... Development and Research, telephone number 202-402-2409, for technical information regarding the development... incorporating comparable economic variables from the Administration's economic assumptions. For reference, these...

31 CFR 50.14 - Separate line item.

Code of Federal Regulations, 2010 CFR

2010-07-01

....14 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.14 Separate line item. An insurer is deemed to be in compliance with the requirement of providing disclosure on a “separate line item in the policy...

32 CFR 199.15 - Quality and utilization review peer review organization program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... different geographical locations or for different types of providers. (B) For healthcare services provided... TRICARE/CHAMPUS Policy Manual, or until the approved transplant occurs. (D) For healthcare services.... (3) Outlier review. Claims which qualify for additional payment as a long-stay outlier or as a cost...

32 CFR 199.15 - Quality and utilization review peer review organization program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... different geographical locations or for different types of providers. (B) For healthcare services provided... TRICARE/CHAMPUS Policy Manual, or until the approved transplant occurs. (D) For healthcare services.... (3) Outlier review. Claims which qualify for additional payment as a long-stay outlier or as a cost...

75 FR 45769 - Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Ambulatory...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... 2010 OPPS/ASC final rule, we estimated that pass-through spending for both drugs and biologicals and... pass through drugs and non-implantable biologicals, and device categories and the proportion of... and implantable biologicals), ``policy packaged'' drugs (diagnostic radiopharmaceuticals and contrast...

75 FR 40039 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... external defibrillator AFROC Association of Freestanding Radiation Oncology Centers AHA American Heart... Procedure Coding System HCRIS Healthcare Cost Report Information System HDRT High dose radiation therapy HH... rule with comment period IMRT Intensity-Modulated Radiation Therapy IPPE Initial preventive physical...

77 FR 68891 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... Area ICD International Classification of Diseases IMRT Intensity Modulated Radiation Therapy IOM... Stereotactic body radiation therapy SGR Sustainable growth rate TC Technical component TIN Tax identification... Clinical Lab Fee Schedule, which is unaffected by the misvalued code initiative. Radiation therapy centers...

76 FR 42771 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

...--Association of Freestanding Radiation Oncology Centers AFS--Ambulance Fee Schedule AHA--American Heart...) Update Committee AMA-DE--American Medical Association Drug Evaluations AMI--Acute Myocardial Infarction.../Low-density lipoprotein HDRT--High dose radiation therapy HEMS--Helicopter Emergency Medical Services...

75 FR 3904 - Appointments to the Medicaid and CHIP Payment and Access Commission (MACPAC)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-25

...: The Children's Health Insurance Program Reauthorization Act of 2009 established MACPAC to review..., Professor, Clinical Dentistry, College of Dental Medicine and Clinical Health Policy and Management, Mailman... Washington University; and Robin Smith, foster and adoptive parent of special needs children covered by...

77 FR 22666 - Payment System Risk Policy; Daylight Overdraft Posting Rules

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

... of separately-sorted savings bonds and to eliminate a reference to the contractual clearing balance... clearing balance program are effective July 12, 2012. FOR FURTHER INFORMATION CONTACT: Susan V. Foley... account balances according to a set of ``posting rules'' that determine the intraday timing of debits and...

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2012. Final rule.

PubMed

2011-08-08

This final rule updates the payment rates used under the prospective payment system for skilled nursing facilities (SNFs) for fiscal year 2012. In addition, it recalibrates the case-mix indexes so that they more accurately reflect parity in expenditures between RUG-IV and the previous case-mix classification system. It also includes a discussion of a Non-Therapy Ancillary component currently under development within CMS. In addition, this final rule discusses the impact of certain provisions of the Affordable Care Act, and reduces the SNF market basket percentage by the multi-factor productivity adjustment. This rule also implements certain changes relating to the payment of group therapy services and implements new resident assessment policies. Finally, this rule announces that the proposed provisions regarding the ownership disclosure requirements set forth in section 6101 of the Affordable Care Act will be finalized at a later date.

Payments for Environmental Services in a Policymix: Spatial and Temporal Articulation in Mexico.

PubMed

Ezzine-de-Blas, Driss; Dutilly, Céline; Lara-Pulido, José-Alberto; Le Velly, Gwenolé; Guevara-Sanginés, Alejando

2016-01-01

Government based Payments for Ecosystem Services (PES) have been criticized for not maximizing environmental effectiveness through appropriate targeting, while instead prioritizing social side-objectives. In Mexico, existing literature on how the Payments for Ecosystem Services-Hydrological program (PSA-H) has targeted deforestation and forest degradation shows that both the process of identifying the eligible areas and the choice of the selection criteria for enrolling forest parcels have been under the influence of competing agendas. In the present paper we study the influence of the PSA-H multi-level governance on the environmental effectiveness of the program-the degree to which forest at high risk of deforestation is enrolled- building from a "policyscape" framework. In particular, we combine governance analysis with two distinct applications of the policyscape framework: First, at national level we assess the functional overlap between the PSA-H and other environmental and rural programs with regard to the risk of deforestation. Second, at regional level in the states of Chiapas and Yucatan, we describe the changing policy agenda and the role of technical intermediaries in defining the temporal spatialization of the PSA-H eligible and enrolled areas with regard to key socio-economic criteria. We find that, although at national level the PSA-H program has been described as coping with both social and environmental indicators thanks to successful adaptive management, our analysis show that PSA-H is mainly found in communities where deforestation risk is low and in combination with other environmental programs (protected areas and forest management programs). Such inertia is reinforced at regional level as a result of the eligible areas' characteristics and the behaviour of technical intermediaries, which seek to minimise transaction costs and sources of uncertainty. Our project-specific analysis shows the importance of integrating the governance of a program in the policyscape framework as a way to better systematize complex interactions at different spatial and institutional scales between policies and landscape characteristics.

Implications of global budget payment system on nursing home costs.

PubMed

Di Giorgio, Laura; Filippini, Massimo; Masiero, Giuliano

2014-04-01

Pressure on health care systems due to the increasing expenditures of the elderly population is pushing policy makers to adopt new regulation and payment schemes for nursing home services. We consider the behavior of nonprofit nursing homes under different payment schemes and empirically investigate the implications of prospective payments on nursing home costs under tightly regulated quality aspects. To evaluate the impact of the policy change introduced in 2006 in Southern Switzerland - from retrospective to prospective payment - we use a panel of 41 homes observed over a 10-years period (2001-2010). We employ a fixed effects model with a time trend that is allowed to change after the policy reform. There is evidence that the new payment system slightly reduces costs without impacting quality. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Military Retirement Fund Audited Financial Report. Fiscal Year 2013

DTIC Science & Technology

2013-12-09

accumulates funds to finance, on an actuarial basis, the liabilities of DoD under military retirement and survivor benefit programs. Within DoD, the...for the accounting, investing, payment of benefits, and reporting of the MRF. The DoD Office of the Actuary (OACT) within OUSD(P&R) calculates the... actuarial liability of the MRF. The Office of Military Personnel Policy within OUSD(P&R) issues policy related to MRS benefits. While the MRF does

Medicare program; revision to accrual basis of accounting policy. Department of Health and Human Services (HHS), Health Care Financing Administration (HCFA). Final rule.

PubMed

1999-09-27

Medicare policy provides that payroll taxes that a provider becomes obligated to remit to governmental agencies are included in allowable costs only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in 1 year but not paid until the next year, the associated payroll taxes are not an allowable cost until the next year. This final rule provides for an exception when payment would be made to the employee in the current year but for the fact that regularly scheduled payment date is after the end of the year. In that case, the rule requires allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this rule is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on end-of-the-year payroll is allowable in the current period rather than in the following period.

Medicare program; revision to accrual basis of accounting policy. Health Care Financing Administration (HCFA), HHS. Final rule.

PubMed

1999-09-27

Medicare policy provides that payroll taxes that a provider becomes obligated to remit to governmental agencies are included in allowable costs only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in 1 year but not paid until the next year, the associated payroll taxes are not an allowable cost until the next year. This final rule provides for an exception when payment would be made to the employee in the current year but for the fact the regularly scheduled payment date is after the end of the year. In that case, the rule requires allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this rule is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on end-of-the-year payroll is allowable in the current period rather than in the following period.

Medicare program; revision to accrual basis of accounting policy--HCFA. Proposed rule.

PubMed

1998-05-18

Current policy provides that payroll taxes a provider becomes obligated to remit to governmental agencies are included in allowable costs under Medicare only in the cost reporting period in which payment (upon which the payroll taxes are based) is actually made to an employee. Therefore, for payroll accrued in one year but not paid until the next year, the associated payroll taxes on the payroll are not an allowable cost until the next year. This proposed rule would make one exception, in the situation where payment would be made to the employee in the current year but for the fact the regularly scheduled payment date is after the end of the year. In that case, the rule would require allowance in the current year of accrued taxes on payroll that is accrued through the end of the year but not paid until the beginning of the next year, thus allowing accrued taxes on end-of-the year payroll in the same year that the accrual of the payroll itself is allowed. The effect of this proposal is not on the allowability of cost but rather only on the timing of payment; that is, the cost of payroll taxes on and-of-the-year payroll would be allowable in the current period rather than in the following period.

Effects of physician payment reform on provision of home dialysis.

PubMed

Erickson, Kevin F; Winkelmayer, Wolfgang C; Chertow, Glenn M; Bhattacharya, Jay

2016-06-01

Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P < .001) reduction in home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.

Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy

ERIC Educational Resources Information Center

Schoenman, Julie A.; Mueller, Curt D.

2005-01-01

Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the…

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

31 CFR 50.17 - Use of model forms.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Use of model forms. 50.17 Section 50.17 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Disclosures as Conditions for Federal Payment § 50.17 Use of model forms. (a) Policies in force on...

Welfare Eligibility: Programs Treat Indian Tribal Trust Fund Report to Congressional Committees.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of Human Resources.

This report was sought by the Conference Committee on the Consolidated Omnibus Budget Reconciliation Act of 1985, concerned that federal law allows payments from tribal trust funds to be excluded when determining eligibility for welfare benefits to American Indians. Applicable federal laws and eligibility policies were reviewed to determine the…

75 FR 26349 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... (AOE): AMA-PCPI Systemic Antimicrobial Therapy-- Avoidance of Inappropriate Use. 100 Colorectal Cancer... Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic... Diabetes Mellitus. 113 Preventive Care and Screening: NCQA Colorectal Cancer Screening. TBD Hypertension...

77 FR 46213 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

.... Monitoring Impact of FY 2012 Policy Changes and Certain SNF Practices A. RUG Distributions B. Group Therapy... Common Procedure Coding System HR-III Hybrid Resource Utilization Groups, Version 3 IHS IGI (Information... OCN OMB Control Number OMB Office of Management and Budget OMRA Other Medicare-Required Assessment PPS...

Orthopaedic Resident Practice Management and Health Policy Education: Evaluation of Experience and Expectations.

PubMed

Stautberg Iii, Eugene F; Romero, Jose; Bender, Sean; DeHart, Marc

2018-04-11

Introduction Practice management and health policy have generally not been considered integral to orthopaedic resident education. Our objective was to evaluate residents' current experience and knowledge, formal training, and desire for further education in practice management and health policy. Methods We developed a 29-question survey that was divided into three sections: practice management, initial employment opportunity, and health policy. Within each section, questions were directed at a resident's current experience and knowledge, formal training, and interest in further education. The survey was distributed at the end of the academic year through an Internet-based survey tool (www.surveymonkey.com) to orthopaedic residents representing multiple programs and all postgraduate years. Results The survey was distributed to 121 residents representing eight residency programs. Of those, 87 residents responded, resulting in a 72% response rate. All postgraduate years were represented. Regarding practice management, 66% had "no confidence" or "some confidence" in coding clinical encounters. When asked if practice models, finance management, and coding should be taught in residency, 95%, 93%, and 97% responded "yes," respectively. When evaluating first employment opportunities, the three most important factors were location, operating room block time, and call. Regarding health policy, 28% were "moderately familiar" or "very familiar" with the Physician Payments Sunshine Act, and 72% were "not familiar" or "somewhat familiar" with bundled payments for arthroplasty. Finally, when asked if yearly lectures in political activities would enhance resident education, 90% responded "yes." Discussion and conclusion Regarding practice management, the survey suggests that current orthopaedic residents are not familiar with basic topics, do not receive formal training, and want further education. The survey suggests that residents also receive minimal training in health policy. Residents feel that health policy will be important in their careers, and they would benefit from formal training in residency.

Does the benefits schedule of cash assistance programs affect the purchase of temptation goods? Evidence from Peru.

PubMed

White, Justin S; Basu, Sanjay

2016-03-01

A critique of cash assistance programs is that beneficiaries may spend the money on "temptation goods" such as alcohol and tobacco. We exploit a change in the payment schedule of Peru's conditional cash transfer program to identify the impact of benefit receipt frequency on the purchase of temptation goods. We use annual household data among cross-sectional and panel samples to analyze the effect of the policy change on the share of the household budget devoted to four categories of temptation goods. Using a difference-in-differences estimation approach, we find that larger, less frequent payments increased the expenditure share of alcohol by 55-80% and sweets by 10-40%, although the absolute magnitudes of these effects are small. Our study suggests that less frequent benefits scheduling may lead cash recipients to make certain types of temptation purchases. Copyright © 2016 Elsevier B.V. All rights reserved.

Changes in the Medicare home health care market: the impact of reimbursement policy.

PubMed

Choi, Sunha; Davitt, Joan K

2009-03-01

The Balanced Budget Act of 1997 introduced 2 new reimbursement structures, the Interim Payment System (IPS, 1997-2000) and the Prospective Payment System (PPS, begun October 2000) for Medicare home health agencies (HHAs) under the fee-for-service program. This article describes and compares the impact of these changes on the Medicare home health market from a period before the BBA through the IPS and PPS in relation to agency characteristics. A secondary analysis of 1996, 1999, and 2002 Provider of Services data was conducted on all Medicare-certified HHAs. Frequencies and rates of change were calculated by agency characteristics to describe changes in the number of active agencies through those years. Logistic regression models were used to compare factors associated with market exits under different payment systems. The results indicate dramatic but disproportional changes in response to the IPS and the PPS among Medicare home health care agencies. Agency closures were greater and market entries fewer during the IPS, but more branch offices/subunits were closed during the PPS. Proprietary and freestanding agencies experienced greater volatility throughout, with the greatest number of closures seen in Region VI (Dallas). These results demonstrate the direct impact of policy changes on the home health care market and highlight the need to evaluate policy changes to understand both intended and unintended impacts on health markets. Future research should analyze the effect of these policy changes on other healthcare providers and systems and their impact on health outcomes for Medicare beneficiaries.

Evaluating interactions of forest conservation policies on avoided deforestation.

PubMed

Robalino, Juan; Sandoval, Catalina; Barton, David N; Chacon, Adriana; Pfaff, Alexander

2015-01-01

We estimate the effects on deforestation that have resulted from policy interactions between parks and payments and between park buffers and payments in Costa Rica between 2000 and 2005. We show that the characteristics of the areas where protected and unprotected lands are located differ significantly. Additionally, we find that land characteristics of each of the policies and of the places where they interact also differ significantly. To adequately estimate the effects of the policies and their interactions, we use matching methods. Matching is implemented not only to define adequate control groups, as in previous research, but also to define those groups of locations under the influence of policies that are comparable to each other. We find that it is more effective to locate parks and payments away from each other, rather than in the same location or near each other. The high levels of enforcement inside both parks and lands with payments, and the presence of conservation spillovers that reduce deforestation near parks, significantly reduce the potential impact of combining these two policies.

Effects of Physician Payment Reform on Provision of Home Dialysis

PubMed Central

Erickson, Kevin F.; Winkelmayer, Wolfgang C.; Chertow, Glenn M.; Bhattacharya, Jay

2016-01-01

Objectives Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004 the Centers for Medicare and Medicaid Services reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Study Design Cohort study of patients starting dialysis in the US in the three years before and after payment reform. Methods We conducted difference-in-difference analyses comparing patients with Traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Results Patients with Traditional Medicare coverage experienced a 0.7% (95% CI 0.2%–1.1%; p=0.003) reduction in the absolute probability of home dialysis use following payment reform compared to patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI 0.5%–1.4%; p<0.001) reduction in home dialysis use following payment reform compared to patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). Conclusions Transition from a capitated to tiered fee-for-service payment model for dialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts. PMID:27355909

The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

PubMed

Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

2009-09-01

Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

Effects of payments for ecosystem services on wildlife habitat recovery.

PubMed

Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

2016-08-01

Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

Health programs at risk in wake of '84 election.

PubMed

Iglehart, J K

1985-01-01

President Ronald Reagan's reelection suggests that government will continue to promote policies that favor marketplace allocation of medical care resources and that it will continue to cut social welfare programs, particularly health programs for the elderly and the poor. Unlike previous administrations, which focused on controlling private and public health care costs, President Reagan has targeted Medicare and Medicaid expenditures--a policy which has caused substantial cost shifting to underwrite hospitals' uncompensated and undercompensated care. Physician payment policies likely will receive the greatest attention in spending reduction efforts. Congress, as it showed in the president's first term, can cut spending sharply. Its task, however, has been complicated by the president's campaign declaration that defense spending and Social Security benefits were off-limits. Expected to lead health care debate on Capitol Hill are Sens. Albert Gore, Jr., D-TN, and Phil Gramm, R-TX, and Rep. James Jones, D-OK.

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.

75 FR 66686 - Defense Federal Acquisition Regulation Supplement; Balance of Payments Program Exemption for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-29

... Federal Acquisition Regulation Supplement; Balance of Payments Program Exemption for Commercial... Balance of Payments Program for construction material that is commercial information technology. DATES..., Balance of Payments Program--Construction Material, and 252.225- 7045, Balance of Payments Program...

Medicare program; home health prospective payment system rate update for calendar year 2011; changes in certification requirements for home health agencies and hospices. Final rule.

PubMed

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.

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.

Policy trends and reforms in the German DRG-based hospital payment system.

PubMed

Klein-Hitpaß, Uwe; Scheller-Kreinsen, David

2015-03-01

A central structural point in all DRG-based hospital payment systems is the conversion of relative weights into actual payments. In this context policy makers need to address (amongst other things) (a) how the price level of DRG-payments from one period to the following period is changed and (b) whether and how hospital payments based on DRGs are to be differentiated beyond patient characteristics, e.g. by organizational, regional or state-level factors. Both policy problems can be and in international comparison often are empirically addressed. In Germany relative weights are derived from a highly sophisticated empirical cost calculation, whereas the annual changes of DRG-based payments (base rates) as well as the differentiation of DRG-based hospital payments beyond patient characteristics are not empirically addressed. Rather a complex set of regulations and quasi-market negotiations are applied. There were over the last decade also timid attempts to foster the use of empirical data to address these points. However, these reforms failed to increase the fairness, transparency and rationality of the mechanism to convert relative weights into actual DRG-based hospital payments. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Payment in Heaven: Can Early Childhood Education Policies Help Women Too?

