Sample records for qualified health plan

  1. Community Characteristics and Qualified Health Plan Selection during the First Open Enrollment Period.

    PubMed

    Boudreaux, Michel; Blewett, Lynn A; Fried, Brett; Hempstead, Katherine; Karaca-Mandic, Pinar

    2017-06-01

    To examine state and community factors that contributed to geographic variation in qualified health plan selection during the first open enrollment period. Administrative data on qualified health plan selections at the ZIP code area merged with survey estimates from the American Community Survey. Descriptive and regression analyses. Data were generated by healthcare.gov and from a household survey. Thirty-one percent of the variation in qualified health plan selection ratios resulted from between-state differences, and the rest was driven by local area differences. Education, language, age, gender, and the ethnic composition of communities contributed to disparate levels of plan selection. Medicaid expansion states had a qualified health plan selection ratio that was 4.4 points lower than non-Medicaid expansion states, controlling for covariates. Our results suggest community-level differences in the intensity or receptiveness to outreach and enrollment activities during the first open enrollment period. © Health Research and Educational Trust.

  2. 45 CFR 156.298 - Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    PubMed

    2013-06-04

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

  4. 76 FR 41865 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-15

    ... Organization IHS Indian Health Service IRS Internal Revenue Service NAIC National Association of Insurance... Organization QHP Qualified Health Plan SHOP Small Business Health Options Program SSA Social Security... (IHS), Indian tribes, tribal organizations, and urban Indian organizations. We propose some provisions...

  5. 78 FR 33233 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

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

  6. 26 CFR 1.405-1 - Qualified bond purchase plans.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) and Treasury Department Circular, Public Debt Series—No. 1-63. (b) Qualified bond purchase plans. (1...) Under a qualified bond purchase plan, the bonds may be distributed to the employees at any time, and the.... Accordingly, even though a qualified bond purchase plan is designed as a pension plan, it need not provide...

  7. 26 CFR 1.405-1 - Qualified bond purchase plans.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., see section 405(b) and Treasury Department Circular, Public Debt Series—No. 1-63. (b) Qualified bond...) Under a qualified bond purchase plan, the bonds may be distributed to the employees at any time, and the.... Accordingly, even though a qualified bond purchase plan is designed as a pension plan, it need not provide...

  8. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Requirements for qualified retiree prescription... belief. (5) Timing—(i) General rule. An application for a given plan year must be submitted prior to the... plan years that end in 2006, an application must be submitted by September 30, 2005 unless a request...

  9. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Requirements for qualified retiree prescription... belief. (5) Timing—(i) General rule. An application for a given plan year must be submitted prior to the... plan years that end in 2006, an application must be submitted by September 30, 2005 unless a request...

  10. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Requirements for qualified retiree prescription... belief. (5) Timing—(i) General rule. An application for a given plan year must be submitted prior to the... plan years that end in 2006, an application must be submitted by September 30, 2005 unless a request...

  11. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Requirements for qualified retiree prescription... belief. (5) Timing—(i) General rule. An application for a given plan year must be submitted prior to the... plan years that end in 2006, an application must be submitted by September 30, 2005 unless a request...

  12. Patient Protection and Affordable Care Act; third party payment of qualified health plan premiums. Interim final rule with comment period.

    PubMed

    2014-03-19

    This interim final rule requires issuers of qualified health plans (QHPs), including stand-alone dental plans (SADPs), to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations.

  13. Rural considerations in establishing network adequacy standards for qualified health plans in state and regional health insurance exchanges.

    PubMed

    Talbot, Jean A; Coburn, Andrew; Croll, Zach; Ziller, Erika

    2013-06-01

    The Affordable Care Act (ACA) requires Health Insurance Exchanges (HIEs) to specify network adequacy standards for the Qualified Health Plans (QHPs) they offer to consumers. This article examines rural issues surrounding network adequacy standards, and offers recommendations for crafting standards that optimize rural access. This policy analysis reviews ACA requirements for QHP network adequacy standards, considering Medicaid managed care and Medicare Advantage (MA) standards as models. We analyze the implications of stringent vs flexible access standards in terms of how choices might affect health plans' participation in rural markets and rural enrollees' access to care. Finally, we propose strategies for designing standards with the degree of flexibility most likely to benefit rural consumers. A traditional approach to safeguarding rural access is to impose strict network adequacy standards on plans in rural areas. However, if strict standards prove difficult to meet due to rural provider scarcity, they might diminish QHPs' willingness to serve rural areas. Thus, they could exacerbate rather than alleviate rural access problems. To benefit rural communities, network adequacy standards must be strong enough to provide real protections for beneficiaries, yet flexible enough to accommodate rural delivery system constraints and remain attainable for QHPs. Useful strategies to achieve this balance might include: adjusting standards according to degrees of rurality and rural utilization norms; counting midlevel clinicians toward fulfillment of patient-provider ratios; and allowing plans to ensure rural access through delivery system innovations such as telehealth. © 2013 National Rural Health Association.

  14. Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule.

    PubMed

    2012-07-20

    This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

  15. 42 CFR 417.414 - Qualifying condition: Range of services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.414 Qualifying condition...

  16. 26 CFR 1.401-7 - Forfeitures under a qualified pension plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Forfeitures under a qualified pension plan. 1...) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-7 Forfeitures under a qualified pension plan. (a) General rules. In the case of a trust forming a part of a...

  17. Privacy and Confidentiality Practices In Adolescent Family Planning Care At Federally Qualified Health Centers.

    PubMed

    Beeson, Tishra; Mead, Katherine H; Wood, Susan; Goldberg, Debora Goetz; Shin, Peter; Rosenbaum, Sara

    2016-03-01

    The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs). A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted to provide additional contextual information. Among FQHCs reporting on confidentiality, most reported providing written or verbal information regarding adolescents' rights to confidential care (81%) and limiting access to family planning and medical records to protect adolescents' confidentiality (84%). Far fewer reported maintaining separate medical records for family planning (10%), using a security block on electronic medical records to prevent disclosures (43%) or using separate contact information for communications regarding family planning services (50%). Index scores were higher among FQHCs that received Title X funding than among those that did not (coefficient, 0.70) and among FQHCs with the largest patient volumes than among those with the smallest caseloads (0.43). Case studies highlighted how a lack of guidelines and providers' confusion over relevant laws present a challenge in offering confidential care to adolescents. The organizational practices used to ensure adolescent family planning confidentiality in FQHCs are varied across organizations. Copyright © 2016 by the Guttmacher Institute.