ERIC Educational Resources Information Center

Newberry, Jan; Marpinjun, Sri

2018-01-01

Based on research and activism on early childhood education and care in the area of Yogyakarta, Indonesia, we argue that the Indonesian government's focus on early childhood has come at a cost to local women. Community-based early childhood programs are delivered by women whose work is unpaid or underpaid. Although early childhood education in the…

76 FR 15859 - Tobacco Transition Payment Program; Cigar and Cigarette Per Unit Assessments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

... cigars, large and small, the same. That policy is under review as the result of a court decision. This... either side of the margin of the two categories, making it seemingly burdensome and market-affecting to separate the categories, which may have been a motivation for Congress as well. That would seem to be...

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2015. Final rule.

PubMed

2014-08-05

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2015. In addition, it adopts the most recent Office of Management and Budget (OMB) statistical area delineations to identify a facility's urban or rural status for the purpose of determining which set of rate tables will apply to the facility, and to determine the SNF PPS wage index including a 1-year transition with a blended wage index for all providers for FY 2015. This final rule also contains a revision to policies related to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA). This final rule includes a discussion of a provision related to the Affordable Care Act involving Civil Money Penalties. Finally, this final rule discusses the SNF therapy payment research currently underway within CMS, observed trends related to therapy utilization among SNF providers, and the agency's commitment to accelerating health information exchange in SNFs.

Payment of research participants: current practice and policies of Irish research ethics committees.

PubMed

Roche, Eric; King, Romaine; Mohan, Helen M; Gavin, Blanaid; McNicholas, Fiona

2013-09-01

Payment of research participants helps to increase recruitment for research studies, but can pose ethical dilemmas. Research ethics committees (RECs) have a centrally important role in guiding this practice, but standardisation of the ethical approval process in Ireland is lacking. Our aim was to examine REC policies, experiences and concerns with respect to the payment of participants in research projects in Ireland. Postal survey of all RECs in Ireland. Response rate was 62.5% (n=50). 80% of RECs reported not to have any established policy on the payment of research subjects while 20% had refused ethics approval to studies because the investigators proposed to pay research participants. The most commonly cited concerns were the potential for inducement and undermining of voluntary consent. There is considerable variability among RECs on the payment of research participants and a lack of clear consensus guidelines on the subject. The development of standardised guidelines on the payment of research subjects may enhance recruitment of research participants.

Medicare Postacute Care Payment Reforms Have Potential to Improve Efficiency, but May Need Changes to Cut Costs

PubMed Central

Grabowski, David C.; Huckfeldt, Peter J.; Sood, Neeraj; Escarce, José J; Newhouse, Joseph P.

2012-01-01

The Affordable Care Act mandates changes in payment policies for Medicare postacute care services intended to contain spending in the long run and help ensure the program’s financial sustainability. In addition to reducing annual payment increases to providers under the existing prospective payment systems, the act calls for demonstration projects of bundled payment, accountable care organizations, and other strategies to promote care coordination and reduce spending. Experience with the adoption of Medicare prospective payment systems in postacute care settings approximately a decade ago suggests that current reforms could, but need not necessarily, produce such undesirable effects as decreased access for less profitable patients, poorer patient outcomes, and only short-lived curbs on spending. Policy makers will need to be vigilant in monitoring the impact of the Affordable Care Act reforms and be prepared to amend policies as necessary to ensure that the reforms exert persistent controls on spending without compromising the delivery of patient-appropriate postacute services. PMID:22949442

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

PubMed

Berenson, Robert A; Rice, Thomas

2015-12-01

The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

48 CFR 232.7002 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 232.7002 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7002 Policy. (a)(1) Contractors shall submit payment requests...

48 CFR 232.7002 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 232.7002 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7002 Policy. (a)(1) Contractors shall submit payment requests...

48 CFR 232.7002 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 232.7002 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7002 Policy. (a) Contractors shall submit payment requests and...

48 CFR 232.7002 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 232.7002 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7002 Policy. (a) Contractors shall submit payment requests and...

48 CFR 232.7002 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 232.7002 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7002 Policy. (a)(1) Contractors shall submit payment requests...

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

What should we call instruments commonly known as payments for environmental services? A review of the literature and a proposal.

PubMed

Shelley, Barry G

2011-02-01

Researchers, policy makers, and practitioners have used various terms to describe instruments that reward the stewardship of ecosystem services that benefit "external" actors. Payments for environmental services, or PES, has been the predominant name. However, critics have challenged both the payments and environmental components of this nomenclature, most commonly proposing markets, compensation, or rewards as alternatives for the former, and ecosystem for the latter. Additional questions arise regarding what to call the agents directly involved in the transaction: sellers and buyers, or stewards and beneficiaries? For some, concerns about this terminology have emerged from so-called "pro-poor PES" debates that ask if actors could and should incorporate poverty alleviation goals into PES instruments. This review of the modulating use of terms and the arguments about which best fit theory and experience points to the key policy and ethical issues at stake as PES programs face critical and timely questions about the direction they will head. The author contends that the choices of terms will influence that direction and proposes a new alternative-rewards for ecosystem service stewardship (RESS)-that better encompasses pro-poor options. © 2011 New York Academy of Sciences.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

PubMed

2012-08-31

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. Some of the 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) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. 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) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

12 CFR 412.5 - Policy.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Policy. 412.5 Section 412.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ACCEPTANCE OF PAYMENT FROM A NON-FEDERAL SOURCE FOR TRAVEL EXPENSES § 412.5 Policy. As provided in this part, Eximbank may accept payment from a non-Federal source...

Evaluating Interactions of Forest Conservation Policies on Avoided Deforestation

PubMed Central

Robalino, Juan; Sandoval, Catalina; Barton, David N.; Chacon, Adriana; Pfaff, Alexander

2015-01-01

We estimate the effects on deforestation that have resulted from policy interactions between parks and payments and between park buffers and payments in Costa Rica between 2000 and 2005. We show that the characteristics of the areas where protected and unprotected lands are located differ significantly. Additionally, we find that land characteristics of each of the policies and of the places where they interact also differ significantly. To adequately estimate the effects of the policies and their interactions, we use matching methods. Matching is implemented not only to define adequate control groups, as in previous research, but also to define those groups of locations under the influence of policies that are comparable to each other. We find that it is more effective to locate parks and payments away from each other, rather than in the same location or near each other. The high levels of enforcement inside both parks and lands with payments, and the presence of conservation spillovers that reduce deforestation near parks, significantly reduce the potential impact of combining these two policies. PMID:25909323

42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2017-10-01 2017-10-01 false Treatment of incentive programs or add-on payments...

42 CFR § 510.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

Code of Federal Regulations, 2010 CFR

2016-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.320 Treatment of incentive programs or add-on payments under existing Medicare payment systems. The CJR model... 42 Public Health 5 2016-10-01 2016-10-01 false Treatment of incentive programs or add-on payments...

41 CFR 102-38.290 - What types of payment may we accept?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What types of payment... PROPERTY Completion of Sale Payments § 102-38.290 What types of payment may we accept? You must adopt a payment policy that protects the Government against fraud. Acceptable payments include, but are not...

Medicaid eligibility policy in the 1980s: medical utilitarianism and the "deserving" poor.

PubMed

Tanenbaum, S J

1995-01-01

Between 1981 and the early 1990s, the Medicaid program grew substantially, in part because, for the first time in the program's history, eligibility for medical assistance was severed from eligibility for income-maintenance payments. Program participation had always been reserved for the "deserving poor," and these were originally defined as persons excluded from market relationships through no fault of their own. The Medicaid expansion of the 1980s, however, created a new constituency of poor, and not-so-poor, persons whose actual or predictable medical problems promised a calculable return on program funds.

42 CFR § 512.320 - Treatment of incentive programs or add-on payments under existing Medicare payment systems.

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.320 Treatment of incentive... under such models are independent of, and do not affect, any incentive programs or add-on payments under... 42 Public Health 5 2017-10-01 2017-10-01 false Treatment of incentive programs or add-on payments...

How will provider-focused payment reform impact geographic variation in Medicare spending?

PubMed

Auerbach, David; Mehrotra, Ateev; Hussey, Peter; Huckfeldt, Peter J; Alpert, Abby; Lau, Christopher; Shier, Victoria

2015-06-01

The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending. We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies. Policy simulation based on 2008 national Medicare data combined with other publicly available data. Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165). In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

Designer policy for carbon and biodiversity co-benefits under global change

NASA Astrophysics Data System (ADS)

Bryan, Brett A.; Runting, Rebecca K.; Capon, Tim; Perring, Michael P.; Cunningham, Shaun C.; Kragt, Marit E.; Nolan, Martin; Law, Elizabeth A.; Renwick, Anna R.; Eber, Sue; Christian, Rochelle; Wilson, Kerrie A.

2016-03-01

Carbon payments can help mitigate both climate change and biodiversity decline through the reforestation of agricultural land. However, to achieve biodiversity co-benefits, carbon payments often require support from other policy mechanisms such as regulation, targeting, and complementary incentives. We evaluated 14 policy mechanisms for supplying carbon and biodiversity co-benefits through reforestation of carbon plantings (CP) and environmental plantings (EP) in Australia’s 85.3 Mha agricultural land under global change. The reference policy--uniform payments (bidders are paid the same price) with land-use competition (both CP and EP eligible for payments), targeting carbon--achieved significant carbon sequestration but negligible biodiversity co-benefits. Land-use regulation (only EP eligible) and two additional incentives complementing the reference policy (biodiversity premium, carbon levy) increased biodiversity co-benefits, but mostly inefficiently. Discriminatory payments (bidders are paid their bid price) with land-use competition were efficient, and with multifunctional targeting of both carbon and biodiversity co-benefits increased the biodiversity co-benefits almost 100-fold. Our findings were robust to uncertainty in global outlook, and to key agricultural productivity and land-use adoption assumptions. The results suggest clear policy directions, but careful mechanism design will be key to realising these efficiencies in practice. Choices remain for society about the amount of carbon and biodiversity co-benefits desired, and the price it is prepared to pay for them.

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... identify the process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid...

Will Ohio Always Have an Antioch,...Rio Grande,...Wilberforce,...Xavier? Private Schools and Public Policy in Higher Education in Ohio.

ERIC Educational Resources Information Center

Frueh, Lloyd, II; Treacy, John J.

This document details the effects of various state programs and proposals which seek to aid the private schools including contracting by the Ohio Board of Regents for instructional services with private institutions, grants for capital improvements and special services, direct payments to students and long-term loans to students to recover…

How to buy a medical home? Policy options and practical questions.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for "new" PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.

How to Buy a Medical Home? Policy Options and Practical Questions

PubMed Central

Berenson, Robert A.

2010-01-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for “new” PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations. PMID:20467911

Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

PubMed

Atuoye, Kilian Nasung; Vercillo, Siera; Antabe, Roger; Galaa, Sylvester Zackaria; Luginaah, Isaac

2016-11-01

Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

Having it all: national benefit equity and local payment parity in Medicare.

PubMed

Dowd, Bryan; Feldman, Roger

2002-01-01

The Medicare Payment Advisory Commission (MedPAC) has identified two important problems with the Medicare+Choice (M+C) program: nationwide geographic inequity in government-financed benefits, and unequal government payments for M+C plans versus fee-for-service (FFS) Medicare in the same market area. MedPAC concludes that both problems cannot be solved simultaneously. We argue that both problems could be solved if Congress discontinued its policy of underwriting the cost of FFS Medicare. Instead, Congress should define a national entitlement benefit package and have all health plans submit bids on the package in each market area. The government's premium contribution should be equal to the lowest bid submitted by a qualified health plan in each market area. The contribution could be adjusted for health risk, the special obligations of FFS Medicare, and welfare enhancements associated with FFS Medicare that are valued by both beneficiaries and taxpayers but unrelated to beneficiaries' health status.

Medicaid Prior Authorization Policies for Medication Treatment of Attention-Deficit/Hyperactivity Disorder in Young Children, United States, 2015.

PubMed

Hulkower, Rachel L; Kelley, Meghan; Cloud, Lindsay K; Visser, Susanna N

In 2011, the American Academy of Pediatrics updated its guidelines for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) to recommend that clinicians refer parents of preschoolers (aged 4-5) for training in behavior therapy and subsequently treat with medication if behavior therapy fails to sufficiently improve functioning. Data available from just before the release of the guidelines suggest that fewer than half of preschoolers with ADHD received behavior therapy and about half received medication. About half of those who received medication also received behavior therapy. Prior authorization policies for ADHD medication may guide physicians toward recommended behavior therapy. Characterizing existing prior authorization policies is an important step toward evaluating the impact of these policies on treatment patterns. We inventoried existing prior authorization policies and characterized policy components to inform future evaluation efforts. A 50-state legal assessment characterized ADHD prior authorization policies in state Medicaid programs. We designed a database to capture data on policy characteristics and authorization criteria, including data on age restrictions and fail-first behavior therapy requirements. In 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required that prescribers indicate whether nonmedication treatments were considered before Medicaid payment for ADHD medication could be approved. Medicaid policies on ADHD medication treatment are diverse; some policies are tied to the diagnosis and treatment guidelines of the American Academy of Pediatrics. Evaluations are needed to determine if certain policy interventions guide families toward the use of behavior therapy as the first-line ADHD treatment for young children.

7 CFR 1469.23 - Program payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM Contracts and Payments § 1469.23 Program payments. (a) Stewardship component of CSP payments. (1) The conservation stewardship plan... Agriculture Statistics Service (NASS) land rental data, and Conservation Reserve Program (CRP) rental rates...

Rural implications of Medicare's post-acute-care transfer payment policy.

PubMed

Schoenman, Julie A; Mueller, Curt D

2005-01-01

Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the full DRG payment only when the patient's length of stay (LOS) is short relative to the geometric mean LOS for the DRG; otherwise, the full DRG payment is received. This policy originally applied to 10 DRGs beginning in fiscal year 1999 and was expanded to additional DRGs in FY2004. The Secretary may include other DRGs and types of PAC settings in future expansions. This article examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors used 1998-2001 Medicare Provider Analysis and Review (MEDPAR) data to investigate changes in hospital discharge patterns after the original policy was implemented, compute the change in Medicare revenue resulting from the payment change, and simulate the expected revenue reductions under expansions to additional DRGs and swing-bed discharges. Neither rural nor urban hospitals appear to have made a sustained change in their discharge behavior so as to limit their exposure to the transfer policy. Financial impacts from the initial policy were similar in relative terms for both types of hospitals and would be expected to be fairly similar for an expansion to additional DRGs. On average, including swing-bed discharges in the transfer policy would have a very small financial impact on small rural hospitals; only hospitals that make extensive use of swing beds after a short inpatient stay might expect large declines in total Medicare revenue. Rural hospitals are not disproportionately harmed by the PAC transfer policy. An expanded policy may even benefit rural hospitals by recognizing their lower use of post-acute-care and readjusting DRG weights so that they are paid more appropriately when providing the full course of inpatient care.

42 CFR § 414.1460 - Monitoring and program integrity.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1460 Monitoring and program integrity. (a) Vetting eligible clinicians prior to payment of the APM Incentive Payment. Prior to...

48 CFR 32.007 - Contract financing payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... extent of contract financing arrangements are integrated with agency contract pricing policies. (4... otherwise prescribed in agency policies and procedures or otherwise specified in paragraph (b) of this... due date. (3) Agency heads may prescribe shorter periods for payment based on contract pricing or...

76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Changes to Payments to Hospitals for Graduate Medical Education Costs..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of...

The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

PubMed Central

Baicker, Katherine; Chernew, Michael; Robbins, Jacob

2013-01-01

More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans. PMID:24308880

How Successful Is Medicare Advantage?

PubMed Central

Newhouse, Joseph P; McGuire, Thomas G

2014-01-01

Context Medicare Part C, or Medicare Advantage (MA), now almost 30 years old, has generally been viewed as a policy disappointment. Enrollment has vacillated but has never come close to the penetration of managed care plans in the commercial insurance market or in Medicaid, and because of payment policy decisions and selection, the MA program is viewed as having added to cost rather than saving funds for the Medicare program. Recent changes in Medicare policy, including improved risk adjustment, however, may have changed this picture. Methods This article summarizes findings from our group's work evaluating MA's recent performance and investigating payment options for improving its performance even more. We studied the behavior of both beneficiaries and plans, as well as the effects of Medicare policy. Findings Beneficiaries make “mistakes” in their choice of MA plan options that can be explained by behavioral economics. Few beneficiaries make an active choice after they enroll in Medicare. The high prevalence of “zero-premium” plans signals inefficiency in plan design and in the market's functioning. That is, Medicare premium policies interfere with economically efficient choices. The adverse selection problem, in which healthier, lower-cost beneficiaries tend to join MA, appears much diminished. The available measures, while limited, suggest that, on average, MA plans offer care of equal or higher quality and for less cost than traditional Medicare (TM). In counties, greater MA penetration appears to improve TM's performance. Conclusions Medicare policies regarding lock-in provisions and risk adjustment that were adopted in the mid-2000s have mitigated the adverse selection problem previously plaguing MA. On average, MA plans appear to offer higher value than TM, and positive spillovers from MA into TM imply that reimbursement should not necessarily be neutral. Policy changes in Medicare that reform the way that beneficiaries are charged for MA plan membership are warranted to move more beneficiaries into MA. PMID:24890251

How successful is Medicare Advantage?

PubMed

Newhouse, Joseph P; McGuire, Thomas G

2014-06-01

Medicare Part C, or Medicare Advantage (MA), now almost 30 years old, has generally been viewed as a policy disappointment. Enrollment has vacillated but has never come close to the penetration of managed care plans in the commercial insurance market or in Medicaid, and because of payment policy decisions and selection, the MA program is viewed as having added to cost rather than saving funds for the Medicare program. Recent changes in Medicare policy, including improved risk adjustment, however, may have changed this picture. This article summarizes findings from our group's work evaluating MA's recent performance and investigating payment options for improving its performance even more. We studied the behavior of both beneficiaries and plans, as well as the effects of Medicare policy. Beneficiaries make "mistakes" in their choice of MA plan options that can be explained by behavioral economics. Few beneficiaries make an active choice after they enroll in Medicare. The high prevalence of "zero-premium" plans signals inefficiency in plan design and in the market's functioning. That is, Medicare premium policies interfere with economically efficient choices. The adverse selection problem, in which healthier, lower-cost beneficiaries tend to join MA, appears much diminished. The available measures, while limited, suggest that, on average, MA plans offer care of equal or higher quality and for less cost than traditional Medicare (TM). In counties, greater MA penetration appears to improve TM's performance. Medicare policies regarding lock-in provisions and risk adjustment that were adopted in the mid-2000s have mitigated the adverse selection problem previously plaguing MA. On average, MA plans appear to offer higher value than TM, and positive spillovers from MA into TM imply that reimbursement should not necessarily be neutral. Policy changes in Medicare that reform the way that beneficiaries are charged for MA plan membership are warranted to move more beneficiaries into MA. © 2014 Milbank Memorial Fund.

Determinants Of Impoverishment Due To Out Of Pocket Payments In Nigeria.

PubMed

Aregbeshola, Bolaji Samson; Khan, Samina Mohsin

2017-01-01

Poverty is an extreme consequence of out of pocket payments in countries with health systems that do not provide financial risk protection through mandatory health insurance coverage for people in both the formal and informal sectors. The study assessed the determinants of impoverishment due to out of pocket payments in Nigeria. Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with impoverishment in Nigeria. Household and individual characteristics associated with impoverishment were determined using binary logistic regression. A significance level of p<0.05 was used. Results show that lack of health insurance, having a member above 65 years, large household size, household socio-economic status, type of illness suffered, type of health facility visited, geo-political zones, education of household heads and location were major determinants of impoverishment due to out of pocket health expenditure. Findings from the study show that most households and individuals are vulnerable to financial risk due to this regressive source of payments for health care services. This explains why the level of poverty keeps increasing in spite of the numerous poverty alleviation programs across the country. Policy makers and political actors need to design a new health system financing policy that will increase financial risk protection for people in both the formal and informal sectors. Governments and decision makers have to focus on health as a determinant of economic well-being.

The impact of Medicare home health policy changes on Medicare beneficiaries: part II.

PubMed

Ahrens, Joann

2005-01-01

This brief presents the results of a follow-up study (Murtaugh et al., 2003) on the effects of the Balanced Budget Act of 1997 on Medicare home health service use and beneficiary outcomes.[The results of the initial study (McCall et al., 2001) were discussed in a Spring 2003 policy brief and fact sheet.] The 2003 study found that the new payment systems have had a significant impact on the Medicare home health benefit: utilization declined, aggregate payments and payments per visit decreased (and then increased), the mix of services shifted, and the types of patients served appears to have changed. These results show that policy goals-in this case attempting to limit the use of the Medicare home health benefit while shifting services towards skilled care-can be instituted through changes in the payment system, though it is important to examine the impact of changes for possible unintended effects. Further study on the sustained impact of the current payment system-particularly on quality of care-is still needed.

Tradition and Change in Marriage Payments in Vietnam, 1963–2000

PubMed Central

Teerawichitchainan, Bussarawan; Knodel, John

2013-01-01

Trends and determinants of marriage payments have rarely been examined at the population level despite their plausible implications for the welfare of family and the distribution of wealth across families and generations. In this study, we analyze population-based data from the Vietnam Study of Family Change to document prevalence and directions of marriage payments in Vietnam from 1963 to 2000. We investigate the extent to which structural and policy transformations (particularly market reform and the socialist policy that banned brideprice) influenced the practice of marriage payments as well as estimate how societal changes indirectly impacted payments via their effects on population characteristics. Results indicate that marriage payments surged following market reform but also reveal more nuanced trends and regional differences during earlier years. While the socialist attempts to eradicate brideprice appear to have been moderately successful in the North prior to economic renovation the evidence suggests they were largely unsuccessful in the South. Results suggest that structural and policy change explained most of the observed variations in marriage payments and that changing characteristics of the individuals who married mattered relatively little. We interpret the reemergence of marriage payments as attesting to resilience of traditional values and the unraveling of the socialist agenda, especially in the North, but also as a reflection of economic prosperity associated with market reform. PMID:23833635

Integrating Risk Adjustment and Enrollee Premiums in Health Plan Payment

PubMed Central

McGuire, Thomas G.; Glazer, Jacob; Newhouse, Joseph P.; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D.; Zuvekas, Samuel

2013-01-01

In two important health policy contexts – private plans in Medicare and the new state-run “Exchanges” created as part of the Affordable Care Act (ACA) – plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). PMID:24308878

Understanding Washington: a nephrologist's perspective from inside the Beltway.

PubMed

Rubin, Robert J

2013-12-01

The major principles that drive U.S. federal health policy-making are: (1) fixed or reduced costs, (2) ensured outcomes (or no evidence of undertreatment), (3) streamlined administration, and (4) political viability. A corollary is that providers are uniquely sensitive to financial incentives. Understanding these principles is vital to understanding federal health policy. Critically, these principles are nonpartisan and have been supported and used by all administrations since President Reagan. This article examines the end-stage renal disease (ESRD) prospective payment system, colloquially called "The Bundle," in the context of these major principles. Successful health policy, successful legislation, and successful regulation building all require executive leadership, mutual trust, and compromise. This is demonstrated by the events surrounding the passage of the Medicare inpatient prospective payment system, which governs hospital reimbursement for Medicare beneficiaries, including those not covered in the ESRD program. Given that the ESRD benefit consumes 6.3% of the Medicare budget for approximately 2% of Medicare beneficiaries, if nephrology is to experience future success, we must change how both policymakers and the wider field of medicine perceive our specialty. Understanding the major principles behind health care policy may facilitate this goal. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

76 FR 1669 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-11

... Areas Based on CBSA Labor Market Areas, we made technical and typographical errors in the composite rate... Based on CBSA Labor Market Areas, we made a technical error in the composite wage index for the nonurban... column, a. Second full paragraph, (1) Line 23, the figure ``1.181'' is corrected to read ``1.182.'' (2...

The effect of changing state health policy on hospital uncompensated care.

PubMed

Davidoff, A J; LoSasso, A T; Bazzoli, G J; Zuckerman, S

2000-01-01

This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period 1990 through 1995, we find that not-for-profit and public hospitals' uncompensated care levels respond positively to Medicaid payment generosity, although the magnitude of the effect is small. Not-for-profit hospitals respond negatively to Medicaid HMO penetration. Public and for-profit hospitals respond negatively to increases in Medicaid eligibility. Results suggest that public insurance payment generosity is an effective but inefficient policy instrument for influencing uncompensated care among not-for-profit hospitals. Further, in localities with high HMO penetration or high penetration of for-profit hospitals, it may be necessary to establish explicit payments for care of the uninsured.

76 FR 24213 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-29

...This proposed rule would implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a 2 percent reduction in the annual increase factor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This proposed rule would also update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year 2012 (for discharges occurring on or after October 1, 2011 and on or before September 30, 2012) as required by the Social Security Act (the Act). The Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each FY the classification and weighting factors for the IRF prospective payment system (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are also proposing to consolidate, clarify, and revise existing policies regarding IRF hospitals and IRF units of hospitals to eliminate unnecessary confusion and enhance consistency. Furthermore, in accordance with the general principles of the President's January 18, 2011 Executive Order entitled ``Improving Regulation and Regulatory Review,'' we are proposing to amend existing regulatory provisions regarding ``new'' facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs) to improve clarity and remove obsolete material.

Cost-effectiveness of conservation payment schemes for species with different range sizes.

PubMed

Drechsler, Martin; Smith, Henrik G; Sturm, Astrid; Wätzold, Frank

2016-08-01

Payments to compensate landowners for carrying out costly land-use measures that benefit endangered biodiversity have become an important policy instrument. When designing such payments, it is important to take into account that spatially connected habitats are more valuable for many species than isolated ones. One way to incentivize provision of connected habitats is to offer landowners an agglomeration bonus, that is, a bonus on top of payments they are receiving to conserve land if the land is spatially connected. Researchers have compared the cost-effectiveness of the agglomeration bonus with 2 alternatives: an all-or-nothing, agglomeration payment, where landowners receive a payment only if the conserved land parcels have a certain level of spatial connectivity, and a spatially homogeneous payment, where landowners receive a payment for conserved land parcels irrespective of their location. Their results show the agglomeration bonus is rarely the most cost-effective option, and when it is, it is only slightly better than one of the alternatives. This suggests that the agglomeration bonus should not be given priority as a policy design option. However, this finding is based on consideration of only 1 species. We examined whether the same applied to 2 species, one for which the homogeneous payment is best and the other for which the agglomeration payment is most cost-effective. We modified a published conceptual model so that we were able to assess the cost-effectiveness of payment schemes for 2 species and applied it to a grassland bird and a grassland butterfly in Germany that require the same habitat but have different spatial-connectivity needs. When conserving both species, the agglomeration bonus was more cost-effective than the agglomeration and the homogeneous payment; thus, we showed that as a policy the agglomeration bonus is a useful conservation-payment option. © 2016 Society for Conservation Biology.

76 FR 7935 - Advanced Biofuel Payment Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

...The Rural Business-Cooperative Service (Agency) is establishing the Advanced Biofuel Payment Program authorized under the Food, Conservation, and Energy Act of 2008. Under this Program, the Agency will enter into contracts with advanced biofuel producers to pay such producers for the production of eligible advanced biofuels. To be eligible for payments, advanced biofuels must be produced from renewable biomass, excluding corn kernel starch, in a biofuel facility located in a State. In addition, this interim rule establishes new program requirements for applicants to submit applications for Fiscal Year 2010 payments for the Advanced Biofuel Payment Program. These new program requirements supersede the Notice of Contract Proposal (NOCP) for Payments to Eligible Advanced Biofuel Producers in its entirety.

The resource utilization group system: its effect on nursing home case mix and costs.

PubMed

Thorpe, K E; Gertler, P J; Goldman, P

1991-01-01

Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.

48 CFR 252.225-7035 - Buy American Act-Free Trade Agreements-Balance of Payments Program Certificate.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Trade Agreements-Balance of Payments Program Certificate. 252.225-7035 Section 252.225-7035 Federal... Trade Agreements—Balance of Payments Program Certificate. As prescribed in 225.1101(10)(i), use the following provision: Buy American Act—Free Trade Agreements—Balance of Payments Program Certificate (DEC...

48 CFR 252.225-7036 - Buy American Act-Free Trade Agreements-Balance of Payments Program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Trade Agreements-Balance of Payments Program. 252.225-7036 Section 252.225-7036 Federal Acquisition... Trade Agreements—Balance of Payments Program. As prescribed in 225.1101(11)(i)(A), use the following clause: Buy American Act—Free Trade Agreements—Balance of Payments Program (DEC 2010) (a) Definitions. As...

48 CFR 252.225-7036 - Buy American Act-Free Trade Agreements-Balance of Payments Program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Trade Agreements-Balance of Payments Program. 252.225-7036 Section 252.225-7036 Federal Acquisition... Trade Agreements—Balance of Payments Program. As prescribed in 225.1101(11)(i), use the following clause: Buy American Act—Free Trade Agreements—Balance of Payments Program (JUL 2009) (a) Definitions. As used...

48 CFR 252.225-7035 - Buy American Act-Free Trade Agreements-Balance of Payments Program Certificate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Trade Agreements-Balance of Payments Program Certificate. 252.225-7035 Section 252.225-7035 Federal... Trade Agreements—Balance of Payments Program Certificate. As prescribed in 225.1101(10), use the following provision: Buy American Act—Free Trade Agreements—Balance of Payments Program Certificate (DEC...

The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison.

PubMed

Simoens, Steven; Giuffrida, Antonio

2004-01-01

This article reviews policies on physician payment methods that Organisation for Economic Cooperation and Development (OECD) countries have implemented to promote an efficient deployment of physicians. Countries' experiences show that payment by fee-for-service, capitation and salary influences physician activity levels and productivity. However, the impact of these simple payment methods is complex and may be diluted by clinical, demographic, ethical and organisational factors. Policies that have attempted to curb health expenditure by controlling fee levels have sometimes been eroded by physicians increasing the volume of service supply, or providing services that attract higher fees. Flexible blended payment methods based on the combination of a fixed component, through either capitation or salary, and a variable component, through fee-for-service, may produce a desirable mix of incentives. Integrating such blended payment methods with mechanisms to monitor physician activity may offer potential success.

Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

PubMed

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-06-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

PubMed Central

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-01-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes. PMID:20644697

Evaluating The Role Of Payment Policy In Driving Vertical Integration In The Oncology Market.

PubMed

Alpert, Abby; Hsi, Helen; Jacobson, Mireille

2017-04-01

The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003-15, finding that the rate of hospital or health system ownership of practices doubled from about 30 percent to about 60 percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that dramatically reduced reimbursement for chemotherapy drugs, and the expansion of hospital eligibility for the 340B Drug Discount Program under the Affordable Care Act (ACA). To evaluate the evidence for these explanations, we used difference-in-differences methods to assess whether consolidation increased more in areas with greater exposure to each policy than in areas with less exposure. We found little evidence that either policy contributed to vertical integration. Rather, increased consolidation in the market for cancer care may be part of a broader post-ACA trend toward integrated health care systems. Project HOPE—The People-to-People Health Foundation, Inc.

22 CFR 201.26 - Expenditure of marine insurance loss payments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Expenditure of marine insurance loss payments... § 201.26 Expenditure of marine insurance loss payments. Unless otherwise authorized by USAID, any marine insurance loss payment under a marine insurance policy financed pursuant to this part 201 received by the...

22 CFR 201.26 - Expenditure of marine insurance loss payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Expenditure of marine insurance loss payments... § 201.26 Expenditure of marine insurance loss payments. Unless otherwise authorized by USAID, any marine insurance loss payment under a marine insurance policy financed pursuant to this part 201 received by the...

Integrating risk adjustment and enrollee premiums in health plan payment.

PubMed

McGuire, Thomas G; Glazer, Jacob; Newhouse, Joseph P; Normand, Sharon-Lise; Shi, Julie; Sinaiko, Anna D; Zuvekas, Samuel H

2013-12-01

In two important health policy contexts - private plans in Medicare and the new state-run "Exchanges" created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS). Copyright © 2013 Elsevier B.V. All rights reserved.

Introductory Overview of the Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network: Examining the Impact of US Health Policies and Practices to Prevent Diabetes and Its Complications.

PubMed

Duru, O Kenrik; Mangione, Carol M; Rodriguez, Hector P; Ross-Degnan, Dennis; Wharam, J Frank; Black, Bernard; Kho, Abel; Huguet, Nathalie; Angier, Heather; Mayer, Victoria; Siscovick, David; Kraschnewski, Jennifer L; Shi, Lizheng; Nauman, Elizabeth; Gregg, Edward W; Ali, Mohammed K; Thornton, Pamela; Clauser, Steven

2018-02-05

Diabetes incidence is rising among vulnerable population subgroups including minorities and individuals with limited education. Many diabetes-related programs and public policies are unevaluated while others are analyzed with research designs highly susceptible to bias which can result in flawed conclusions. The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network includes eight research centers and three funding agencies using rigorous methods to evaluate natural experiments in health policy and program delivery. NEXT-D2 research studies use quasi-experimental methods to assess three major areas as they relate to diabetes: health insurance expansion; healthcare financing and payment models; and innovations in care coordination. The studies will report on preventive processes, achievement of diabetes care goals, and incidence of complications. Some studies assess healthcare utilization while others focus on patient-reported outcomes. NEXT-D2 examines the effect of public and private policies on diabetes care and prevention at a critical time, given ongoing and rapid shifts in the US health policy landscape.

20 CFR 627.305 - Payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Federal or federally assisted program based on need, other than as provided under the Social Security Act... are: Needs-based payments for eligible individuals in programs under title II; incentive and bonus payments for participants in title II programs; work-based training payments for work experience, entry...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

The experience of rural independent pharmacies with medicare part D: reports from the field.

PubMed

Radford, Andrea; Slifkin, Rebecca; Fraser, Roslyn; Mason, Michelle; Mueller, Keith

2007-01-01

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created prescription drug coverage for Medicare beneficiaries through a new Part D program, the single largest addition to Medicare since its creation in 1965. Prior to program implementation in January 2006, concerns had been voiced as to how independent pharmacies, which represent a higher proportion of all retail pharmacies in rural areas, would fare under the new program. This article describes first-hand reports from rural pharmacist-owners about their experiences with Medicare Part D plans in the first 7 months of 2006 in order to gain a more thorough understanding of the challenges faced by rural independent pharmacies as a result of program implementation. A semi-structured interview protocol was utilized in telephone interviews with 22 pharmacist-owners of rural independent pharmacies in 10 states. The rural independent pharmacists interviewed are experiencing major changes in payment, administrative burden, and interaction with patients as a result of the shift of patients into Medicare Part D plans. While administrative burden has greatly increased, payment and clinical interaction have decreased. Actions should be considered that would help rural independent pharmacists adjust to the new circumstances of having Medicare patients mirror, for administrative and payment purposes, commercially insured patients. Long-term modification of existing policies and regulations may be necessary to assure reasonable access to pharmaceuticals for rural populations. Further study is needed to determine how best to target these modifications to essential pharmacies.

Assessing the effects of regional payment for watershed services program on water quality using an intervention analysis model.

PubMed

Lu, Yan; He, Tian

2014-09-15

Much attention has been recently paid to ex-post assessments of socioeconomic and environmental benefits of payment for ecosystem services (PES) programs on poverty reduction, water quality, and forest protection. To evaluate the effects of a regional PES program on water quality, we selected chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) as indicators of water quality. Statistical methods and an intervention analysis model were employed to assess whether the PES program produced substantial changes in water quality at 10 water-quality sampling stations in the Shaying River watershed, China during 2006-2011. Statistical results from paired-sample t-tests and box plots of COD and NH3-N concentrations at the 10 stations showed that the PES program has played a positive role in improving water quality and reducing trans-boundary water pollution in the Shaying River watershed. Using the intervention analysis model, we quantitatively evaluated the effects of the intervention policy, i.e., the watershed PES program, on water quality at the 10 stations. The results suggest that this method could be used to assess the environmental benefits of watershed or water-related PES programs, such as improvements in water quality, seasonal flow regulation, erosion and sedimentation, and aquatic habitat. Copyright © 2014 Elsevier B.V. All rights reserved.