  18. 33 CFR 154.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... BULK Response Plans for Oil Facilities § 154.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate who meet... implementation of the facility response plan; and (4) Be trained in the responsibilities of the qualified...

  19. 33 CFR 154.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... BULK Response Plans for Oil Facilities § 154.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate who meet... implementation of the facility response plan; and (4) Be trained in the responsibilities of the qualified...

  20. 33 CFR 154.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... BULK Response Plans for Oil Facilities § 154.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate who meet... implementation of the facility response plan; and (4) Be trained in the responsibilities of the qualified...

  1. 33 CFR 154.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... BULK Response Plans for Oil Facilities § 154.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate who meet... implementation of the facility response plan; and (4) Be trained in the responsibilities of the qualified...

  2. 5 CFR 890.201 - Minimum standards for health benefits plans.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Minimum standards for health benefits... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans § 890.201 Minimum standards for health benefits plans. (a) To qualify for approval by OPM, a health benefits plan...

  3. 5 CFR 890.201 - Minimum standards for health benefits plans.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Minimum standards for health benefits... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Health Benefits Plans § 890.201 Minimum standards for health benefits plans. (a) To qualify for approval by OPM, a health benefits plan...

  4. 26 CFR 1.408(q)-1 - Deemed IRAs in qualified employer plans.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Deemed IRAs in qualified employer plans. 1.408(q)-1 Section 1.408(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.408(q)-1 Deemed IRAs in qualified employer plans. (a) In general. Under section 408(q), a...

  5. 26 CFR 1.408(q)-1 - Deemed IRAs in qualified employer plans.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Deemed IRAs in qualified employer plans. 1.408(q)-1 Section 1.408(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.408(q)-1 Deemed IRAs in qualified employer plans. (a) In general. Under section 408(q), a...

  6. 26 CFR 1.408(q)-1 - Deemed IRAs in qualified employer plans.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Deemed IRAs in qualified employer plans. 1.408(q)-1 Section 1.408(q)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY.... § 1.408(q)-1 Deemed IRAs in qualified employer plans. (a) In general. Under section 408(q), a...

  7. 26 CFR 1.42-17 - Qualified allocation plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...-17 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-17 Qualified allocation plan. (a) Requirements—(1) In general. [Reserved] (2..., real estate taxes during construction, title and recording fees, construction period interest...

  8. 40 CFR Appendix G to Part 112 - Tier I Qualified Facility SPCC Plan

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC Plan...

  9. 40 CFR Appendix G to Part 112 - Tier I Qualified Facility SPCC Plan

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC Plan...

  10. 40 CFR Appendix G to Part 112 - Tier I Qualified Facility SPCC Plan

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC Plan...

  11. 40 CFR Appendix G to Part 112 - Tier I Qualified Facility SPCC Plan

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC Plan...

  12. 40 CFR Appendix G to Part 112 - Tier I Qualified Facility SPCC Plan

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Tier I Qualified Facility SPCC Plan G Appendix G to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. G Appendix G to Part 112—Tier I Qualified Facility SPCC Plan...

  13. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate... familiar with the implementation of the vessel response plan; and (4) Be trained in the responsibilities of...

  14. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate... familiar with the implementation of the vessel response plan; and (4) Be trained in the responsibilities of...

  15. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate... familiar with the implementation of the vessel response plan; and (4) Be trained in the responsibilities of...

  16. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1026 Qualified individual and alternate qualified individual. (a) The response plan must identify a qualified individual and at least one alternate... familiar with the implementation of the vessel response plan; and (4) Be trained in the responsibilities of...

  17. The Career Plans of Newly Qualified South African Teachers

    ERIC Educational Resources Information Center

    Bertram, Carol; Appleton, Simon; Muthukrishna, Nithi; Wedekind, Volker

    2006-01-01

    We report on survey data collected from 776 final-year student teachers from 11 higher education institutions in October 2004. The purpose of the survey was to find out how many newly qualified teachers were planning to teach abroad and how many were planning to teach in South Africa. Two issues formed the backdrop of the study: teacher migration…

  18. 42 CFR 417.418 - Qualifying condition: Quality assurance program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.418...

  19. 78 FR 15553 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-11

    ... at a single level of coverage but would have the option of doing so. For plan years beginning on or... exercise this option, but would instead assist employers in choosing a single QHP to offer their qualified... a SHOP (Sec. 155.705) Facilitating employee choice at a single level of coverage selected by the...

  20. Employee Health Plan Details | Alaska Division of Retirement and Benefits

    Science.gov Websites

    Health Information Life Disability DCAP Forms/Publications Features Empower Retirement Account Info Home Retirement Benefits Employer Services AlaskaCare Easy Navigation Employee Health Gym Discount Health Plan FAQs Overview What Plan am I in? Information Enrollment Information FAQs Premiums Qualified

  1. Assessing Culture and Climate of Federally Qualified Health Centers: A Plan for Implementing Behavioral Health Interventions.

    PubMed

    Kramer, Teresa L; Drummond, Karen L; Curran, Geoffrey M; Fortney, John C

    2017-01-01

    This study examines organizational factors relating to climate and culture that might facilitate or impede the implementation of evidence-based practices (EBP) targeting behavioral health in federally qualified health centers (FQHCs). Employees at six FQHCs participating in an evidence-based quality improvement (EBQI) initiative for mood disorders and alcohol abuse were interviewed (N=32) or surveyed using the Organizational Context Survey (OCS) assessing culture and climate (N=64). The FQHCs scored relatively well on proficiency, a previously established predictor of successful EBP implementation, but also logged high scores on scales assessing rigidity and resistance, which may hinder implementation. Qualitative data contextualized scores on FQHC culture and climate dimensions. Results suggest that the unique culture of FQHCs may influence implementation of evidence-based behavioral health interventions.

  2. 42 CFR 417.412 - Qualifying condition: Administration and management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Qualifying condition: Administration and management. 417.412 Section 417.412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS...

  3. 42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic and Federally... AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services Payment for Rural Health Clinic and Federally Qualified Health Center Services § 405.2462 Payment for rural health clinic...

  4. 26 CFR 1.72-16 - Life insurance contracts purchased under qualified employee plans.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... includible in the gross income of the employee under this paragraph shall be considered as premiums or other... in Gross Income § 1.72-16 Life insurance contracts purchased under qualified employee plans. (a) Applicability of section. This section provides rules for the tax treatment of premiums paid under qualified...

  5. 42 CFR 417.413 - Qualifying condition: Operating experience and enrollment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Qualifying Conditions for Medicare Contracts § 417.413..., as appropriate. (b) Standard: Enrollment and operating experience for HMOs or CMPs to contract on a...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  7. 45 CFR 156.265 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  9. 45 CFR 156.1240 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  10. 45 CFR 156.260 - Enrollment periods for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  11. 45 CFR 156.1240 - Enrollment process for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  13. 45 CFR 156.260 - Enrollment periods for qualified individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  14. 20 CFR 404.1053 - “Qualified benefits” under a cafeteria plan.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false âQualified benefitsâ under a cafeteria plan. 404.1053 Section 404.1053 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income...

  15. 20 CFR 404.1053 - “Qualified benefits” under a cafeteria plan.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false âQualified benefitsâ under a cafeteria plan. 404.1053 Section 404.1053 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income...

  16. 20 CFR 404.1053 - “Qualified benefits” under a cafeteria plan.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false âQualified benefitsâ under a cafeteria plan. 404.1053 Section 404.1053 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income...

  17. 20 CFR 404.1053 - “Qualified benefits” under a cafeteria plan.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false âQualified benefitsâ under a cafeteria plan. 404.1053 Section 404.1053 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income...

  18. 20 CFR 404.1053 - “Qualified benefits” under a cafeteria plan.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false âQualified benefitsâ under a cafeteria plan. 404.1053 Section 404.1053 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income...

  19. 45 CFR 156.270 - Termination of coverage for qualified individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  1. 45 CFR 156.270 - Termination of coverage for qualified individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  2. 78 FR 25909 - Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-03

    ... Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the...

  3. 45 CFR 155.400 - Enrollment of qualified individuals into QHPs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....400 Section 155.400 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.400...

  4. 45 CFR 155.400 - Enrollment of qualified individuals into QHPs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....400 Section 155.400 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans § 155.400...

  5. The Role of Federally Qualified Health Centers in Delivering Family Planning Services to Adolescents.

    PubMed

    Mead, Katherine H; Beeson, Tishra; Wood, Susan F; Goldberg, Debora Goetz; Shin, Peter; Rosenbaum, Sara

    2015-07-01

    The purpose of this article was to examine the role of community health centers (CHCs) in providing comprehensive family planning services to adolescents, looking at the range of services offered and factors associated with provision of these services. This study employed a mixed methods approach comprising a national survey of CHCs and six in-depth case studies of health centers to examine the organization and delivery of family planning services. We developed an adolescent family planning index comprising nine family planning services specifically tailored to adolescents. We analyzed the influence of state-level family planning policies, funding for adolescents, and organizational characteristics on the provision of these services in CHCs. The case studies identified barriers to the provision of family planning to adolescent patients. The survey found substantial variation in the provision of family planning services at CHCs, with a mean of 6.33 out of a maximum score of 13 on the family planning adolescent services index. Title X funding and location within a favorable state policy environment were significantly associated with higher scores on the family planning adolescent services index (p value < .001 and .002, respectively). Case studies revealed barriers to adolescent family planning, including lack of funding, lack of knowledge, and limitations on school-based clinical services. CHCs have the opportunity to play a significant role in providing high-quality family planning to low-income, medically underserved adolescents. Additional funding, resources, and a favorable policy climate would further improve CHCs' ability to serve the family planning needs of this special patient population. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. 26 CFR 1.408(q)-1 - Deemed IRAs in qualified employer plans.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... governing instrument creating the trust must satisfy the requirements of section 408(a) (1), (2), (3), (4... accounts of any of the deemed IRAs is invested in life insurance contracts, regardless of whether the separate account for the qualified employer plan invests in life insurance contracts. (iii) Separate...

  7. 26 CFR 1.408(q)-1 - Deemed IRAs in qualified employer plans.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... governing instrument creating the trust must satisfy the requirements of section 408(a) (1), (2), (3), (4... accounts of any of the deemed IRAs is invested in life insurance contracts, regardless of whether the separate account for the qualified employer plan invests in life insurance contracts. (iii) Separate...

  8. Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit. Final regulations.

    PubMed

    2015-12-18

    This document contains final regulations on the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act, 2011. These final regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges, sometimes called Marketplaces) and claim the health insurance premium tax credit, and Exchanges that make qualified health plans available to individuals and employers.

  9. 42 CFR 422.527 - Agreements with Federally qualified health centers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Application Procedures and Contracts for Medicare Advantage Organizations § 422.527 Agreements with Federally qualified health centers...

  10. 26 CFR 54.4980B-3 - Qualified beneficiaries.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the day before the qualifying event (that is, the divorce or death) will have been by reason of D's... event, and the reason for the individual's lack of actual coverage (such as the individual's having..., the individual is covered under the group health plan by reason of another individual's election of...

  11. 42 CFR 417.155 - How the HMO option must be included in the health benefits plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in its health benefits plan. (3) In all cases, the HMO has the right to include, with the basic... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS...-standing” health benefits—(1) Basic requirement. At the request of a qualified HMO, the employing entity or...

  12. 26 CFR 1.405-2 - Deduction of contributions to qualified bond purchase plans.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...), (9), and (10) and 404(e) shall also apply. (c) Accrual method taxpayers. In the case of a taxpayer using the accrual method of accounting, a contribution to a qualified bond purchase plan will be deemed paid on the last day of the year of accrual if— (1) During the taxable year of accrual the taxpayer...

  13. An Economic Approach to Setting Contribution Limits in Qualified State-Sponsored Tuition Savings Plans.

    ERIC Educational Resources Information Center

    Ma, Jennifer; Warshawsky, Mark J.; Ameriks, John; Blohm, Julia A.

    This study used an expected utility framework with a mean-lower partial moment specification for investor utility to determine the asset allocation and the allowable contribution limits for qualified state-sponsored tuition savings plans. Given the assumptions about state policymakers' perceptions of investor utility, the study determined the…

  14. Career destinations, views and future plans of the UK medical qualifiers of 1988.

    PubMed

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2010-01-01

    To report the career destinations, views and future plans of a cohort of senior doctors who qualified in the 1980s. Postal questionnaire survey of all doctors who qualified from all UK medical schools in 1988. The response rate was 69%. We estimated that 81% of the total cohort was working in the NHS, 16 years after qualification; and that at least 94% of graduates who, when students, were from UK homes, were working in medicine. Of NHS doctors, 30% worked part-time. NHS doctors rated their job satisfaction highly (median score 19.9, scale 5-25) but were less satisfied with the amount of leisure time available to them (median score 5.4, scale 1-10). NHS doctors were very positive about their careers, but were less positive about working hours and some other aspects of the NHS. Women were more positive than men about working conditions; general practitioners were more positive than hospital doctors. Twenty-five percent reported unmet needs for further training or career-related advice, particularly about career development. Twenty-nine percent intended to reduce their hours in future, while 6%, mainly part-time women, planned to increase their hours. Overall, 10% of NHS doctors planned to do more service work in future and 24% planned to do less; among part-time women, 18% planned to do more and only 14% less. These NHS doctors, now in their 40s, had a high level of satisfaction with their jobs and their careers but were less satisfied with some other aspects of their working environment. A substantial percentage had expectations about future career development and change.