The incentive effects of the Medicare indirect medical education policy.

PubMed

Nicholson, S; Song, D

2001-11-01

Medicare provided teaching hospitals with US$ 5.9 billion in supplemental graduate medical education (GME) payments in 1998. These payments distort input and output prices and provide teaching hospitals with incentives to hire residents, close beds, and admit more Medicare patients. The structure of the GME payment policy creates substantial variation in input and output prices between teaching hospitals. We examine the extent to which hospitals responded to these financial incentives using a panel data set of 3,900 hospitals, including over 900 teaching hospitals. We find that teaching hospitals did hire residents and close beds in response to the Medicare policy, but did not increase Medicare admissions or alter their use of registered nurses (RNs).

7 CFR 1427.1204 - Eligible domestic users and exporters.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Cotton Competitiveness Payment Program § 1427.1204 Eligible domestic users and exporters. (a) For the... entered into an agreement with CCC to participate in the ELS Cotton Competitiveness Payment Program; or (2... Competitiveness Payment Program. (b) Payment applications must contain the documentation required by this subpart...

Impact of nitrogen reduction measures on nitrogen surplus, income and production of German agriculture.

PubMed

Gömann, H; Kreins, P; Møller, C

2004-01-01

Among the numerous non-point sources of diffuse water pollution with nitrogen, agriculture is counted one of the main sources. The agricultural policies of the Agenda 2000 and a decoupling of direct payments for farmers from their production decisions are exemplarily evaluated as nitrogen reduction measures using the Regional Agricultural and Environmental Information System RAUMIS. The results show that until the target year 2010 the risk of diffuse pollution of water bodies with nitrogen is a regional problem in Germany. These problems are neither mitigated by the policies of Agenda 2000 nor by a decoupling of direct payments from production decisions of farmers. While total nitrogen surplus reduces considerably after a decoupling of direct payments due to decreases of land-use the nitrogen surplus on the remaining cultivated area increases resulting from structural changes. Granting the same amount of direct payments to farmers in both policy alternatives the agricultural sector income would be higher after a decoupling of direct payments opposed to the Agenda 2000 resulting from a more efficient allocation of inputs.

Fiscal Year 2010 U.S. Government Financial Statements: Federal Government Continues To Face Financial Management And Long-Term Fiscal Challenges

DTIC Science & Technology

2011-03-09

effective oversight of federal government programs and policies. Over the years, certain material weaknesses in internal control over...ineffective process for preparing the consolidated financial statements. In addition to the material weaknesses underlying these major impediments, GAO...noted material weaknesses involving billions of dollars in improper payments, information security, and tax collection activities. With regard to the

Policy Makers Will Need A Way To Update Bundled Payments That Reflects Highly Skewed Spending Growth Of Various Care Episodes

PubMed Central

Rosen, Allison B.; Aizcorbe, Ana; Ryu, Alexander J.; Nestoriak, Nicole; Cutler, David M.; Chernew, Michael E.

2015-01-01

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset. PMID:23650329

ESRD care within the US Department of Veterans Affairs: a forward-looking program with an illuminating past.

PubMed

Watnick, Suzanne; Crowley, Susan T

2014-03-01

The first governmental agency to provide maintenance hemodialysis to patients with end-stage renal disease (ESRD) was the Veterans Administration (VA; now the US Department of Veterans Affairs). Many historical VA policies and programs set the stage for the later care of both veteran and civilian patients with ESRD. More recent VA initiatives that target restructuring of care models based on quality management, system-wide payment policies to promote cost-effective dialysis, and innovation grants aim to improve contemporary care. The VA currently supports an expanded and diversified nationwide treatment program for patients with ESRD using an integrated patient-centered care paradigm. This narrative review of ESRD care by the VA explores not only the medical advances, but also the historical, socioeconomic, ethical, and political forces related to the care of veterans with ESRD. Published by Elsevier Inc.

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and the Merit-based Incentive Payment System.

PubMed

Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

2017-06-01

As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment. Quality will replace the Physician Quality Reporting System and clinicians will report on 6 measures from a list of over 250 options. Advancing care information will replace meaningful use and will assess clinicians on activities related to integration of electronic health record technology into their practice. Improvement activities will require clinicians to attest to completion of activities focused on improvements in care coordination, beneficiary engagement, and patient safety. Finally, cost will be determined automatically from Medicare claims data. In this article, we will provide a detailed review of the Medicare Access and Children's Health Insurance Program Reauthorization Act with a focus on MIPS and briefly discuss the potential implications for dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.

PubMed

Edelstein, Burton L

2014-01-01

The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.

A New Culture of Transparency: Industry Payments to Orthopedic Surgeons.

PubMed

Lopez, Joseph; Ahmed, Rizwan; Bae, Sunjae; Hicks, Caitlin W; El Dafrawy, Mostafa; Osgood, Greg M; Segev, Dorry L

2016-11-01

Under the Physician Payments Sunshine Act, "payments or transfers of value" by biomedical companies to physicians must be disclosed through the Open Payments Program. Designed to provide transparency of financial transactions between medication and device manufacturers and health care providers, the Open Payments Program shows financial relationships between industry and health care providers. Awareness of this program is crucial because its interpretation or misinterpretation by patients, physicians, and the general public can affect patient care, clinical practice, and research. This study evaluated nonresearch payments by industry to orthopedic surgeons. A retrospective cross-sectional review of the first wave of Physician Payments Sunshine Act data (August through December 2013) was performed to characterize industry payments to orthopedic surgeons by subspecialty, amount, type, origin, and geographic distribution. During this 5-month period, orthopedic surgeons (n=14,828) received $107,666,826, which included 3% of those listed in the Open Payments Program and 23% of the total amount paid. Of orthopedic surgeons who received payment, 45% received less than $100 and 1% received $100,000 or more. Median payment (interquartile range) was $119 ($34-$636), and mean payment was $7261±95,887. The largest payment to an individual orthopedic surgeon was $7,849,711. The 2 largest payment categories were royalty or license fees (68%) and consulting fees (13%). During the study period, orthopedic surgeons had substantial financial ties to industry. Of orthopedic surgeons who received payments, the largest proportion (45%) received less than $100 and only 1% received large payments (≥$100,000). The Open Payments Program offers insight into industry payments to orthopedic surgeons. [Orthopedics. 2016; 39(6):e1058-e1062.]. Copyright 2016, SLACK Incorporated.

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

42 CFR 495.208 - Avoiding duplicate payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.208 Avoiding duplicate payment. (a) Unless a qualifying MA EP is entitled to a maximum payment for a year under the Medicare FFS EHR incentive program, payment for such an individual is only made under the MA EHR incentive program...

7 CFR 760.506 - Payment calculations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

7 CFR 760.506 - Payment calculations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

7 CFR 760.506 - Payment calculations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

7 CFR 760.506 - Payment calculations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... who meets all of the requirements of § 760.504(b) or be considered the owner of the trees under... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Tree Assistance Program § 760.506 Payment calculations. (a) Payment to an eligible orchardist or nursery tree grower for the cost of replanting or...

Financing graduate medical education in family medicine.

PubMed

Colwill, J M

1989-03-01

Family practice residency programs differ fiscally from residency programs in most other specialties because they have limited income-generating potential. The present review demonstrates that the typical family practice residency program has been fiscally solvent as a result of receiving approximately one-third of its income from state and federal appropriations. The level of such support plateaued in the 1980s and programs have not continued to expand despite an ongoing shortage of family physicians. Today, declining Medicare payments to hospitals threaten hospitals' contributions to family practice residency programs. The ability of family practice residency programs to meet the continuing need for family physicians will depend upon the development of specific state and federal policies that provide fiscal incentives to maintain and expand family practice residencies.

Check in the Mail or More in the Paycheck: Does the Effectiveness of Fiscal Stimulus Depend on How It Is Delivered?†

PubMed Central

Sahm, Claudia R.; Shapiro, Matthew D.; Slemrod, Joel

2013-01-01

Recent fiscal policies, including the 2008 stimulus payments and the 2009 Making Work Pay Tax Credit, aimed to increase household spending. This paper quantifies the spending response to these policies and examines differences in spending by whether the stimulus was delivered as a one-time payment or as a flow of payments from reduced withholding. Based on responses from a representative sample of households in the Thomson Reuters University of Michigan Surveys of Consumers, the paper finds that the reduction in withholding in 2009 boosted spending at roughly half the rate (13 percent) as the one-time payments (25 percent) in 2008. PMID:23970951

7 CFR 1951.11 - Application of payments on real estate accounts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 14 2011-01-01 2011-01-01 false Application of payments on real estate accounts. 1951... Servicing Policies § 1951.11 Application of payments on real estate accounts. (a) Regular payments. If a borrower owes more than one type of real estate loan, or has received initial and subsequent real estate...

7 CFR 1951.11 - Application of payments on real estate accounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 14 2010-01-01 2009-01-01 true Application of payments on real estate accounts. 1951... Servicing Policies § 1951.11 Application of payments on real estate accounts. (a) Regular payments. If a borrower owes more than one type of real estate loan, or has received initial and subsequent real estate...

7 CFR 1951.11 - Application of payments on real estate accounts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 14 2012-01-01 2012-01-01 false Application of payments on real estate accounts. 1951... Servicing Policies § 1951.11 Application of payments on real estate accounts. (a) Regular payments. If a borrower owes more than one type of real estate loan, or has received initial and subsequent real estate...

7 CFR 1951.11 - Application of payments on real estate accounts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 14 2013-01-01 2013-01-01 false Application of payments on real estate accounts. 1951... Servicing Policies § 1951.11 Application of payments on real estate accounts. (a) Regular payments. If a borrower owes more than one type of real estate loan, or has received initial and subsequent real estate...

7 CFR 1951.11 - Application of payments on real estate accounts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 14 2014-01-01 2014-01-01 false Application of payments on real estate accounts. 1951... Servicing Policies § 1951.11 Application of payments on real estate accounts. (a) Regular payments. If a borrower owes more than one type of real estate loan, or has received initial and subsequent real estate...

7 CFR 1486.406 - Will CCC make advance payments to Recipients?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Will CCC make advance payments to Recipients? 1486... Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a) Policy. In general, CCC operates the EMP on a cost reimbursable basis. (b) Exception. Upon request, CCC may make advance payments to a...

7 CFR 1486.406 - Will CCC make advance payments to Recipients?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Will CCC make advance payments to Recipients? 1486... Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a) Policy. In general, CCC operates the EMP on a cost reimbursable basis. (b) Exception. Upon request, CCC may make advance payments to a...

7 CFR 1486.406 - Will CCC make advance payments to Recipients?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Will CCC make advance payments to Recipients? 1486... Reimbursements § 1486.406 Will CCC make advance payments to Recipients? (a) Policy. In general, CCC operates the EMP on a cost reimbursable basis. (b) Exception. Upon request, CCC may make advance payments to a...

42 CFR 422.304 - Monthly payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422.304 Monthly... original fee-for-service benefits for an individual in an MA payment area for a month. (1) Payment of bid...

7 CFR 550.22 - Payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GENERAL ADMINISTRATIVE POLICY FOR NON-ASSISTANCE COOPERATIVE AGREEMENTS Management of Agreements Financial Management § 550.22 Payment. (a) Payment methods shall minimize the time elapsing between the transfer of...) The time period covered by the invoice; and (vii) Total dollar amount itemized by budget categories...

48 CFR 232.007 - Contract financing payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contract financing... SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 232.007 Contract financing payments. (a) DoD policy is to make contract financing payments as quickly as possible. Generally...

20 CFR 408.1205 - How can a State have SSA administer its State recognition payment program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... recognition payment program? 408.1205 Section 408.1205 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Federal Administration of State Recognition Payments § 408.1205 How can a State have SSA administer its State recognition payment program? A State (or...

75 FR 55801 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... 0938-AP87 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing... Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2011.'' DATES: Effective... illustrate the skilled nursing facility (SNF) prospective payment system (PPS) payment rate computations for...

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Private expenditure and the role of private health insurance in Greece: status quo and future trends.

PubMed

Siskou, Olga; Kaitelidou, Daphne; Economou, Charalampos; Kostagiolas, Peter; Liaropoulos, Lycourgos

2009-10-01

The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.

Medicare program; additional extension of the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital Inpatient Prospective Payment Systems (IPPS) for acute care hospitals for fiscal year 2014. Extension of a payment adjustment and a program.

PubMed

2014-06-17

This document announces changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for the second half of FY 2014 (April 1, 2014 through September 30, 2014) in accordance with sections 105 and 106, respectively, of the Protecting Access to Medicare Act of 2014 (PAMA).

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

76 FR 47835 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

...This final rule will implement section 3004 of the Affordable Care Act, which establishes a new quality reporting program that provides for a 2 percent reduction in the annual increase factor beginning in 2014 for failure to report quality data to the Secretary of Health and Human Services. This final rule will also update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2012 (for discharges occurring on or after October 1, 2011 and on or before September 30, 2012) as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before the August 1 that precedes the start of each FY the classification and weighting factors for the IRF prospective payment system (PPS) case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year. We are also consolidating, clarifying, and revising existing policies regarding IRF hospitals and IRF units of hospitals to eliminate unnecessary confusion and enhance consistency. Furthermore, in accordance with the general principles of the President's January 18, 2011 Executive Order entitled ``Improving Regulation and Regulatory Review,'' we are amending existing regulatory provisions regarding ''new'' facilities and changes in the bed size and square footage of IRFs and inpatient psychiatric facilities (IPFs) to improve clarity and remove obsolete material.

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Profession, "Performance", and Policy: Teachers, Examinations, and the State in England and Wales, 1846-1862

ERIC Educational Resources Information Center

Knudsen, Andrew T.

2016-01-01

When historians discuss the impact of examinations on elementary education in mid-Victorian England and Wales they typically focus on the Revised Code of 1862. The Revised Code is famous for instituting a policy of "payment-by-results" for teachers in state-supported voluntary schools. "Payment-by-results" made government…

Equity in out-of-pocket payment in Chile

PubMed Central

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-01-01

ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity. PMID:28492762

Equity in out-of-pocket payment in Chile.

PubMed

Mondaca, Alicia Lorena Núñez; Chi, Chunhuei

2017-05-04

To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity.

76 FR 24343 - Advanced Biofuel Payment Program; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

...-AA75 Advanced Biofuel Payment Program; Correction AGENCY: Rural Business-Cooperative Service; Rural... Federal Register of February 11, 2011, establishing the Advanced Biofuel Payment Program authorized under... this Program, the Agency will enter into contracts with advanced biofuel producers to pay such...

24 CFR 888.315 - Restrictions on retroactive payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROGRAM, SECTION 202 SUPPORTIVE HOUSING FOR THE ELDERLY PROGRAM AND SECTION 811 SUPPORTIVE HOUSING FOR PERSONS WITH DISABILITIES PROGRAM) SECTION 8 HOUSING ASSISTANCE PAYMENTS PROGRAM-FAIR MARKET RENTS AND... Elderly or Handicapped, and Special Allocations Projects § 888.315 Restrictions on retroactive payments...

7 CFR 1493.60 - Payment guarantee.

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

7 CFR 1493.60 - Payment guarantee.

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

7 CFR 1493.60 - Payment guarantee.

Code of Federal Regulations, 2012 CFR

2012-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the...

48 CFR 1032.7002 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... classified information or national security; (b) Where a contract otherwise requires the electronic... process electronic payment submissions through the Treasury Internet Payment Platform or successor system...

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

Runaway Costs in Medi-Cal—A Myth

PubMed Central

Heckman, John R.; Jones, Michael W.

1980-01-01

An analysis of increases in Medi-Cal expenditures to their present level, more than $4 billion a year, shows them to be attributable largely to changes in eligibility and scope of benefits. The actual costs of providing care have risen at a relatively modest rate. If in fact costs are to be lowered from present levels, public policy makers must make important decisions concerning program changes which transcend merely altering payment and delivery methods. PMID:6996335

Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change.

PubMed

Lee, Tae-Jin; Cheong, Chelim

2017-11-01

To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

7 CFR 226.11 - Program payments for centers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

7 CFR 226.11 - Program payments for centers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

7 CFR 226.11 - Program payments for centers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.11 Program... payments for administrative costs to the amount approved in the annual administrative budget of the...

41 CFR 301-73.301 - How do we obtain travel payment system services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... payment system services? 301-73.301 Section 301-73.301 Public Contracts and Property Management Federal... PROGRAMS Travel Payment System § 301-73.301 How do we obtain travel payment system services? You may participate in GSA's or another Federal agency's travel payment system services program or you may contract...

Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

PubMed

2016-11-04

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

Setting Physicians' Prices in FFS Medicare: An Economic Perspective

PubMed Central

Dowd, Bryan; Feldman, Roger; Nyman, John; Town, Bob

2006-01-01

Recent policy discussions by the Medicare Payment Advisory Commission (MedPAC) regarding physician prices in the traditional fee-for-service (FFS) Medicare Program reflect movement toward a market pricing model. Earlier objectives such as sustainable levels of spending have given way to concerns over the relationship between fees and actual costs, access to care, and the importance of demand and supply in local markets. An important objective in other policy settings is economically efficient distribution of services. We explain the meaning of economic efficiency for Medicare physician prices and explore difficulties one might encounter in pursuing economic efficiency, as well as the cost of not pursuing it. PMID:17427848

The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization.

PubMed

Baicker, Katherine; Chernew, Michael E; Robbins, Jacob A

2013-12-01

More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial - offsetting more than 10% of increased payments to Medicare Advantage plans. Copyright © 2013 Elsevier B.V. All rights reserved.

Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

PubMed Central

Carrin, Guy; Hanvoravongchai, Piya

2003-01-01

In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies. PMID:12914661

Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-03-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-01-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018

41 CFR 105-60.305-9 - Form of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-9 Form of payment. Requesters...

41 CFR 105-60.305-9 - Form of payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-9 Form of payment. Requesters...

48 CFR 3.804 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PRACTICES AND PERSONAL CONFLICTS OF INTEREST Limitations on the Payment of Funds To Influence Federal... the provision at 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain...

Turning readmission reduction policies into results: some lessons from a multistate initiative to reduce readmissions.