  15. Career destinations, views and future plans of the UK medical qualifiers of 1988

    PubMed Central

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2010-01-01

    Summary Objectives To report the career destinations, views and future plans of a cohort of senior doctors who qualified in the 1980s. Methods Postal questionnaire survey of all doctors who qualified from all UK medical schools in 1988. Results The response rate was 69%. We estimated that 81% of the total cohort was working in the NHS, 16 years after qualification; and that at least 94% of graduates who, when students, were from UK homes, were working in medicine. Of NHS doctors, 30% worked part-time. NHS doctors rated their job satisfaction highly (median score 19.9, scale 5–25) but were less satisfied with the amount of leisure time available to them (median score 5.4, scale 1–10). NHS doctors were very positive about their careers, but were less positive about working hours and some other aspects of the NHS. Women were more positive than men about working conditions; general practitioners were more positive than hospital doctors. Twenty-five percent reported unmet needs for further training or career-related advice, particularly about career development. Twenty-nine percent intended to reduce their hours in future, while 6%, mainly part-time women, planned to increase their hours. Overall, 10% of NHS doctors planned to do more service work in future and 24% planned to do less; among part-time women, 18% planned to do more and only 14% less. Conclusions These NHS doctors, now in their 40s, had a high level of satisfaction with their jobs and their careers but were less satisfied with some other aspects of their working environment. A substantial percentage had expectations about future career development and change. PMID:20056666

  16. Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

    PubMed

    Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

    Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

  17. 42 CFR 440.365 - Coverage of rural health clinic and federally qualified health center (FQHC) services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage of rural health clinic and federally... clinic and federally qualified health center (FQHC) services. If a State provides benchmark or benchmark... otherwise, to rural health clinic services and FQHC services as defined in subparagraphs (B) and (C) of...

  18. 42 CFR 417.164 - Effect of revocation of qualification on inclusion in employee's health benefit plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Effect of revocation of qualification on inclusion... Qualified Health Maintenance Organizations § 417.164 Effect of revocation of qualification on inclusion in... rules apply: (a) The HMO may not seek inclusion in employees health benefits plans under subpart E of...

  19. 42 CFR 417.164 - Effect of revocation of qualification on inclusion in employee's health benefit plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of revocation of qualification on inclusion... Qualified Health Maintenance Organizations § 417.164 Effect of revocation of qualification on inclusion in... rules apply: (a) The HMO may not seek inclusion in employees health benefits plans under subpart E of...

  20. 33 CFR 155.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... familiar with the implementation of the vessel response plan; and (4) Be trained in the responsibilities of... vessel may designate an organization to fulfill the role of the qualified individual and alternate...

  1. 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...

  2. In Every Core Class, a Qualified Teacher...

    ERIC Educational Resources Information Center

    Keller, Bess

    2006-01-01

    This article reports the teacher-quality plans of putting a highly qualified teacher in every core class which were due to the Education Department in July 7. In the plans, states are required to describe which groups of teachers are not yet highly qualified according to the federal standard, how they would help--and prod--districts to use only…

  3. 26 CFR 54.4980B-3 - Qualified beneficiaries.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

  4. 26 CFR 54.4980B-3 - Qualified beneficiaries.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

  5. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Inclusion of medical benefits for retired employees in qualified pension or annuity plans. 1.401-14 Section 1.401-14 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-14 Inclusion of medical benefits for retired employees in...

  6. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Inclusion of medical benefits for retired employees in qualified pension or annuity plans. 1.401-14 Section 1.401-14 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-14 Inclusion of medical benefits for retired employees in...

  7. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Inclusion of medical benefits for retired employees in qualified pension or annuity plans. 1.401-14 Section 1.401-14 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-14 Inclusion of medical benefits for retired employees in...

  8. 26 CFR 1.401-14 - Inclusion of medical benefits for retired employees in qualified pension or annuity plans.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Inclusion of medical benefits for retired employees in qualified pension or annuity plans. 1.401-14 Section 1.401-14 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.401-14 Inclusion of medical benefits for retired employees in...

  9. Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings

    PubMed Central

    Lee, Sang Mee; Sharma, Ravi; Ngo-Metzger, Quyen; Mukamel, Dana B.; Gao, Yue; White, Laura M.; Shi, Leiyu; Chin, Marshall H.; Laiteerapong, Neda; Huang, Elbert S.

    2016-01-01

    Objectives. To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods. Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings. Results. We found that health center patients had lower use and spending than did non–health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients. Conclusions. Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees. PMID:27631748

  10. 45 CFR 156.330 - Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  11. 42 CFR 435.116 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must provide...

  12. 42 CFR 435.116 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must provide...

  13. 42 CFR 435.116 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must provide...

  14. 40 CFR 35.4190 - How does my group identify a qualified technical advisor?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... health, environmental sciences, engineering, environmental law and planning); and (3) Ability to... 40 Protection of Environment 1 2013-07-01 2013-07-01 false How does my group identify a qualified technical advisor? 35.4190 Section 35.4190 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS...

  15. 40 CFR 35.4190 - How does my group identify a qualified technical advisor?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... health, environmental sciences, engineering, environmental law and planning); and (3) Ability to... 40 Protection of Environment 1 2014-07-01 2014-07-01 false How does my group identify a qualified technical advisor? 35.4190 Section 35.4190 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS...

  16. 40 CFR 35.4190 - How does my group identify a qualified technical advisor?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... health, environmental sciences, engineering, environmental law and planning); and (3) Ability to... 40 Protection of Environment 1 2012-07-01 2012-07-01 false How does my group identify a qualified technical advisor? 35.4190 Section 35.4190 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS...

  17. 26 CFR 1.127-2 - Qualified educational assistance program.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Qualified educational assistance program. 1.127... Qualified educational assistance program. (a) In general. A qualified educational assistance program is a plan established and maintained by an employer under which the employer provides educational assistance...

  18. 78 FR 40832 - Proposed Collection; Comment Request for Qualified Retirement Plans Under Sections 401(k) and 401...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-08

    ... Qualified Retirement Plans Under Sections 401(k) and 401(m) and Guidance on Cash or Deferred Arrangements... cash or deferred arrangements. DATES: Written comments should be received on or before September 6... Cash or Deferred Arrangements. OMB Number: 1545-1669. Regulation/Notice Number: REG-108639-99/Notice...

  19. Who Governs Federally Qualified Health Centers?

    PubMed Central

    Wright, Brad

    2017-01-01

    To make them more responsive to their community’s needs, federally qualified health centers (FQHCs) are required to have a governing board comprised of at least 51% consumers. However, the extent to which consumer board members actually resemble the typical FQHC patient has not been assessed, which according to the political science literature on representation may influence the board’s ability to represent the community. This mixed-methods study uses four years of data from the Health Resources and Services Administration, combined with Uniform Data System, Bureau of Labor Statistics, and Area Resource File data to describe and identify factors associated with the composition of FQHC governing boards. Board members are classified into one of three groups: non-consumers, non-representative consumers (who do not resemble the typical FQHC patient), and representative consumers (who resemble the typical FQHC patient). The analysis finds that a minority of board members are representative consumers, and telephone interviews with a stratified random sample of 30 FQHC board members confirmed the existence of significant socioeconomic gaps between consumer board members and FQHC patients. This may make FQHCs less responsive to the needs of the predominantly low-income communities they serve. PMID:23052684

  20. 75 FR 15492 - Proposed Collection; Comment Request for Qualified Retirement Plans Under Sections 401(k) and 401...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-29

    ... Collection; Comment Request for Qualified Retirement Plans Under Sections 401(k) and 401(m) and Guidance on... comments concerning REG-108639-99 (NPRM) Sections 401(k) and 401(m); Notice 2000-3 Guidance on Cash or...-99 (NPRM) Sections 401(k) and 401(m); Notice 2000-3 Guidance on Cash or Deferred Arrangements. OMB...

  1. Guidelines for Analysis of Health Manpower Planning. Volume 3: Health Manpower Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Staff, Robert J.; Porter, Dennis R.

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this third of ten manuals in the International Health Planning Methods Series deals with health manpower planning and assessment. It provides a conceptual and…

  2. 30 CFR 75.812-1 - Qualified person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Qualified person. 75.812-1 Section 75.812-1 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Underground High-Voltage Distribution § 75.812-1 Qualified...

  3. PLAN Bicol, Philippines: health manpower development program in action.

    PubMed

    Lind, K

    1994-06-01

    PLAN Bicol in the Philippines is a community based Health Manpower Development Program (HMDP) geared toward training and mobilization of indigenous health practitioners, providing infrastructural and logistical support to individual families, and educating the community about health, nutrition, and the environment. The field officer recommends at the initiation of a project that program staff have roles that are well defined. New programs should be introduced to the community first and should involve the community in the planning stages. The HMDP program is directed to 38 villages located around national parks that have suffered from deforestation. Community health issues are malnutrition, low immunization, and lack of access to health services. HMDP established a training program for auxiliary health workers (AHWs), who make a commitment to return to their villages after training. Midwives are being trained at local schools. Village houses are being built and repaired; water systems and sanitary toilet facilities are being installed. Village health stations have been constructed and equipped with basic medicines, supplies, and equipment, and are open 5 days a week. Health education classes inform the community about nutrition and health. The problems at inception were the unwillingness of field staff to participate in the program and a high drop out rate among AHWs. Problems were worked out as the program progressed. Facilitative factors are the close coordination with the provincial health office, community acceptance, and the availability of qualified people.

  4. 26 CFR 1.860F-1 - Qualified liquidations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Qualified liquidations. 1.860F-1 Section 1.860F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Real Estate Investment Trusts § 1.860F-1 Qualified liquidations. A plan of...

  5. 26 CFR 1.860F-1 - Qualified liquidations.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 9 2011-04-01 2011-04-01 false Qualified liquidations. 1.860F-1 Section 1.860F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Real Estate Investment Trusts § 1.860F-1 Qualified liquidations. A plan...

  6. 26 CFR 1.860F-1 - Qualified liquidations.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 9 2014-04-01 2014-04-01 false Qualified liquidations. 1.860F-1 Section 1.860F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Real Estate Investment Trusts § 1.860F-1 Qualified liquidations. A plan...

  7. 26 CFR 1.860F-1 - Qualified liquidations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 9 2012-04-01 2012-04-01 false Qualified liquidations. 1.860F-1 Section 1.860F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Real Estate Investment Trusts § 1.860F-1 Qualified liquidations. A plan...

  8. 26 CFR 1.860F-1 - Qualified liquidations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 9 2013-04-01 2013-04-01 false Qualified liquidations. 1.860F-1 Section 1.860F-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Real Estate Investment Trusts § 1.860F-1 Qualified liquidations. A plan...

  9. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 436...

  10. 42 CFR 435.119 - Qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified family members. 435.119 Section 435.119... Family Members § 435.119 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 435.116 of this...

  11. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified family members. 436.121 Section 436.121... Coverage of the Categorically Needy § 436.121 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 436...

  12. 42 CFR 435.119 - Qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified family members. 435.119 Section 435.119... Family Members § 435.119 Qualified family members. (a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 435.116 of this...

  13. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Qualified pregnant women and children who are not... to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an... RICO, AND THE VIRGIN ISLANDS Mandatory Coverage of the Categorically Needy § 436.120 Qualified pregnant...

  14. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an... RICO, AND THE VIRGIN ISLANDS Mandatory Coverage of the Categorically Needy § 436.120 Qualified pregnant...

  15. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an... RICO, AND THE VIRGIN ISLANDS Mandatory Coverage of the Categorically Needy § 436.120 Qualified pregnant...

  16. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Qualified pregnant women and children who are not... to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an... RICO, AND THE VIRGIN ISLANDS Mandatory Coverage of the Categorically Needy § 436.120 Qualified pregnant...

  17. 42 CFR 436.120 - Qualified pregnant women and children who are not qualified family members.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Qualified pregnant women and children who are not... to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an... RICO, AND THE VIRGIN ISLANDS Mandatory Coverage of the Categorically Needy § 436.120 Qualified pregnant...

  18. 76 FR 4907 - The Consumer Operated and Oriented Plan (CO-OP) Advisory Board, February 7, 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-27

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES [OCIIO-9978-N] The Consumer Operated and Oriented Plan (CO... Department's strategy to foster the creation of qualified nonprofit health insurance issuers. Specifically... Oversight (OCIIO) on the Department's strategy to foster the creation of qualified nonprofit health...

  19. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Electrical work; qualified person. 77.103... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as...