PubMed

Mittler, Jessica N; O'Hora, Jennifer L; Harvey, Jillian B; Press, Matthew J; Volpp, Kevin G; Scanlon, Dennis P

2013-08-01

Efforts are under way nationally to reduce avoidable hospital readmissions by changing payments to hospitals, but it is unclear how well or how quickly these policy changes will produce widespread reductions in hospital readmissions. To examine some of the challenges to implementing such approaches, the authors analyzed the early experiences of 3 statewide programs to reduce preventable readmissions that began in 2009. Based on interviews with program participants in 2011, the authors identified 3 key obstacles to progress: the difficulty of developing collaborative relationships across care settings, gaps in evidence for effective interventions, and deficits in quality improvement capabilities among some organizations. These findings underscore the uncertainty of success of current readmissions policies and suggest that immediate improvement in readmission rates through a change in reimbursement may be unlikely unless these other obstacles are addressed expeditiously. In particular, cultivation of productive collaboration across care settings will be critical because these kinds of relationships are not well established or naturally occurring in most communities.

24 CFR 882.403 - ACC, housing assistance payments contract, and lease.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false ACC, housing assistance payments... Procedures for Moderate Rehabilitation-Basic Policies § 882.403 ACC, housing assistance payments contract, and lease. (a) Maximum Total ACC Commitments. The maximum total annual contribution that may be...

46 CFR 308.507 - Security for payment of premiums.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

46 CFR 308.507 - Security for payment of premiums.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

46 CFR 308.507 - Security for payment of premiums.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

46 CFR 308.507 - Security for payment of premiums.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

46 CFR 308.507 - Security for payment of premiums.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Security for payment of premiums. 308.507 Section 308.507 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.507 Security for payment of...

75 FR 41397 - Asparagus Revenue Market Loss Assistance Payment Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... Revenue Market Loss Assistance Payment Program AGENCY: Commodity Credit Corporation and Farm Service... to implement the new Asparagus Revenue Market Loss Assistance Payment (ALAP) Program authorized by the Food, Conservation, and Energy Act of 2008 (the 2008 Farm Bill). The purpose of the program is to...

Electricity market design for generator revenue sufficiency with increased variable generation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levin, Todd; Botterud, Audun

Here, we present a computationally efficient mixed-integer program (MIP) that determines optimal generator expansion decisions, and hourly unit commitment and dispatch in a power system. The impact of increasing wind power capacity on the optimal generation mix and generator profitability is analyzed for a test case that approximates the electricity market in Texas (ERCOT). We analyze three market policies that may support resource adequacy: Operating Reserve Demand Curves (ORDC), Fixed Reserve Scarcity Prices (FRSP) and fixed capacity payments (CP). Optimal expansion plans are comparable between the ORDC and FRSP implementations, while capacity payments may result in additional new capacity. Themore » FRSP policy leads to frequent reserves scarcity events and corresponding price spikes, while the ORDC implementation results in more continuous energy prices. Average energy prices decrease with increasing wind penetration under all policies, as do revenues for baseload and wind generators. Intermediate and peak load plants benefit from higher reserve prices and are less exposed to reduced energy prices. All else equal, an ORDC approach may be preferred to FRSP as it results in similar expansion and revenues with less extreme energy prices. A fixed CP leads to additional new flexible NGCT units, but lower profits for other technologies.« less

Electricity market design for generator revenue sufficiency with increased variable generation

DOE PAGES

Levin, Todd; Botterud, Audun

2015-10-01

Here, we present a computationally efficient mixed-integer program (MIP) that determines optimal generator expansion decisions, and hourly unit commitment and dispatch in a power system. The impact of increasing wind power capacity on the optimal generation mix and generator profitability is analyzed for a test case that approximates the electricity market in Texas (ERCOT). We analyze three market policies that may support resource adequacy: Operating Reserve Demand Curves (ORDC), Fixed Reserve Scarcity Prices (FRSP) and fixed capacity payments (CP). Optimal expansion plans are comparable between the ORDC and FRSP implementations, while capacity payments may result in additional new capacity. Themore » FRSP policy leads to frequent reserves scarcity events and corresponding price spikes, while the ORDC implementation results in more continuous energy prices. Average energy prices decrease with increasing wind penetration under all policies, as do revenues for baseload and wind generators. Intermediate and peak load plants benefit from higher reserve prices and are less exposed to reduced energy prices. All else equal, an ORDC approach may be preferred to FRSP as it results in similar expansion and revenues with less extreme energy prices. A fixed CP leads to additional new flexible NGCT units, but lower profits for other technologies.« less

7 CFR 4288.113 - Payment record requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... for Program payments, an advanced biofuel producer must maintain records for all relevant fiscal years and fiscal year quarters for each advanced biofuel facility indicating: (a) The type of eligible...

7 CFR 1416.304 - Payment calculations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Payment calculations. 1416.304 Section 1416.304 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT... PROGRAMS Citrus Disaster Program § 1416.304 Payment calculations. (a) Payments will be calculated by...

41 CFR 105-60.305-7 - Assurance of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-7 Assurance of payment. If fees...

41 CFR 105-60.305-7 - Assurance of payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-7 Assurance of payment. If fees...

42 CFR § 414.1310 - Applicability.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1310 Applicability. (a) Program Implementation. Except as specified in paragraph (b) of this section, MIPS applies to payments for items and...

7 CFR 4288.132 - Payment adjustments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... otherwise payable to the advanced biofuel producer if there is a difference between the amount actually...

7 CFR 4288.132 - Payment adjustments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to the advanced biofuel producer if there is a difference between the amount actually produced and...

7 CFR 4288.132 - Payment adjustments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to the advanced biofuel producer if there is a difference between the amount actually produced and...

Pharmaceutical policies: effects of cap and co-payment on rational drug use.

PubMed

Austvoll-Dahlgren, A; Aaserud, M; Vist, G; Ramsay, C; Oxman, A D; Sturm, H; Kösters, J P; Vernby, A

2008-01-23

Growing expenditures on prescription drugs represent a major challenge to many health systems. Cap and co-payment (direct cost-share) policies are intended as an incentive to deter unnecessary or marginal utilisation, and to reduce third-party payer expenditures by shifting parts of the financial burden from the insurer to patients, thus increasing their financial responsibility for prescription drugs. Direct patient drug payment policies include caps (maximum number of prescriptions or drugs that are reimbursed), fixed co-payments (patients pay a fixed amount per prescription or drug), coinsurance (patients pay a percent of the price), ceilings (patients pay the full price or part of the cost up to a ceiling, after which drugs are free or available at reduced cost), and tier co-payments (differential co-payments usually assigned to generic and brand drugs). To determine the effects of cap and co-payment (cost-sharing) policies on drug use, healthcare utilisation, health outcomes and costs (expenditures). We searched the following databases and web sites: Effective Practice and Organisation of Care Group Register (date of last search: 6 September 07), Cochrane Central Register of Controlled Trials (27 August 07), MEDLINE (29 August 07), EMBASE (29 August 07), NHS EED (27 August 07), ISI Web of Science (09 January 07), CSA Worldwide Political Science Abstracts (21 October 03), EconLit (23 October 03), SIGLE (12 November 03), INRUD (21 November 03), PAIS International (23 March 04), International Political Science Abstracts (09 January 04), PubMed (25 February 04), NTIS (03 March 04), IPA (22 April 04), OECD Publications & Documents (30 August 05), SourceOECD (30 August 05), World Bank Documents & Reports (30 August 05), World Bank e-Library (04 May 05), JOLIS (22 February 06), Global Jolis (22 February 06), WHOLIS(22 February 06), WHO web site browsed (25 August 05). We defined policies in this review as laws, rules, or financial or administrative orders made by governments, non-government organisations or private insurers. We included randomised controlled trials, non-randomised controlled trials, interrupted time series analyses, repeated measures studies and controlled before-after studies of cap or co-payment policies for a large jurisdiction or system of care. To be included, a study had to include an objective measure of at least one of the following outcomes: drug use, healthcare utilisation, health outcomes or costs (expenditures). Two authors independently extracted data and assessed study limitations. We undertook quantitative analysis of time series data for studies with sufficient data. We included 30 evaluations (in 21 studies). Of these, 11 evaluated fixed co-payment, six evaluated coinsurance with a ceiling, four evaluated caps, three evaluated fixed co-payment with a ceiling, three evaluated tier co-payment, one evaluated ceiling, one evaluated fixed co-payment and coinsurance with a ceiling, and one evaluated a fixed co-payment with a cap. Most of the included evaluations were observational studies and the quality of the evidence was found to be generally low to moderate. Introducing or increasing direct co-payments reduced drug use and saved plan drug expenditures across studies. Patients responded through drug discontinuation or by cost-sharing. Investigators found reductions for life-sustaining drugs or drugs that are important in treating chronic conditions as well as other drugs. Few studies reported on the effects on health and healthcare utilisation. One study found adverse effects on health through increased healthcare utilisation when a cap was introduced in a vulnerable population. No statistically significant change in use of healthcare services was found in other studies when a cap was introduced on a drug considered over-prescribed in a vulnerable population, or following a shift from a two-tier to a three-tier system with increased co-payments for tier-1 drugs in a general population. We found a diversity of cap and co-payment policies. Poor reporting of the intensity of interventions and differences in setting, populations and interventions made it difficult to make comparisons across studies. Cap and co-payment polices can reduce drug use and save plan drug expenditures. However, although insufficient data on health outcomes were available, substantial reductions in the use of life-sustaining drugs or drugs that are important in treating chronic conditions may have adverse effects on health, and as a result increase the use of healthcare services and overall expenditures. Direct payments are less likely to cause harm if only non-essential drugs are included or exemptions are built in to ensure that patients receive needed medical care.

Factors associated with enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme program in six study areas in rural Beijing.

PubMed

Wang, Hongman; Gu, Danan; Dupre, Matthew Egan

2008-01-01

This study examines the factors associated with the enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme (NCMS) program in six study areas in rural Beijing. Data come from a sample of 890 persons aged 15-88 from 890 households who were randomly interviewed from six rural counties/districts in Beijing. Findings from multi-level models indicate that gender, socioeconomic status, adequate knowledge about the policy, subjective premium contribution, subjective co-payment rates, and need are significantly associated with enrollment. We further find that the sustainability of the NCMS program is only significantly related to knowledge about the policy and satisfaction with the overall performance of the program. The NCMS program should be further promoted through different media avenues. It is also necessary to expand the types of services to include basic medical care and other specialized services to meet the different needs of the rural population. In addition, supervision of the system's performance should be enhanced and characteristics of the local community should be considered in the implementation of the NCMS.

Some hospitals are falling behind in meeting 'meaningful use' criteria and could be vulnerable to penalties in 2015.

PubMed

DesRoches, Catherine M; Worzala, Chantal; Bates, Scott

2013-08-01

With nearly $30 billion in incentives available, it is critical to know to what extent US hospitals have been able to respond to those incentives by adopting electronic health record (EHR) systems that meet Medicare's criteria for their "meaningful use." Medicare has provided aggregate incentive payment data, but still missing is an understanding of how these payments are distributed across hospital types and years. Our analysis of Medicare data found a substantial increase in the percentage of hospitals receiving EHR incentive payments between 2011 (17.4 percent) and 2012 (36.8 percent). However, this increase was not uniform across all hospitals, and the overall proportion of hospitals receiving a payment for meaningful use was low. Critical-access, smaller, and publicly owned or nonprofit hospitals appeared to be at particular risk for failing to meet Medicare's meaningful-use criteria, and the overall proportion of hospitals receiving a payment for meaningful use was low. Starting in 2015, hospitals that fail to meet the criteria will be subject to financial penalties. To address the needs of institutions in danger of incurring these penalties, policy makers could implement targeted grant programs and provide additional information technology workforce support. In addition, the capacity of EHR system vendors should be carefully monitored to ensure that these institutions have access to the technology they need.

Cost of schizophrenia in the Medicare program.

PubMed

Feldman, Rachel; Bailey, Robert A; Muller, James; Le, Jennifer; Dirani, Riad

2014-06-01

Medicare beneficiaries diagnosed with non-schizoaffective schizophrenia (MBS) in a 5% national Medicare fee-for-service sample from 2003-2007 were followed for 1-6 years. Medicare population and cost estimates also were made from 2001-2009. Service utilization and Medicare (and beneficiary share) payments for all services except prescription drugs were analyzed. Although adults with schizophrenia make up approximately 1% of the US adult population, they represent about 1.5% of Medicare beneficiaries. MBSs are disproportionately male and minority compared to national data describing the overall schizophrenia population. They also are younger than the general Medicare population (GMB): males are 9 years younger than females on average, and most enter Medicare long before age 65 through eligibility for social security disability, remaining in the program until death. The cost of care for MBSs in 2009 was, on average, 80% higher than for the average GMB per patient year (2010 dollars), and more than 50% of these costs are attributable to a combination of psychiatric and medical hospitalizations, concentrated in about 30% of MBSs with 1 or more hospitalizations per year. From 2004-2009, total estimated Medicare fee-for-service payments for MBSs increased from $9.4 billion to $11.5 billion, excluding Part D prescription drugs and payments for services to MBSs in Medicare for less than 1 year. Study results characterize utilization and costs for other services and suggest opportunities for further study to inform policy to improve access and continuity of care and decrease costs to the Medicare program associated with this population.

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research. Final rule.

PubMed

2016-08-05

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2017. In addition, it specifies a potentially preventable readmission measure for the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), and implements requirements for that program, including performance standards, a scoring methodology, and a review and correction process for performance information to be made public, aimed at implementing value-based purchasing for SNFs. Additionally, this final rule includes additional polices and measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This final rule also responds to comments on the SNF Payment Models Research (PMR) project.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study.

PubMed

Liu, Jessica J; Bell, Chaim M; Matelski, John J; Detsky, Allan S; Cram, Peter

2017-10-26

Objective  To estimate financial payments from industry to US journal editors. Design  Retrospective observational study. Setting  52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014. Participants  713 editors at the associate level and above identified from each journal's online masthead. Main outcome measures  All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible. Results  Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals. Conclusions  Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

PubMed Central

Bell, Chaim M; Matelski, John J; Detsky, Allan S; Cram, Peter

2017-01-01

Objective To estimate financial payments from industry to US journal editors. Design Retrospective observational study. Setting 52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014. Participants 713 editors at the associate level and above identified from each journal’s online masthead. Main outcome measures All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible. Results Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals. Conclusions Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research. PMID:29074628

45 CFR 400.66 - Eligibility and payment levels in a publicly-administered RCA program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Eligibility and payment levels in a publicly... REFUGEE RESETTLEMENT PROGRAM Refugee Cash Assistance § 400.66 Eligibility and payment levels in a publicly-administered RCA program. (a) In administering a publicly-administered refugee cash assistance program, the...

7 CFR 1493.60 - Payment guarantee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

7 CFR 1493.60 - Payment guarantee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Export Credit Guarantee Program (GSM-102) and CCC Intermediate Export Credit Guarantee Program (GSM-103) Operations § 1493.60 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC...

7 CFR 4288.133 - Payment liability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any other creditor...

7 CFR 4288.133 - Payment liability.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any other creditor...

7 CFR 220.18 - Withholding payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.18 Withholding payments. In accordance...'s acceptance of the corrective actions, payments will be released for any breakfasts served in...

7 CFR 220.18 - Withholding payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.18 Withholding payments. In accordance...'s acceptance of the corrective actions, payments will be released for any breakfasts served in...

Sole Community Hospitals: Are They Different? A Statistical Analysis of the Hospitals and Their Treatment under TEFRA and PPS. Hospital Studies Program. Hospital Cost and Utilization Project. Research Note 5.

ERIC Educational Resources Information Center

Farley, Dean E.

A study examined the treatment of sole community hospitals under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) and the Prospective Payment System (PPS) for Medicare as compared to the treatment of hospitals not designated as sole community hospitals under these same two policy guidelines. (A sole community hospital is defined as a…

Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change

PubMed Central

2017-01-01

Objectives To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design. PMID:29207446

Introducing out-of-pocket payment for general practice in Denmark: feasibility and support.

PubMed

Poulsen, Camilla Aavang

2014-07-01

The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context. An analysis of the healthcare-policy debate in Parliament and the media from 1990 until September 2012. The materials are parliamentary hearings/discussions and newspaper articles. Kingdon's model on Policy Windows and the Advocacy Coalition framework by Sabatier and Jenkins are used to investigate explanations. The arguments from the proponents are: that OOP payment for GP will reduce pressure on the primary sector; that the current allocation of OOP payment in the sector is historically conditioned; and that resistance towards OOP payment is based on emotions. The main argument from the opponents is that OOP payment will increase social inequality in health. There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context. Copyright © 2014. Published by Elsevier Ireland Ltd.

Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data.

PubMed

Samuel, Andre M; Webb, Matthew L; Lukasiewicz, Adam M; Bohl, Daniel D; Basques, Bryce A; Russo, Glenn S; Rathi, Vinay K; Grauer, Jonathan N

2015-10-01

Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments. We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons? We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual. A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34-619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons. Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings. Level III, Economic and Decision Analysis.

Creative payment strategy helps ensure a future for teaching hospitals.

PubMed

Vancil, D R; Shroyer, A L

1998-11-01

The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

Equity in the Medicaid Program: Changes in the Latter 1980s

PubMed Central

Adams, E. Kathleen

1995-01-01

The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expansions significantly increased equity in the coverage of the poor, but inequality in real resources per enrollee remained significant. Although equity improved from 1984 through 1991, the increased use of provider-specific tax and voluntary donation (T&D) programs by traditionally high-spending States played an important role in the 1992 figures. PMID:10142581

Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

PubMed

2017-11-01

This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

48 CFR 803.804 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Limitation on the Payment of Funds to Influence... disclosures furnished under the clause at FAR 52.203-12, Limitations on Payments to Influence Certain Federal...

31 CFR 515.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Payment of certain checks and drafts... Licenses, Authorizations, and Statements of Licensing Policy § 515.531 Payment of certain checks and drafts... blocked accounts with such banking institution: (1) Of checks and drafts drawn or issued prior to the...

31 CFR 535.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Payment of certain checks and drafts... Licenses, Authorizations and Statements of Licensing Policy § 535.531 Payment of certain checks and drafts... from blocked accounts with such banking institution of checks and drafts drawn or issued prior to the...

31 CFR 535.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Payment of certain checks and drafts... Licenses, Authorizations and Statements of Licensing Policy § 535.531 Payment of certain checks and drafts... from blocked accounts with such banking institution of checks and drafts drawn or issued prior to the...

31 CFR 515.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Payment of certain checks and drafts... Licenses, Authorizations, and Statements of Licensing Policy § 515.531 Payment of certain checks and drafts... blocked accounts with such banking institution: (1) Of checks and drafts drawn or issued prior to the...