  20. 30 CFR 77.103 - Electrical work; qualified person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Electrical work; qualified person. 77.103... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Qualified and Certified Persons § 77.103 Electrical work; qualified person. (a) Except as...

  1. Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State

    PubMed Central

    McManus, Kathleen A.; Rhodes, Anne; Bailey, Steven; Yerkes, Lauren; Engelhard, Carolyn L.; Ingersoll, Karen S.; Stukenborg, George J.; Dillingham, Rebecca

    2016-01-01

    Background. With the Patient Protection and Affordable Care Act, many state AIDS Drug Assistance Programs (ADAPs) shifted their healthcare delivery model from direct medication provision to purchasing qualified health plans (QHPs). The objective of this study was to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients' QHP enrollment and to assess the relationship between QHP coverage and human immunodeficiency virus (HIV) viral suppression. Methods. The cohort included persons living with HIV who were enrolled in the Virginia ADAP (n = 3933). Data were collected from 1 January 2013 through 31 December 2014. Multivariable binary logistic regression was conducted to assess for associations with QHP enrollment and between QHP coverage and viral load (VL) suppression. Results. In the cohort, 47.1% enrolled in QHPs, and enrollment varied significantly based on demographic and healthcare delivery factors. In multivariable binary logistic regression, controlling for time, age, sex, race/ethnicity, and region, factors significantly associated with achieving HIV viral suppression included QHP coverage (adjusted odds ratio, 1.346; 95% confidence interval, 1.041–1.740; P = .02), an initially undetectable VL (2.809; 2.174–3.636; P < .001), HIV rather than AIDS disease status (1.377; 1.049–1.808; P = .02), and HIV clinic (P < .001). Conclusions. QHP coverage was associated with viral suppression, an essential outcome for individuals and for public health. Promoting QHP coverage in clinics that provide care to persons living with HIV may offer a new opportunity to increase rates of viral suppression. PMID:27143661

  2. Do consumer reports of health plan quality affect health plan selection?

    PubMed Central

    Spranca, M; Kanouse, D E; Elliott, M; Short, P F; Farley, D O; Hays, R D

    2000-01-01

    OBJECTIVE: To learn whether consumer reports of health plan quality can affect health plan selection. DATA SOURCES: A sample of 311 privately insured adults from Los Angeles County. STUDY DESIGN: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical health plans and selected one. The health plans varied as to cost, coverage, type of plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey. DATA ANALYSIS: We used multinomial logistic regression to model each consumer's choice among health plans. PRINCIPAL FINDINGS: In the absence of CAHPS information, 86 percent of consumers preferred plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive plans covering fewer services if CAHPS ratings identified those plans as higher quality (59 percent of consumers preferred plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive plans covering more services as higher quality (89 percent of consumers preferred plans covering more services). CONCLUSIONS: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of health plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference. PMID:11130805

  3. 45 CFR 155.1065 - Stand-alone dental plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Stand-alone dental plans. 155.1065 Section 155... Functions: Certification of Qualified Health Plans § 155.1065 Stand-alone dental plans. (a) General requirements. The Exchange must allow the offering of a limited scope dental benefits plan through the Exchange...

  4. 45 CFR 155.1065 - Stand-alone dental plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Stand-alone dental plans. 155.1065 Section 155... Functions: Certification of Qualified Health Plans § 155.1065 Stand-alone dental plans. (a) General requirements. The Exchange must allow the offering of a limited scope dental benefits plan through the Exchange...

  5. 45 CFR 155.1065 - Stand-alone dental plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Stand-alone dental plans. 155.1065 Section 155... Functions: Certification of Qualified Health Plans § 155.1065 Stand-alone dental plans. (a) General requirements. The Exchange must allow the offering of a limited scope dental benefits plan through the Exchange...

  6. Clinical Perspectives on Colorectal Cancer Screening at Latino-Serving Federally Qualified Health Centers

    ERIC Educational Resources Information Center

    Coronado, Gloria D.; Petrik, Amanda F.; Spofford, Mark; Talbot, Jocelyn; Do, Huyen Hoai; Taylor, Victoria M.

    2015-01-01

    Purpose: Colorectal cancer is the second most common cause of cancer death in the United States, and rates of screening for colorectal cancer are low. We sought to gather the perceptions of clinic personnel at Latino-serving Federally Qualified Health Centers (operating 17 clinics) about barriers to utilization of screening services for colorectal…

  7. Guidelines for Analysis of Health Facilities Planning in Developing Countries. Volume 5: Health Facilities Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Porter, Dennis R.; And Others

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this fifth of ten manuals in the International Health Planning Methods Series deals with health facilities planning in developing countries. While several specific…

  8. Who plans for health improvement? SEA, HIA and the separation of spatial planning and health planning

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

    Bond, Alan, E-mail: alan.bond@uea.ac.uk; Cave, Ben, E-mail: ben.cave@bcahealth.co.uk; Ballantyne, Rob, E-mail: robdballantyne@gmail.com

    This study examines whether there is active planning for health improvement in the English spatial planning system and how this varies across two regions using a combination of telephone surveys and focus group interviews in 2005 and 2010. The spatial planning profession was found to be ill-equipped to consider the health and well-being implications of its actions, whilst health professionals are rarely engaged and have limited understanding and aspirations when it comes to influencing spatial planning. Strategic Environmental Assessment was not considered to be successful in integrating health into spatial plans, given it was the responsibility of planners lacking themore » capacity to do so. For their part, health professionals have insufficient knowledge and understanding of planning and how to engage with it to be able to plan for health gains rather than simply respond to health impacts. HIA practice is patchy and generally undertaken by health professionals outside the statutory planning framework. Thus, whilst appropriate assessment tools exist, they currently lack a coherent context within which they can function effectively and the implementation of the Kiev protocol requiring the engagement of health professionals in SEA is not to likely improve the consideration of health in planning while there continues to be separation of functions between professions and lack of understanding of the other profession. -- Highlights: ► Health professionals have limited aspirations for health improvement through the planning system. ► Spatial planners are ill-equipped to understand the health and well-being implications of their activities. ► SEA and HIA currently do not embed health consideration in planning decisions. ► The separation of health and planning functions is problematic for the effective conduct of SEA and/or HIA.« less

  9. Guidelines for Analysis of Environmental Health Planning in Developing Countries. Volume 2: Environmental Health Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Fraser, Renee White; Shani, Hadasa

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this second of ten manuals in the International Health Planning Methods Series deals with assessment, planning, and evaluation in the field of environmental health.…

  10. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care.