31 CFR 515.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Payment of certain checks and drafts... Licenses, Authorizations, and Statements of Licensing Policy § 515.531 Payment of certain checks and drafts... blocked accounts with such banking institution: (1) Of checks and drafts drawn or issued prior to the...

31 CFR 535.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Payment of certain checks and drafts... Licenses, Authorizations and Statements of Licensing Policy § 535.531 Payment of certain checks and drafts... from blocked accounts with such banking institution of checks and drafts drawn or issued prior to the...

31 CFR 535.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Payment of certain checks and drafts... Licenses, Authorizations and Statements of Licensing Policy § 535.531 Payment of certain checks and drafts... from blocked accounts with such banking institution of checks and drafts drawn or issued prior to the...

31 CFR 515.531 - Payment of certain checks and drafts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Payment of certain checks and drafts... Licenses, Authorizations, and Statements of Licensing Policy § 515.531 Payment of certain checks and drafts... blocked accounts with such banking institution: (1) Of checks and drafts drawn or issued prior to the...

12 CFR 230.7 - Payment of interest.

Code of Federal Regulations, 2010 CFR

2010-01-01

... crediting policies. This section does not require institutions to compound or credit interest at any... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Payment of interest. 230.7 Section 230.7 Banks... IN SAVINGS (REGULATION DD) § 230.7 Payment of interest. (a) Permissible methods—(1) Balance on which...

26 CFR 1.7872-15 - Split-dollar loans.

Code of Federal Regulations, 2010 CFR

2010-04-01

... or indirectly by the non-owner to the owner (including a premium payment made by the non-owner...-dollar life insurance arrangement, the employer makes premium payments on this policy, there is a... paragraph (a)(2)(i) of this section, each premium payment is a loan for Federal tax purposes. Example 2. (i...

42 CFR 418.307 - Periodic interim payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Payment for Hospice Care § 418.307 Periodic interim payments... payments. The biweekly interim payment amount is based on the total estimated Medicare payments for the...

7 CFR 1493.450 - Payment guarantee.

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

7 CFR 1493.450 - Payment guarantee.

Code of Federal Regulations, 2012 CFR

2012-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

7 CFR 1493.450 - Payment guarantee.

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF AGRICULTURE EXPORT PROGRAMS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount not to exceed the guaranteed...

7 CFR 4288.133 - Payment liability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... to any claim or lien against the advanced biofuel, or proceeds thereof, in favor of the owner or any...

42 CFR 110.83 - Payment of all benefits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Secretary determines the mechanism of payment of Program benefits. She may choose to pay any benefits under... Secretary has the discretion to make interim payments of benefits under this Program, even before a final... only in exceptional cases. The Secretary may, for example, make an interim payment of medical benefits...

48 CFR 252.225-7044 - Balance of Payments Program-Construction Material.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Balance of Payments... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7044 Balance of Payments Program—Construction Material. As prescribed in 225.7503(a), use the following clause: Balance of Payments Program...

48 CFR 252.225-7044 - Balance of Payments Program-Construction Material.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Balance of Payments... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7044 Balance of Payments Program—Construction Material. As prescribed in 225.7503(a)(1), use the following clause: Balance of Payments Program...

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

PubMed

2016-11-14

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

47 CFR 24.249 - Payment issues.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990 Mhz Band § 24.249 Payment... directly to the PCS relocator or the voluntarily relocating microwave incumbent the amount owed within...

47 CFR 24.249 - Payment issues.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990 Mhz Band § 24.249 Payment... directly to the PCS relocator or the voluntarily relocating microwave incumbent the amount owed within...

47 CFR 24.249 - Payment issues.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990 Mhz Band § 24.249 Payment... directly to the PCS relocator or the voluntarily relocating microwave incumbent the amount owed within...

47 CFR 24.249 - Payment issues.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Broadband PCS Policies Governing Microwave Relocation from the 1850-1990 Mhz Band § 24.249 Payment... directly to the PCS relocator or the voluntarily relocating microwave incumbent the amount owed within...

The relevance of systematic reviews on pharmaceutical policy to low- and middle-income countries.

PubMed

Gray, Andrew Lofts; Suleman, Fatima

2015-10-01

Low- and middle-income countries (LMICs) rely on available evidence when devising and implementing pharmaceutical policies. Aim of the review To provide a critical overview of systematic reviews of pharmaceutical policies, with particular focus on the relevance of such reviews in low- and middle-income countries. A search for systematic reviews (SRs) of studies of the interventions of interest was conducted until May 2009 in MEDLINE, EconLit, CINAHL, the Cochrane site, ProQuest, EMBASE, JOLIS, ISI Web of Science, International Pharmaceutical Abstracts, International Network for Rational Use of Drugs, National Technical Information Service, Public Affairs Information Service, SourceOECD, the System for Information on Grey Literature in Europe, and the WHO library database. The search was updated to July 2013, based on the yields of the initial search strategy. 20 SRs that met all inclusion criteria were retrieved in full text. Four SRs were subsequently rejected on the basis of quality considerations and the findings of 16 SRs were extracted and their applicability in LMICs considered. Of these, 5 were Cochrane Reviews. All included SRs were published in English. SRs related to registration and classification policies, marketing policies, prescribing policies, reimbursement policies, policies on price and payments, co-payments and caps and multi-component policies were retrieved. No SRs related to patent and profit policies, sales and dispensing policies, policies that regulate the provision of health insurance, or policies on patient information were retrieved. Only one of the systematic reviews retrieved utilised a study conducted in a developing country. The direct applicability of the evidence from these SRs in LMICs is limited. However, as middle-income countries move towards universal health coverage, the multi-component policies that govern reimbursement for medicines, and which impose caps on payments and co-payments by patients, may become more applicable. As such they will have direct implications for the practice of clinical pharmacy in such settings. Considerable effort will be needed to systemically review the available primary evidence from studies conducted in developing country settings, where such data exist.

Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

PubMed Central

2013-01-01

Background Previous studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon. Methods For the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services. Results We identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay. Conclusions A large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies. PMID:23414488

An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas

ERIC Educational Resources Information Center

Chan, Leighton; Hart, L. Gary; Ricketts III, Thomas C.; Beaver, Shelli K.

2004-01-01

Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's…

Psychosocial stress and cardiovascular disease. Part 3: Clinical and policy implications of research on the transcendental meditation program.

PubMed

Walton, Kenneth G; Schneider, Robert H; Salerno, John W; Nidich, Sanford I

2005-01-01

Cardiovascular disease (CVD) remains the leading cause of death in the United States today and a major contributor to total health care costs. Psychosocial stress has been implicated in CVD, and psychosocial approaches to primary and secondary prevention are gaining research support. This third article in the series on psychosocial stress and CVD continues the evaluation of one such approach, the Maharishi Transcendental Meditation program, a psychophysiological approach from the Vedic tradition that is systematically taught by qualified teachers throughout the world. Evidence suggests not only that this program can provide benefits in prevention but also that it may reduce CVD-related and other health care expenses. On the basis of data from the studies available to date, the Transcendental Meditation program may be responsible for reductions of 80% or greater in medical insurance claims and payments to physicians. This article evaluates the implications of research on the Transcendental Meditation program for health care policy and for large-scale clinical implementation of the program. The Transcendental Meditation program can be used by individuals of any ethnic or cultural background, and compliance with the practice regimen is generally high. The main steps necessary for wider adoption appear to be: (1) educating health care providers and patients about the nature and expected benefits of the program, and (2) adjustments in public policies at the state and national levels to allow this program to be included in private and public health insurance plans.

7 CFR 80.1 - Applicability and payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

48 CFR 225.003 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the meaning given in the clauses at 252.225-7001, Buy American Act and Balance of Payments Program; and 252.225-7036, Buy American Act—Free Trade Agreements—Balance of Payments Program, instead of the....225-7036, Buy American Act—Free Trade Agreements—Balance of Payments Program. Qualifying country end...

76 FR 6313 - Asparagus Revenue Market Loss Assistance Payment Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-04

... Revenue Market Loss Assistance Payment Program AGENCY: Commodity Credit Corporation and Farm Service Agency, USDA. ACTION: Final rule. SUMMARY: This rule implements the Asparagus Revenue Market Loss Assistance Payment (ALAP) Program authorized by the Food, Conservation and Energy Act of 2008 (the 2008 Farm...

7 CFR 80.1 - Applicability and payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

7 CFR 80.1 - Applicability and payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

7 CFR 80.1 - Applicability and payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

7 CFR 80.1 - Applicability and payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... PROGRAMS FRESH RUSSET POTATO DIVERSION PROGRAM Fresh Russet Potato Diversion Program § 80.1 Applicability and payments. Payment be received or retained with respect to diversions of 2001 Fresh Russet potatoes... producers or other persons under this part based upon their diversion of potatoes, shall be allowed except...

38 CFR 21.5136 - Benefit payments-secondary school program.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

38 CFR 21.5136 - Benefit payments-secondary school program.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.

PubMed

Wang, C Jason; Cheng, Skye H; Wu, Jen-You; Lin, Yi-Ping; Kao, Wen-Hsin; Lin, Chia-Li; Chen, Yin-Jou; Tsai, Shu-Ling; Kao, Feng-Yu; Huang, Andrew T

2017-03-01

Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program. Data were obtained from the Taiwan Cancer Database, National Health Insurance Claims Data, the National Death Registry, and the bundled-payment enrollment file. Women with newly diagnosed breast cancer and a documented first cancer treatment from January 1, 2004, to December 31, 2008, were selected from the Taiwan Cancer Database and followed up for 5 years, with the last follow-up data available on December 31, 2013. Patients in the bundled-payment program were matched at a ratio of 1:3 with control individuals in an FFS program using a propensity score method. The final sample of 17 940 patients included 4485 (25%) in the bundled-payment group and 13 455 (75%) in the FFS group. Rates of adherence to quality indicators, survival rates, and medical payments (excluding bonuses paid in the bundled-payment group). The Kaplan-Meier method was used to calculate 5-year overall and event-free survival rates by cancer stage, and the Cox proportional hazards regression model was used to examine the effect of the bundled-payment program on overall and event-free survival. Sensitivity analysis for bonus payments in the bundled-payment group was also performed. The study population included 17 940 women (mean [SD] age, 52.2 [10.3] years). In the bundled-payment group, 1473 of 4215 patients (34.9%) with applicable quality indicators had full (100%) adherence to quality indicators compared with 3438 of 12 506 patients (27.5%) with applicable quality indicators in the FFS group (P < .001). The 5-year event-free survival rates for patients with stages 0 to III breast cancer were 84.48% for the bundled-payment group and 80.88% for the FFS group (P < .01). Although the 5-year medical payments of the bundled-payment group remained stable, the cumulative medical payments for the FFS group steadily increased from $16 000 to $19 230 and exceeded pay-for-performance bundled payments starting in 2008. In Taiwan, compared with the regular FFS program, bundled payment may lead to better adherence to quality indicators, better outcomes, and more effective cost-control over time.

7 CFR 82.10 - Claim for payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROGRAMS CLINGSTONE PEACH DIVERSION PROGRAM § 82.10 Claim for payment. To obtain payment for the trees... form shall include the CCPA's certification that the qualifying trees from the acreage have been...

7 CFR 82.10 - Claim for payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROGRAMS CLINGSTONE PEACH DIVERSION PROGRAM § 82.10 Claim for payment. To obtain payment for the trees... form shall include the CCPA's certification that the qualifying trees from the acreage have been...

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

PubMed

DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

Prediction of Change in Prescription Ingredient Costs and Co-payment Rates under a Reference Pricing System in South Korea.

PubMed

Heo, Ji Haeng; Rascati, Karen L; Lee, Eui-Kyung

2017-05-01

The reference pricing system (RPS) establishes reference prices within interchangeable reference groupings. For drugs priced higher than the reference point, patients pay the difference between the reference price and the total price. To predict potential changes in prescription ingredient costs and co-payment rates after implementation of an RPS in South Korea. Korean National Health Insurance claims data were used as a baseline to develop possible RPS models. Five components of a potential RPS policy were varied: reference groupings, reference pricing methods, co-pay reduction programs, manufacturer price reductions, and increased drug substitutions. The potential changes for prescription ingredient costs and co-payment rates were predicted for the various scenarios. It was predicted that transferring the difference (total price minus reference price) from the insurer to patients would reduce ingredient costs from 1.4% to 22.8% for the third-party payer (government), but patient co-payment rates would increase from a baseline of 20.4% to 22.0% using chemical groupings and to 25.0% using therapeutic groupings. Savings rates in prescription ingredient costs (government and patient combined) were predicted to range from 1.6% to 13.7% depending on various scenarios. Although the co-payment rate would increase, a 15% price reduction by manufacturers coupled with a substitution rate of 30% would result in a decrease in the co-payment amount (change in absolute dollars vs. change in rates). Our models predicted that the implementation of RPS in South Korea would lead to savings in ingredient costs for the third-party payer and co-payments for patients with potential scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

42 CFR 460.180 - Medicare payment to PACE organizations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.180 Medicare payment to PACE organizations. (a) Principle of...

7 CFR 760.4 - Normal marketings of milk.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... section are adjusted for any change in the daily average number of cows milked during each pay period the milk is off the market compared with the average number of cows milked daily during the base period. (d...

48 CFR 252.225-7013 - Duty-free entry.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the Buy American Act-Free Trade Agreements-Balance of Payments Program clause of this contract; or... product have the meanings given in the Trade Agreements clause, the Buy American Act and Balance of Payments Program clause, or the Buy American Act—Free Trade Agreements—Balance of Payments Program clause...

42 CFR 455.23 - Suspension of payments in cases of fraud.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Suspension of payments in cases of fraud. 455.23... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and Investigation Program § 455.23 Suspension of payments in cases of fraud. (a) Basis for...

78 FR 77418 - Notice of Request for Revision of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

... to a currently approved information collection for the Advanced Biofuel Payment Program. DATES... INFORMATION: Title: Advanced Biofuel Payment Program. OMB Number: OMB No. 0570-0063. Expiration Date of... collection. Abstract: The Advanced Biofuel Payment Program was authorized under section 9005 of Title IX of...

Ordering policy for stock-dependent demand rate under progressive payment scheme: a comment

NASA Astrophysics Data System (ADS)

Glock, Christoph H.; Ries, Jörg M.; Schwindl, Kurt

2015-04-01

In a recent paper, Soni and Shah developed a model for finding the optimal ordering policy for a retailer facing stock-dependent demand and a supplier offering a progressive payment scheme. In this comment, we correct several errors in the formulation of the models of Soni and Shah and modify some assumptions to increase the model's applicability. Numerical examples illustrate the benefits of our modifications.

78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment... [CMS-1599-P] RIN 0938-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute... capital-related costs of acute care hospitals to implement changes arising from our continuing experience...

7 CFR 1463.113 - Issuance of payments in event of death.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

7 CFR 1463.113 - Issuance of payments in event of death.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

7 CFR 1463.113 - Issuance of payments in event of death.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

7 CFR 1463.113 - Issuance of payments in event of death.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Issuance of payments in event of death. 1463.113 Section 1463.113 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT... PROGRAM Tobacco Transition Payment Program § 1463.113 Issuance of payments in event of death. If a quota...

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for...

Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

PubMed Central

Campbell, Lauren J.; Cai, Xueya; Gao, Shan; Li, Yue

2016-01-01

Objectives: Racial/ethnic disparities in nursing homes (NHs) are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL) exist. Therefore, this study aims to estimate associations at the NH level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Method: Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000 to 2010 and average number of QoL deficiencies in 2001 to 2011 at the NH level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results: Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion: NH managers and policy makers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QoL deficiencies. PMID:27819015

48 CFR 231.205-6 - Compensation for personal services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... apply to severance payments or early retirement incentive payments. (See 231.205-70(b) for the... contrary to law, employer-employee agreement, or an established policy of the contractor are unallowable...

42 CFR 418.304 - Payment for physician and nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... policies by the physician member of the interdisciplinary group. (b) For services not described in... for hospice pre-election evaluation and counseling services. The intermediary makes payment to the...

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

PubMed

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

31 CFR 598.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... accounts in U.S. financial institutions. 598.504 Section 598.504 Money and Finance: Treasury Regulations... Policy § 598.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... same name. Note to § 598.504: Please refer to part 501, subpart C of this chapter for mandatory...

31 CFR 598.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... accounts in U.S. financial institutions. 598.504 Section 598.504 Money and Finance: Treasury Regulations... Policy § 598.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... same name. Note to § 598.504: Please refer to part 501, subpart C of this chapter for mandatory...

31 CFR 598.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... accounts in U.S. financial institutions. 598.504 Section 598.504 Money and Finance: Treasury Regulations... Policy § 598.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... same name. Note to § 598.504: Please refer to part 501, subpart C of this chapter for mandatory...

31 CFR 598.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... accounts in U.S. financial institutions. 598.504 Section 598.504 Money and Finance: Treasury Regulations... Policy § 598.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... same name. Note to § 598.504: Please refer to part 501, subpart C of this chapter for mandatory...

31 CFR 598.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accounts in U.S. financial institutions. 598.504 Section 598.504 Money and Finance: Treasury Regulations... Policy § 598.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... that comes within the possession or control of a U.S. financial institution must be blocked in an...

31 CFR 547.504 - Payments and transfers to blocked accounts in U.S. financial institutions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accounts in U.S. financial institutions. 547.504 Section 547.504 Money and Finance: Treasury Regulations... Policy § 547.504 Payments and transfers to blocked accounts in U.S. financial institutions. Any payment... institution must be blocked in an account on the books of that financial institution. A transfer of funds or...

Insights into managed care--operational, legal and actuarial.

PubMed

Melek, S P; Johnson, B A; Schryver, D

1997-01-01

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

42 CFR 422.316 - Special rules for payments to Federally qualified health centers.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422.316 Special rules for payments to Federally qualified health centers...

48 CFR 970.3200 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DOE MANAGEMENT AND OPERATING CONTRACTS Contract Financing 970.3200 Policy. It is the policy of the Department of Energy (DOE) to finance management and operating contracts through advance payments and the use...

Industry Funding Among Leadership in Medical Oncology and Radiation Oncology in 2015.