    PubMed

    Frimpong, Jemima A; Jackson, Bradford E; Stewart, LaShonda M; Singh, Karan P; Rivers, Patrick A; Bae, Sejong

    2013-01-31

    The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether 'FQHCs' HIT capacity' is associated with the outcome measures. The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of

  11. 42 CFR 423.884 - Requirements for qualified retiree prescription drug plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... written agreement with its health insurance issuer (as defined in 45 CFR 160.103), or group health plan... email address. (iv) Actuarial attestation that satisfies the standards specified in paragraph (d) of...

  12. 26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

  13. 26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

  14. 26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

  15. 26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

  16. 75 FR 51831 - Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-23

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs AGENCY: Agency for... well health plans and health providers address health plan enrollees' health literacy needs and how...

  17. 42 CFR 417.407 - Requirements for a Competitive Medical Plan (CMP).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for a Competitive Medical Plan (CMP... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL... Requirements for a Competitive Medical Plan (CMP). (a) General rule. To qualify as a CMP, an entity must be...

  18. 42 CFR 417.407 - Requirements for a Competitive Medical Plan (CMP).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Requirements for a Competitive Medical Plan (CMP... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL... Requirements for a Competitive Medical Plan (CMP). (a) General rule. To qualify as a CMP, an entity must be...

  19. Confidence in leadership among the newly qualified.

    PubMed

    Bayliss-Pratt, Lisa; Morley, Mary; Bagley, Liz; Alderson, Steven

    2013-10-23

    The Francis report highlighted the importance of strong leadership from health professionals but it is unclear how prepared those who are newly qualified feel to take on a leadership role. We aimed to assess the confidence of newly qualified health professionals working in the West Midlands in the different competencies of the NHS Leadership Framework. Most respondents felt confident in their abilities to demonstrate personal qualities and work with others, but less so at managing or improving services or setting direction.

  20. 26 CFR 1.144-1 - Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds. 1.144-1 Section 1.144-1 Internal Revenue INTERNAL...) Tax Exemption Requirements for State and Local Bonds § 1.144-1 Qualified small issue bonds, qualified...

  1. 26 CFR 1.144-1 - Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds. 1.144-1 Section 1.144-1 Internal Revenue INTERNAL...) Tax Exemption Requirements for State and Local Bonds § 1.144-1 Qualified small issue bonds, qualified...

  2. 26 CFR 1.144-1 - Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds. 1.144-1 Section 1.144-1 Internal Revenue INTERNAL...) Tax Exemption Requirements for State and Local Bonds § 1.144-1 Qualified small issue bonds, qualified...

  3. 26 CFR 1.144-1 - Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 2 2014-04-01 2014-04-01 false Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds. 1.144-1 Section 1.144-1 Internal Revenue INTERNAL...) Tax Exemption Requirements for State and Local Bonds § 1.144-1 Qualified small issue bonds, qualified...

  4. 26 CFR 1.144-1 - Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Qualified small issue bonds, qualified student loan bonds, and qualified redevelopment bonds. 1.144-1 Section 1.144-1 Internal Revenue INTERNAL...) Tax Exemption Requirements for State and Local Bonds § 1.144-1 Qualified small issue bonds, qualified...

  5. Health Workforce Planning

    PubMed Central

    Al-Sawai, Abdulaziz; Al-Shishtawy, Moeness M.

    2015-01-01

    In most countries, the lack of explicit health workforce planning has resulted in imbalances that threaten the capacity of healthcare systems to attain their objectives. This has directed attention towards the prospect of developing healthcare systems that are more responsive to the needs and expectations of the population by providing health planners with a systematic method to effectively manage human resources in this sector. This review analyses various approaches to health workforce planning and presents the Six-Step Methodology to Integrated Workforce Planning which highlights essential elements in workforce planning to ensure the quality of services. The purpose, scope and ownership of the approach is defined. Furthermore, developing an action plan for managing a health workforce is emphasised and a reviewing and monitoring process to guide corrective actions is suggested. PMID:25685381

  6. 29 CFR 2550.408e - Statutory exemption for acquisition or sale of qualifying employer securities and for acquisition...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... or sale by a plan of qualifying employer securities (as defined in section 407(d)(5) of the Act), or any acquisition, sale or lease by a plan of qualifying employer real property (as defined in section... 29 Labor 9 2010-07-01 2010-07-01 false Statutory exemption for acquisition or sale of qualifying...

  7. Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care

    PubMed Central

    2013-01-01

    Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. Methods The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures. Results The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Conclusions Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful

  8. Understanding health insurance plans

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

  9. Training highly qualified health research personnel: The Pain in Child Health consortium

    PubMed Central

    von Baeyer, Carl L; Stevens, Bonnie J; Chambers, Christine T; Craig, Kenneth D; Finley, G Allen; Grunau, Ruth E; Johnston, C Celeste; Riddell, Rebecca Pillai; Stinson, Jennifer N; Dol, Justine; Campbell-Yeo, Marsha; McGrath, Patrick J

    2014-01-01

    BACKGROUND AND OBJECTIVES: Pain in Child Health (PICH) is a transdisciplinary, international research training consortium. PICH has been funded since 2002 as a Strategic Training Initiative in Health Research of the Canadian Institutes of Health Research, with contributions from other funding partners and the founding participation of five Canadian universities. The goal of PICH has been to create a community of scholars in pediatric pain to improve child health outcomes. METHODS: Quantitative analyses enumerated PICH faculty, trainees, training activities and scientific outputs. Interviews with PICH stakeholders were analyzed using qualitative methods capturing perceptions of the program’s strengths, limitations, and opportunities for development and sustainability. RESULTS: PICH has supported 218 trainee members from 2002 through 2013, from 14 countries and more than 16 disciplines. The faculty at the end of 2013 comprised nine co-principal investigators, 14 Canadian coinvestigators, and 28 Canadian and international collaborators. Trainee members published 697 peer-reviewed journal articles on pediatric pain through 2013, among other research dissemination activities including conference presentations and webinars. Networks have been established between new and established researchers across Canada and in 13 other countries. Perceptions from stakeholders commended PICH for its positive impact on the development of pediatric pain researchers. Stakeholders emphasized skills and abilities gained through PICH, the perceived impact of PICH training on this research field, and considerations for future training in developing researchers in pediatric pain. CONCLUSIONS: PICH has been successfully developing highly qualified health research personnel within a Canadian and international community of pediatric pain scholarship. PMID:25299474