PubMed

Yoo, Stella K; Ahmed, Awad A; Ileto, Jan; Zaorsky, Nicholas G; Deville, Curtiland; Holliday, Emma B; Wilson, Lynn D; Jagsi, Reshma; Thomas, Charles R

2017-10-01

To quantify and determine the relationship between oncology departmental/division heads and private industry vis-à-vis potential financial conflict of interests (FCOIs) as publicly reported by the Centers for Medicare and Medicaid Services Open Payments database. We extracted the names of the chairs/chiefs in medical oncology (MO) and chairs of radiation oncology (RO) for 81 different institutions with both RO and MO training programs as reported by the Association of American Medical Colleges. For each leader, the amount of consulting fees and research payments received in 2015 was determined. Logistic modeling was used to assess associations between the 2 endpoints of receiving a consulting fee and receiving a research payment with various institution-specific and practitioner-specific variables included as covariates: specialty, sex, National Cancer Institute designation, PhD status, and geographic region. The majority of leaders in MO were reported to have received consulting fees or research payments (69.5%) compared with a minority of RO chairs (27.2%). Among those receiving payments, the average (range) consulting fee was $13,413 ($200-$70,423) for MO leaders and $6463 ($837-$16,205) for RO chairs; the average research payment for MO leaders receiving payments was $240,446 ($156-$1,234,762) and $295,089 ($160-$1,219,564) for RO chairs. On multivariable regression when the endpoint was receipt of a research payment, those receiving a consulting fee (odds ratio [OR]: 5.34; 95% confidence interval [CI]: 2.22-13.65) and MO leaders (OR: 5.54; 95% CI: 2.62-12.18) were more likely to receive research payments. Examination of the receipt of consulting fees as the endpoint showed that those receiving a research payment (OR: 5.41; 95% CI: 2.23-13.99) and MO leaders (OR: 3.06; 95% CI: 1.21-8.13) were more likely to receive a consulting fee. Leaders in academic oncology receive consulting or research payments from industry. Relationships between oncology leaders and industry can be beneficial, but guidance is needed to develop consistent institutional policies to manage FCOIs. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers.

PubMed

Tsiachristas, Apostolos; Hipple-Walters, Bethany; Lemmens, Karin M M; Nieboer, Anna P; Rutten-van Mölken, Maureen P M H

2011-07-01

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system--the chain-DTC--is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system. The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs). The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The origins, development, and passage of Medicare's revolutionary prospective payment system.

PubMed

Mayes, Rick

2007-01-01

This article explains the origins, development, and passage of the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it--power that providers had successfully accumulated for more than half a century.

Escaping from poverty trap: a choice between government transfer payments and public services.

PubMed

Chen, Sixia; Li, Jianjun; Lu, Shengfeng; Xiong, Bo

2017-01-01

Anti-poverty has always been an important issue to be settled. What policies should be selected to help individuals escaping from the poverty trap: by directly offering transfer payments or indirectly providing public services? This paper is among the first to explore the effects of public anti-poverty programs system in China. We Using unbalanced panel data of China Health and Nutrition Survey (CHNS) from 1989 to 2009, we demonstrate how the individual poverty status is determined through a four-staged simultaneous model. We choose the 3SLS (Three Staged Linear Squared) methodology to do the estimation. GTPs (Government Transfer Payments) don't have positive effects on poverty reductions. The results demonstrate that GTPs increasing by 10% makes private transfer payments decrease by 3.9%. Meanwhile, GTPs increasing by 10% makes the household income decreased by 27.1%. However, public services (such as medical insurance, health services, hygiene protection etc.) have significantly positive impacts on poverty reduction. Public services share a part of living cost of the poor, and are conducive for people to gain higher household income. GTPs given by governments are not effective in reducing the poverty, as a result of "crowd-out effect" and "inductive effect". However, public services are suggested to be adopted by governments to help the poor out of the poverty trap.

Association of Informal Clinical Integration of Physicians With Cardiac Surgery Payments.

PubMed

Funk, Russell J; Owen-Smith, Jason; Kaufman, Samuel A; Nallamothu, Brahmajee K; Hollingsworth, John M

2018-05-01

To reduce inefficiency and waste associated with care fragmentation, many current programs target greater clinical integration among physicians. However, these programs have led to only modest Medicare spending reductions. Most programs focus on formal integration, which often bears little resemblance to actual physician interaction patterns. To examine how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. National Medicare data from January 1, 2008, through December 31, 2011, identified 253 545 Medicare beneficiaries (aged ≥66 years) from 1186 health systems where Medicare beneficiaries underwent coronary artery bypass grafting (CABG) procedures. Interactions were mapped between all physicians who treated these patients-including primary care physicians and surgical and medical specialists-within a health system during their surgical episode. The level of informal integration was measured in these networks of interacting physicians. Multivariate regression models were fitted to evaluate associations between payments for each surgical episode made on a beneficiary's behalf and the level of informal integration in the health system where the patient was treated. The informal integration level of a health system. Price-standardized total surgical episode and component payments. The total 253 545 study participants included 175 520 men (69.2%; mean [SD] age, 74.51 [5.75] years) and 78 024 women (34.3%; 75.67 [5.91] years). One beneficiary of the 253 545 participants did not have sex information. The low level of informal clinical integration included 84 598 patients (33.4%; mean [SD] age, 75.00 [5.93] years); medium level, 84 442 (33.30%; 74.94 [5.87] years); and high level, 84 505 (33.34%; 74.66 [5.72] years) (P < .001). Informal integration levels varied across health systems. After adjusting for patient, health-system, and community factors, higher levels of informal integration were associated with significantly lower total episode and component payments (β coefficients for informal integration were -365.87 [95% CI, -451.08 to -280.67] for total episode payments, -182.63 [-239.80 to -125.46] for index hospitalization, -43.13 [-55.53 to -30.72] for physician services, -74.48 [-103.45 to -45.51] for hospital readmissions, and -62.04 [-88.00 to -36.07] for postacute care; P < .001 for each association). When beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0%) and postacute care services (5.8%). Informal integration is associated with lower spending. Although most programs that seek to promote clinical integration are focused on health systems' formal structures, policy makers may also want to address informal integration.

Barriers to universal health coverage in Republic of Moldova: a policy analysis of formal and informal out-of-pocket payments.

PubMed

Vian, Taryn; Feeley, Frank G; Domente, Silviu; Negruta, Ala; Matei, Andrei; Habicht, Jarno

2015-08-11

Universal Health Coverage seeks to assure that everyone can obtain the health services they need without financial hardship. Countries which rely heavily on out-of-pocket (OOP) payments, including informal payments (IP), to finance total health expenditures are not likely to achieve universal coverage. The Republic of Moldova is committed to promoting universal coverage, reducing inequities, and expanding financial protection. To achieve these goals, the country must reduce the proportion of total health expenditures paid by households. This study documents the extent of OOP payments and IP in Moldova, analyses trends over time, and identifies factors which may be driving these payments. The study includes analysis of household budget survey data and previous research and policy documents. The team also conducted a review of administrative law intended to control OOP payments and IPs. Focus groups, interviews, and a policy dialogue with key stakeholders were held to validate and discuss findings. OOP payments account for 45% of total health expenditures. Sixteen percent of outpatients and 30% of inpatients reporting that they made OOP payments when seeking care at a health facility in 2012, more than two-thirds of whom also reported paying for medicines at a pharmacy. Among those who paid anything, 36% of outpatients and 82% of inpatients reported paying informally, with the proportion increasing over time for inpatient care. Although many patients consider these payments to be gifts, around one-third of IPs appear to be forced, posing a threat to health care access. Patients perceive that payments are driven by the limited list of reimbursable medicines, a desire to receive better treatment, and fear or extortion. Providers suggested irrational prescribing and ordering of tests as drivers. Providers may believe that IPs are gifts and do not cause harm for patients and the health system in general. Efforts to expand financial protection should focus on reducing household spending on medicines and hospital-based IPs. Reforms should consider ways to reduce medicine prices and promote rational use, strengthen administrative controls, and increase incentives for quality health care provision.

From disclosure to transparency: the use of company payment data.

PubMed

Chimonas, Susan; Frosch, Zachary; Rothman, David J

2011-01-10

It has become standard practice in medical journals to require authors to disclose their relationships with industry. However, these requirements vary among journals and often lack specificity. As a result, disclosures may not consistently reveal author-industry ties. We examined the 2007 physician payment information from 5 orthopedic device companies to evaluate the current journal disclosure system. We compared company payment information for recipients of $1 million or more with disclosures in the recipients' journal articles. Payment data were obtained from Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer. Disclosures were obtained in the acknowledgments section, conflict of interest statements, and financial disclosures of recipients' published articles. We also assessed variations in disclosure by authorship position, payment-article relatedness, and journal disclosure policies. Of the 41 individuals who received $1 million or more in 2007, 32 had published articles relating to orthopedics between January 1, 2008, and January 15, 2009. Disclosures of company payments varied considerably. Prominent authorship position and article-payment relatedness were associated with greater disclosure, although nondisclosure rates remained high (46% among first-, sole-, and senior-authored articles and 50% among articles directly or indirectly related to payments). The accuracy of disclosures did not vary with the strength of journals' disclosure policies. Current journal disclosure practices do not yield complete or consistent information regarding authors' industry ties. Medical journals, along with other medical institutions, should consider new strategies to facilitate accurate and complete transparency.

How nations govern growth.

PubMed

1984-03-02

Officials in China admit that the killing or abondoning of baby girls stems from a government policy limiting couples to 1 child combined with an ancient preference for sons. At the same time leaders maintain that population growth is an national emergency and must be checked. And the 1-child policy remains. To enforce the policy, sterilization is compulsory for 1 parent in a 2-child family. Other reports claim that pregnant women face severe government and social pressure to have an abortion. Comunist governments are not alone in taking a forceful role in population control. In 1975 thousands of people in India were pressured to undergo "voluntary" sterilization. In many places, police and tax collectors, money in hand, "convinced" people to get sterilized. Critics recognize a horribla abuse of government powers in these population control efforts. Recognizing that the populations of the poorest nations will double in 20-30 years, 59 countries responded with some kind of population policy by 1980. These countries are spending an average of US$4.60 on population programs for each US$1 they received in UN aid. In many places, the effort is beginning to show results. A 1982 survey found that 35 countries -- with 88% of the 3rd world population -- had cut the growth of their birthrates by 5-34%. Generally, governments have chosen any of 3 ways to attack the problem: cash payments for sterilization or contraceptive use; penalties for big families; and "delayed incentives." At least 20 governments use money to convince people to have fewer babies. Some programs pay for sterilization,other for contraceptive use. All payments are low. Some governments personalize those who exceed a recommended family size. Other nations have adopted variations of the idea. Some governments, instead of paying up front cash, offer pension plans or bank accounts to limit family size. Almost all population experts believe that the mot successful programs are those which are not imposed from the top but are meshed with the existing culture. They agree that strong government action is needed if third world nations wish to control population growth.

7 CFR 220.4 - Payment of funds to States and FNSROs.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.4 Payment of funds to States and FNSROs. (a) To the extent funds are available, the Secretary shall make breakfast assistance payments to each State agency for breakfasts served to children under the Program. Subject to § 220.13(b)(2...

7 CFR 220.4 - Payment of funds to States and FNSROs.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SCHOOL BREAKFAST PROGRAM § 220.4 Payment of funds to States and FNSROs. (a) To the extent funds are available, the Secretary shall make breakfast assistance payments to each State agency for breakfasts served to children under the Program. Subject to § 220.13(b)(2...

75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices AGENCY... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in...

48 CFR 252.225-7000 - Buy American Act-Balance of Payments Program Certificate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Buy American Act-Balance... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7000 Buy American Act—Balance of Payments Program Certificate. Buy American Act—Balance of Payments Program Certificate (DEC 2009) (a...

48 CFR 252.225-7001 - Buy American Act and Balance of Payments Program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Balance of Payments Program. 252.225-7001 Section 252.225-7001 Federal Acquisition Regulations System... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7001 Buy American Act and Balance of Payments Program. As prescribed in 225.1101(2)(i), use the following clause: Buy American Act and Balance...

75 FR 81915 - Defense Federal Acquisition Regulation Supplement; Foreign Participation in Acquisitions in...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

...) states; and Determination of inapplicability of the Balance of Payments Program evaluation factor to... the provisions of the Balance of Payments Program to offers of products (other than arms, ammunition... supplies. (1)(i) Use the provision at 252.225-7000, Buy American Act--Balance of Payments Program...

48 CFR 252.225-7001 - Buy American Act and Balance of Payments Program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Balance of Payments Program. 252.225-7001 Section 252.225-7001 Federal Acquisition Regulations System... AND CONTRACT CLAUSES Text of Provisions And Clauses 252.225-7001 Buy American Act and Balance of Payments Program. As prescribed in 225.1101(2), use the following clause: Buy American Act and Balance of...

48 CFR 1815.404-472 - Payment of profit or fee under letter contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1815.404-472 Payment of profit or fee under letter contracts. NASA's policy is to...

7 CFR 784.6 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.6... proration provisions of § 784.7, payments for qualifying operations shall be $18 for each qualifying ewe...

Public Opinion Regarding Financial Incentives to Engage in Advance Care Planning and Complete Advance Directives.

PubMed

Auriemma, Catherine L; Chen, Lucy; Olorunnisola, Michael; Delman, Aaron; Nguyen, Christina A; Cooney, Elizabeth; Gabler, Nicole B; Halpern, Scott D

2017-09-01

The Centers for Medicare & Medicaid Services (CMS) recently instituted physician reimbursements for advance care planning (ACP) discussions with patients. To measure public support for similar programs. Cross-sectional online and in-person surveys. English-speaking adults recruited at public parks in Philadelphia, Pennsylvania, from July to August 2013 and online through survey sampling international Web-based recruitment platform in July 2015. Participants indicated support for 6 programs designed to increase advance directive (AD) completion or ACP discussion using 5-point Likert scales. Participants also indicated how much money (US$0-US$1000) was appropriate to incentivize such behaviors, compared to smoking cessation or colonoscopy screening. We recruited 883 participants: 503 online and 380 in-person. The status quo of no systematic approach to motivate AD completion was supported by 67.0% of participants (63.9%-70.1%). The most popular programs were paying patients to complete ADs (58.0%; 54.5%-61.2%) and requiring patients to complete ADs or declination forms for health insurance (54.1%; 50.8%-57.4%). Participants more commonly supported paying patients to complete ADs than paying physicians whose patients complete ADs (22.6%; 19.8%-25.4%) or paying physicians who document ACP discussions (19.1%; 16.5%-21.7%; both P < .001). Participants supported smaller payments for AD completion and ACP than for obtaining screening colonoscopies or stopping smoking. Americans view payments for AD completion or ACP more skeptically than for other health behaviors and prefer that such payments go to patients rather than physicians. The current CMS policy of reimbursing physicians for ACP conversations with patients was the least preferred of the programs evaluated.

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2010 CFR

2010-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2011 CFR

2011-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2012 CFR

2012-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2013 CFR

2013-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2014 CFR

2014-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

PubMed

2011-11-30

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. 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 OPPS. 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. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

42 CFR 412.110 - Total Medicare payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.110 Total Medicare payment. Under the prospective payment systems, Medicare... 42 Public Health 2 2010-10-01 2010-10-01 false Total Medicare payment. 412.110 Section 412.110...

Medicare physician payment systems: impact of 2011 schedule on interventional pain management.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M; Hirsch, Joshua A

2011-01-01

Physicians in the United States have been affected by significant changes in the patterns of medical practice evolving over the last several decades. The recently passed affordable health care law, termed the Patient Protection and Affordable Care Act of 2010 (the ACA, for short) affects physicians more than any other law. Physician services are an integral part of health care. Physicians are paid in the United States for their personal services. This payment also includes the overhead expenses for maintaining an office and providing services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula-based payment, mostly based on the Medicare payment system. Physician services are billed under Part B. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in the Medical Economic Index (MEI). Nevertheless, the policy failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to live up to expectations for operational success. Then, in 1998, the sustainable growth rate (SGR) system was introduced. In 2009, multiple attempts were made by Congress to repeal the formula - rather unsuccessfully. Consequently, the SGR formula continues to hamper physician payments. The mechanism of the SGR includes 3 components that are incorporated into a statutory formula: expenditure targets, growth rate period, and annual adjustments of payment rates for physician services. Further, the relative value of a physician fee schedule is based on 3 components: physician work, practice expense (PE), and malpractice expense that are used to determine a value ranking for each service to which it is applied. On average, the work component represents 53.5% of a service's relative value, the fee component represents 43.6%, and the malpractice component represents 3.9%. The final schedule for physician payment was issued on November 24, 2010. This was based on a total cut of 30.8% with 24.9% of the cut attributed to SGR. However, as usual, with patchwork efficiency, Congress passed a one-year extension of the 0% update, effective through December 2011. Consequently, CMS issued an emergency update of the 2011 Medicare fee schedule, with multiple revisions, resulting in a reduction of the conversion factor of $36.8729 from December 2010 to $33.9764 for 2011.

Determinants in implementing a public policy for an essential volume of free water in Bogotá and Medellín, Colombia.

PubMed

Vargas, Laura; Heller, Léo

2016-03-01

Within the framework for the realization of the human right to water and sanitation, States have the obligation to implement programs and public policies that satisfy the basic needs of their population, especially its most vulnerable demographics. In Colombia, this challenge has been addressed through policies that provide a determined essential amount of free water to people whose access to water and sanitation services are limited due to low income. Through a review of legal and technical documents as well as relevant literature, this article presents an analysis of the particular determinants involved in implementing this program in Bogotá and Medellín, as well as some related concerns. Among such factors, we discuss the evolution and changes of the tariff model used in service provision, estimates of basic consumption, the role of social movements and collective action, and user disconnection due to non-payment. The main particularities and differences of each case highlighted the inconveniences related to the method of identifying eligible users and applying assistance to beneficiary user groups, and the need for national guidelines in implementing this policy.

7 CFR 1430.302 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

7 CFR 1430.302 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

7 CFR 1430.302 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DAIRY PRODUCTS 2004 Dairy Disaster Assistance Payment... purposes of administering the 2004 Dairy Disaster Assistance Payment Program established by this subpart. Application means the 2004 Dairy Disaster Assistance Payment Program Application. Application period means the...

Report: EPA Needs to Reexamine How It Defines Its Payment Recapture Audit Program

EPA Pesticide Factsheets

Report #11-P-0362, July 19, 2011. EPA makes numerous efforts to recapture improper payments, but does not consider its activities to be a formal payment recapture audit program, as defined by OMB guidance.

Efficiency of incentives to jointly increase carbon sequestration and species conservation on a landscape

PubMed Central

Nelson, Erik; Polasky, Stephen; Lewis, David J.; Plantinga, Andrew J.; Lonsdorf, Eric; White, Denis; Bael, David; Lawler, Joshua J.

2008-01-01

We develop an integrated model to predict private land-use decisions in response to policy incentives designed to increase the provision of carbon sequestration and species conservation across heterogeneous landscapes. Using data from the Willamette Basin, Oregon, we compare the provision of carbon sequestration and species conservation under five simple policies that offer payments for conservation. We evaluate policy performance compared with the maximum feasible combinations of carbon sequestration and species conservation on the landscape for various conservation budgets. None of the conservation payment policies produce increases in carbon sequestration and species conservation that approach the maximum potential gains on the landscape. Our results show that policies aimed at increasing the provision of carbon sequestration do not necessarily increase species conservation and that highly targeted policies do not necessarily do as well as more general policies. PMID:18621703

46 CFR 308.515 - Payment in event of loss.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.515 Payment in event of loss. All..., together with appropriate declarations as required by Clause 9, and such further data as may now or...

46 CFR 308.515 - Payment in event of loss.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.515 Payment in event of loss. All..., together with appropriate declarations as required by Clause 9, and such further data as may now or...

76 FR 39385 - Payment Policy Change for Access to NOAA Environmental Data, Information, and Related Products...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... accepted forms of payment are Visa, MasterCard, American Express, Discover, wire transfers and Automated.... currency, by VISA, MasterCard, American Express, and Discover. Cardholder's name, charge card number...

20 CFR 411.355 - What payment options does a State VR agency have?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

20 CFR 411.355 - What payment options does a State VR agency have?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

20 CFR 411.355 - What payment options does a State VR agency have?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

20 CFR 411.355 - What payment options does a State VR agency have?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

20 CFR 411.355 - What payment options does a State VR agency have?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What payment options does a State VR agency... Ticket to Work Program § 411.355 What payment options does a State VR agency have? (a) The Ticket to Work program provides different payment options that are available to a State VR agency for providing services...

78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

... [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer who receives payments under this subpart may be required to refund such payments... General for appropriate action. (a) An eligible advanced biofuel producer receiving payments under this...

48 CFR 2832.903 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 2832.903 Section 2832.903 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Prompt Payment 2832.903 Policy. The HCA is responsible for promulgating policies and...

48 CFR 2832.903 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policy. 2832.903 Section 2832.903 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE General Contracting Requirements CONTRACT FINANCING Prompt Payment 2832.903 Policy. The HCA is responsible for promulgating policies and...

48 CFR 2832.903 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 2832.903 Section 2832.903 Federal Acquisition Regulations System DEPARTMENT OF JUSTICE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Prompt Payment 2832.903 Policy. The HCA is responsible for promulgating policies and...

Towards Patient-Centered Conflicts of Interest Policy

PubMed Central

Young, Peter D.; Xie, Dawei; Schmidt, Harald

2018-01-01

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians’ medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians’ reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. We set out to explore user awareness of the database and the ease of accessibility to disclosed information, however, as we show, both awareness and actual use are very low. Two practical policies can greatly enhance its intended function and help alleviate ethical tension. The first is to provide data for individual physicians not merely in absolute terms, but in meaningful context, that is, in relation to the zip code, city, and state averages. The second increases access to the OPP dataset by adding hyperlinks from physicians’ professional websites directly to their Open Payments disclosure pages. These changes considerably improve transparency and the utility of available data, and can furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices. PMID:29524935

Medicaid nursing home payment and the role of provider taxes.

PubMed

Grabowski, David C; Zhanlian Feng; Mor, Vincent

2008-08-01

In the context of recent state budget shortfalls and the repeal of the Boren Amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. The authors examine this issue using data from a survey of state nursing home payment policies. Results indicate that aggregate inflation-adjusted Medicaid payment rates steadily increased through 2004, and this growth is partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care.

Medicaid Nursing Home Payment and the Role of Provider Taxes

PubMed Central

Feng, Zhanlian; Intrator, Orna; Mor, Vincent

2009-01-01

In the context of recent state budget shortfalls and the repeal of the Boren amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. We examine this issue using data from a survey of state nursing home payment policies. Our results indicate aggregate inflation-adjusted Medicaid payment rates increased steadily through 2004, and this growth was partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care. PMID:18369236

7 CFR 4288.121 - Contract.

Code of Federal Regulations, 2013 CFR

2013-01-01

... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.121 Contract. Advanced biofuel producers determined to be eligible to receive payments must... Agency will forward the contract to the advanced biofuel producer. The advanced biofuel producer must...

7 CFR 4288.121 - Contract.

Code of Federal Regulations, 2012 CFR

2012-01-01

... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.121 Contract. Advanced biofuel producers determined to be eligible to receive payments must... Agency will forward the contract to the advanced biofuel producer. The advanced biofuel producer must...

34 CFR 80.21 - Payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... program income, refunds, and audit recoveries on payment. (1) Grantees and subgrantees shall disburse repayments to and interest earned on a revolving fund before requesting additional cash payments for the same... disburse program income, rebates, refunds, contract settlements, audit recoveries and interest earned on...

24 CFR Appendix A to Part 4001 - Calculation of Upfront Payment or Future Appreciation Payment

Code of Federal Regulations, 2010 CFR

2010-04-01

... to Housing and Urban Development (Continued) BOARD OF DIRECTORS OF THE HOPE FOR HOMEOWNERS PROGRAM HOPE FOR HOMEOWNERS PROGRAM Pt. 4001, App. A Appendix A to Part 4001—Calculation of Upfront Payment or...

Medicaid Bed-Hold Policy and Medicare Skilled Nursing Facility Rehospitalizations

PubMed Central

Grabowski, David C; Feng, Zhanlian; Intrator, Orna; Mor, Vincent

2010-01-01

Objective To analyze the effect of states' Medicaid bed-hold policies on the 30-day rehospitalization of Medicare postacute skilled nursing facility (SNF) residents. Data Sources Minimum data set assessments were merged with Medicare claims and eligibility files for all first-time SNF admissions (N = 3,322,088) over the period 2000 through 2005; states' Medicaid bed-hold policies were obtained via survey. Study Design Regression specification incorporating facility fixed effects to examine changes in Medicaid bed-hold policies on the likelihood of a 30-day SNF rehospitalization. Principal Findings Using a continuous measure of bed-hold generosity, state Medicaid bed-hold was positively related to Medicare SNF rehospitalization. Specifically, the introduction of a bed-hold policy with average generosity increases Medicare rehospitalizations by 1.8 percent, representing roughly 12,000 SNF rehospitalizations at a cost to Medicare of approximately U.S.$100 million over our study period. Conclusions Although facilities do not receive a Medicaid bed-hold payment for Medicare SNF stays, we found that the adoption of more generous policies led to greater SNF rehospitalizations. This type of spillover is largely ignored in current discussions of Medicare payment reforms such as bundled payment. Neither Medicare nor Medicaid has an incentive to internalize the risks and benefits of its actions as they affect the other. PMID:20403059

Community health worker programs in India: a rights-based review.

PubMed

Bhatia, Kavita

2014-09-01

This article presents a historical review of national community health worker (CHW) programs in India using a gender- and rights-based lens. The aim is to derive relevant policy implications to stem attrition and enable sustenance of large-scale CHW programs. For the literature review, relevant government policies, minutes of meetings, reports, newspaper articles and statistics were accessed through official websites and a hand search was conducted for studies on the rights-based aspects of large-scale CHW programs. The analysis shows that the CHWs in three successive Indian national CHW programs have consistently asked for reforms in their service conditions, including increased remuneration. Despite an evolution in stakeholder perspectives regarding the rights of CHWs, service reforms are slow. Performance-based payments do not provide the financial security expected by CHWs as demonstrated in the recent Accredited Social Health Activist (ASHA) program. In most countries, CHWs, who are largely women, have never been integrated into the established, salaried team of health system workers. The two hallmark characteristics of CHWs, namely, their volunteer status and the flexibility of their tasks and timings, impede their rights. The consequences of initiating or neglecting standardization should be considered by all countries with large-scale CHW programs like the ASHA program. © Royal Society for Public Health 2014.

75 FR 19185 - Direct and Counter-Cyclical Program and Average Crop Revenue Election Program, Disaster...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-14

... Program, Disaster Assistance Programs, Marketing Assistance Loans and Loan Deficiency Payments Program... Disaster Program (LFP), the Supplemental Revenue Assistance Payments Program (SURE) and the Marketing... losses, unless the loss has already been reported for the Noninsured Crop Disaster Assistance Program...

Evaluating Industry Payments Among Dermatology Clinical Practice Guidelines Authors.

PubMed

Checketts, Jake X; Sims, Matthew Thomas; Vassar, Matt

2017-12-01

It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines. To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development. Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development. Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively. Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10 000, and 18 accepted more than $50 000. Financial payments amounted to a mean of $157 177 per author. The total reimbursement among the 49 authors from 2013 to 2015 was $7 701 681. Of the 40 authors receiving payments, 22 did not accurately disclose industry relationships. Authors received payments from companies with products directly related to the guideline topic. Violations to the Administrative Regulations were found. Dermatology clinical practice guideline authors received sizable industry payments and did not completely disclose these payments. The American Academy of Dermatology policies may benefit from stricter enforcement or the adoption of new standards.

The 10 Conditions That Increased Vermont's Readiness to Implement Statewide Health System Transformation.

PubMed

Grembowski, David; Marcus-Smith, Miriam

2018-06-01

Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation. The authors reviewed documents, conducted internet searches of public information, interviewed key informants annually in 2014-2016, cross-validated factual and narrative interpretation, and performed content analyses to derive conditions that increased readiness and their implications for policy and practice. Four social conditions (leadership champions; a common vision; collaborative culture; social capital and collective efficacy) and 6 support conditions (money; statewide data; legal infrastructure; federal policy promoting payment reform; delivery system transformation aligned with payment reform; personnel skilled in system reform) increased Vermont's readiness for system transformation. Vermont's experience indicates that increasing statewide readiness for reform is slow, incremental, and exhausting to overcome the sheer inertia of large fee-based systems. The new payments may work because statewide, uniform population-based payment will affect the health care of almost all Vermonters, creating statewide, uniform provider incentives to reduce volume and making the current fee-based system less viable. The conditions for readiness and statewide system transformation may be more likely in states with regulated markets, like Vermont, than in states with highly competitive markets.

7 CFR 784.1 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.1 Applicability. (a... Lamb Replacement and Retention Payment Program will be administered. (b) Unless otherwise determined by...

46 CFR 308.513 - Payment of premiums and fees.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.513 Payment of premiums and fees. The... ”Maritime Administration, Department of Transportation.” ...

7 CFR 4288.105 - Oversight and monitoring.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

7 CFR 4288.105 - Oversight and monitoring.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

7 CFR 4288.105 - Oversight and monitoring.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... of biofuel produced and the type and amount of feedstocks used. (2) Blending verification. The Agency... advanced biofuel eligible for payment. (3) Certificate of Analysis. The Agency will review the producer...

48 CFR 225.7503 - Contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7503 Contract clauses. Unless the entire acquisition is exempt from the Balance of Payments Program— (a)(1) Use the clause at 252.225-7044, Balance of Payments Program—Construction Material, in solicitations and contracts...

48 CFR 225.7503 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Balance of Payments Program 225.7503 Contract clauses. Unless the entire acquisition is exempt from the Balance of Payments Program— (a) Use the clause at 252.225-7044, Balance of Payments Program—Construction Material, in solicitations and contracts...

42 CFR § 512.460 - Compliance enforcement.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Quality Measures, Beneficiary... regulations under this part must not be construed to affect the applicable payment, coverage, program..., commonly referred to as a CAP. (iii) Reducing or eliminating the EPM participant's reconciliation payment...

7 CFR 1493.450 - Payment guarantee.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

7 CFR 1493.450 - Payment guarantee.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.450 Payment guarantee. (a) CCC's obligation. The payment guarantee will provide that CCC agrees to pay the exporter or the exporter's assignee an amount...

42 CFR 412.120 - Reductions to total payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.120 Reductions to total payments. (a) Deductible and coinsurance... 42 Public Health 2 2010-10-01 2010-10-01 false Reductions to total payments. 412.120 Section 412...

Conflicts of Interest in Medical Technology Markets: Evidence from Orthopedic Surgery.

PubMed

Smieliauskas, Fabrice

2016-06-01

Financial relationships between physicians and industry are vital to biomedical innovation yet create the potential for conflicts of interest in medical practice. I consider an inducement model of the role of financial relationships in health care markets, where consulting payments induce physicians to use more devices of the firms that sponsor them. To test the model, I exploit a policy shock, whereby government monitoring of payments to joint replacement surgeons resulted in declines of over 60% in both total payments and in the number of physicians receiving payments from 2007 to 2008. Using hospital discharge data from three states, I find that the loss of payments leads physicians to switch 7 percentage points of their device utilization from their sponsoring firms' devices to other firms' devices, an effect which is concentrated among surgeons with low switching costs. These results offer support for the inducement model. I also find evidence of an increase in medical productivity following the policy intervention, which suggests conditions under which regulation of financial relationships would be socially beneficial. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

PubMed

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

DRG-based hospital payment systems and technological innovation in 12 European countries.

PubMed

Scheller-Kreinsen, David; Quentin, Wilm; Busse, Reinhard

2011-12-01

To assess how diagnosis-related group-based (DRG-based) hospital payment systems in 12 European countries participating in the EuroDRG project pay and incorporate technological innovation. A standardized questionnaire was used to guide comprehensive DRG system descriptions. Researchers from each country reviewed relevant materials to complete the questionnaire and drafted standardized country reports. Two characteristics of DRG-based hospital payment systems were identified as particularly important: the existence of short-term payment instruments encouraging technological innovation in different countries, and the characteristics of long-term updating mechanisms that assure technological innovation is ultimately incorporated into DRG-based hospital payment systems. Short-term payment instruments and long-term updating mechanisms differ greatly among the 12 European countries included in this study. Some countries operate generous short-term payment instruments that provide additional payments to hospitals for making use of technological innovation (e.g., France). Other countries update their DRG-based hospital payment systems very frequently and use more recent data for updates. Generous short-term payment instruments to promote technological innovation should be applied carefully as they may imply rapidly increasing health-care expenditures. In general, they should be granted only if rigorous analyses have demonstrated their benefits. If the evidence remains uncertain, coverage with evidence development frameworks or frequent updates of the DRG-based hospital systems may provide policy alternatives. Once the data and evidence base is substantially improved, future research should empirically investigate how different policy arrangements affect the adoption and use of technological innovation and health-care expenditures. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The Evolution of Private Plans in Medicare.

PubMed

Patel, Yash M; Guterman, Stuart

2017-12-01

Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care. Review of key policy documents, reports, position statements, and academic studies. Private plans have changed considerably since their introduction into Medicare. Enrollment has risen to 33 percent of all Medicare beneficiaries; 99 percent of beneficiaries have access to private plans in 2017. Recent policies have improved risk-adjustment methods, rewarded plans’ performance on quality of care, and reduced average payments to private plans to 100 percent of traditional Medicare spending. As enrollment in private plans continues to grow and as health care costs rise, policymakers should enhance incentives for private plans to meet intended goals for higher-quality care at lower cost.

Distributional consequences of the transition from age-based to income-based prescription drug coverage in British Columbia, Canada.

PubMed

Hanley, Gillian E; Morgan, Steve; Hurley, Jeremiah; van Doorslaer, Eddy

2008-12-01

In May, 2003, British Columbia transitioned from an age-based public drug program, with public subsidy primarily based on age, to an age-irrelevant income-based drug program, in which public subsidy is based primarily on household income. As one of the specific aims of the policy change was to improve fairness by increasing the extent to which payment for drugs is based on ability to pay, we measure the progressivity of pharmaceutical financing before and after the policy change in BC using Kakwani indices. Our results suggest that pharmaceutical financing became less regressive after the policy change. However, this decrease in regressivity arose primarily because high-income seniors were making greater direct contributions to pharmaceutical financing and not because low-income households were making smaller direct contributions. Our results also suggest that if the public financing of pharmaceuticals were maintained or increased, a change from age-based to income-based eligibility can unambiguously improve equity in finance. As populations in developed countries age, governments will increasingly consider reforms to publicly financed health-care programs with age-based eligibility. In assessing policy options, financial equity is likely to be a key consideration. These results suggest that income-based pharmacare can improve financial equity especially when implemented with a commitment to maintain or increase public funding for prescription drugs.

State adoption of nursing home pay-for-performance.

PubMed

Werner, Rachel M; Tamara Konetzka, R; Liang, Kevin

2010-06-01

Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades-with varying degrees of success-health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives.

Translating comparative effectiveness research into Medicaid payment policy: views from medical and pharmacy directors.

PubMed

Weissman, Joel S; Westrich, Kimberly; Hargraves, J Lee; Pearson, Steven D; Dubois, Robert; Emond, Sarah; Olufajo, Olubode A

2015-03-01

As the USA seeks to expand the conduct and dissemination of comparative effectiveness research (CER), views of key stakeholders will help guide the way. We surveyed 60 medical and pharmacy directors from 46 state Medicaid programs. Over 90% felt that CER would lead to better clinical decision-making and overall value within 5 years and were willing to consider cost-effectiveness in setting medical policy. However, perceived poor quality, inconclusive research, restrictive legislative mandates, lack of budget impact and coverage recommendations, and lack of an independent body to interpret study results were major barriers cited to using CER evidence. Given the significant resources being invested in CER, it is critical that these barriers are overcome to maximize its usefulness for stakeholders.

7 CFR 215.15 - Withholding payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

7 CFR 215.15 - Withholding payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

7 CFR 215.15 - Withholding payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

7 CFR 215.15 - Withholding payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

7 CFR 215.15 - Withholding payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Withholding payments. 215.15 Section 215.15 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL MILK PROGRAM FOR CHILDREN § 215.15 Withholding payments. In...

7 CFR 505.6 - Payment of fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL AGRICULTURAL LIBRARY FEES FOR LOANS AND COPYING § 505.6 Payment of fees. NAL charges for interlibrary loans through OCLC's IFM Program (an electronic debit/credit payment program for libraries using...

7 CFR 505.6 - Payment of fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL AGRICULTURAL LIBRARY FEES FOR LOANS AND COPYING § 505.6 Payment of fees. NAL charges for interlibrary loans through OCLC's IFM Program (an electronic debit/credit payment program for libraries using...