  10. Attitudes of qualified vs. student mental health nurses towards an individual diagnosed with schizophrenia.

    PubMed

    Linden, Mark; Kavanagh, Rory

    2012-06-01

      This paper is the report of a study which sought to compare the attitudes held by student and qualified mental health nurses towards individuals with schizophrenia in the Republic of Ireland.   Media portrayals of individuals with schizophrenia often include images of aggression and violence. With global initiatives aimed at reducing the stigma and exclusion associated with mental illness, the attitudes of those who care for people with schizophrenia are of particular interest.   A survey was administered to 66 student mental health nurses, and 121 qualified mental health nurses. Participants completed the community attitudes to mental illness scale and the social interaction scale in 2009. Multivariate analysis of variance was used to test for the effects of qualification, work setting, years of experience and education on the measures.   Nurses employed in a community setting held more positive attitudes, when compared with colleagues who worked in an inpatient setting, as measured by the community mental health ideology subscale, indicating their desire to promote community care for individuals with schizophrenia. Nurses working in an inpatient setting held more socially restrictive attitudes indicating that they felt individuals with schizophrenia were dangerous and should be avoided. These findings were statistically significant at the P < 0·05 level.   Mental health nurses must be alerted to the fact that holding negative attitudes may adversely affect the therapeutic relationship and ultimately lead to stigmatization and its negative consequences. © 2011 The Authors Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  11. 42 CFR 495.206 - Timeframe for payment to qualifying MA organizations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Timeframe for payment to qualifying MA... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.206 Timeframe for payment to qualifying MA organizations. (a) CMS makes payment to qualifying MA...

  12. 42 CFR 495.206 - Timeframe for payment to qualifying MA organizations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Timeframe for payment to qualifying MA... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.206 Timeframe for payment to qualifying MA organizations. (a) CMS makes payment to qualifying MA...

  13. 42 CFR 495.206 - Timeframe for payment to qualifying MA organizations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Timeframe for payment to qualifying MA... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.206 Timeframe for payment to qualifying MA organizations. (a) CMS makes payment to qualifying MA...

  14. 42 CFR 495.206 - Timeframe for payment to qualifying MA organizations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Timeframe for payment to qualifying MA... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.206 Timeframe for payment to qualifying MA organizations. (a) CMS makes payment to qualifying MA...

  15. 42 CFR 495.206 - Timeframe for payment to qualifying MA organizations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Timeframe for payment to qualifying MA... RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.206 Timeframe for payment to qualifying MA organizations. (a) CMS makes payment to qualifying MA...

  16. Increased Transparency and Consumer Protections for 2016 Marketplace Plans.

    PubMed

    Brooks-LaSure, Chiquita

    2015-12-01

    The open enrollment period that ends in December 2015 for coverage begin­ning January 2016 marks the third year of the health care exchanges or marketplaces and of coverage through new qualified health plans. This issue brief investigates several key changes to the qualified health plans, with a focus on increased transparency and consumer protections. A new out-of-pocket costs calculator, requirements regarding provider networks, and prescription drug cost-sharing requirements should serve to better inform and improve consumer selection. In addition, several policy changes will help individuals with more severe health needs. These include: improved prescription drug coverage for HIV/ AIDS and other conditions, allowing prescription drugs that are obtained through the "exceptions" process to count toward the out-of-pocket spending cap, more comprehensive and consistent habilitative coverage, and an individual out-of-pocket spending cap within the family out-of-pocket maximum.

  17. 5 CFR 1653.12 - Qualifying legal processes.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Qualifying legal processes. 1653.12 Section 1653.12 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD COURT ORDERS AND LEGAL PROCESSES AFFECTING THRIFT SAVINGS PLAN ACCOUNTS Legal Process for the Enforcement of a Participant's Legal...

  18. 5 CFR 1653.12 - Qualifying legal processes.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Qualifying legal processes. 1653.12 Section 1653.12 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD COURT ORDERS AND LEGAL PROCESSES AFFECTING THRIFT SAVINGS PLAN ACCOUNTS Legal Process for the Enforcement of a Participant's Legal...

  19. 5 CFR 1653.12 - Qualifying legal processes.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Qualifying legal processes. 1653.12 Section 1653.12 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD COURT ORDERS AND LEGAL PROCESSES AFFECTING THRIFT SAVINGS PLAN ACCOUNTS Legal Process for the Enforcement of a Participant's Legal...

  20. 45 CFR 157.205 - Qualified employer participation process in a SHOP.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Qualified employer participation process in a SHOP... TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.205 Qualified employer participation process in a SHOP. (a) General requirements...

  1. 45 CFR 157.205 - Qualified employer participation process in a SHOP.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Qualified employer participation process in a SHOP... TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.205 Qualified employer participation process in a SHOP. (a) General requirements...

  2. 45 CFR 157.205 - Qualified employer participation process in a SHOP.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Qualified employer participation process in a SHOP... TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.205 Qualified employer participation process in a SHOP. (a) General requirements...

  3. Qualified Tuition Savings Programs: The Impact on Household Saving.

    ERIC Educational Resources Information Center

    Coronado, Julia Lynn; McIntosh, Susan Hume

    This study analyzed the impact tuition savings plans are likely to have on household savings. State-sponsored college savings programs rely mainly on tax incentives to motivate parents to save for their children's education in earmarked accounts. The first such programs were prepaid tuition plans, and other types of qualified tuition savings…

  4. Characteristics of Effective Colorectal Cancer Screening Navigation Programs in Federally Qualified Health Centers: a Systematic Review

    PubMed Central

    Domingo, Jermy-Leigh B.; Braun, Kathryn L.

    2017-01-01

    In the U.S., colorectal cancer (CRC) incidence and mortality have declined due to screening and improvements in early detection; however, racial/ethnic disparities in screening and mortality persist. Patient navigation has been shown to be effective in increasing CRC screening prevalence. This systematic review answered three questions about navigation in federally qualified community health centers (FQHCs): 1) Which navigation activities increased CRC screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported screening completion? Findings suggest that navigation services must be tailored to the specific screening test provided. Federally qualified community health centers report difficulty maintaining a current electronic medical records system and sustaining funding; they should establish excellent patient tracking systems (for follow-up and annual rescreening) and establish multiple protocols to facilitate screening completion. With the movement toward patient-centered care models, patient navigation will be integral to FQHCs and their clients. PMID:28238992

  5. Provider communication and role modeling related to patients' perceptions and use of a federally qualified health center-based farmers' market.

    PubMed

    Friedman, Daniela B; Freedman, Darcy A; Choi, Seul Ki; Anadu, Edith C; Brandt, Heather M; Carvalho, Natalia; Hurley, Thomas G; Young, Vicki M; Hébert, James R

    2014-03-01

    Farmers' markets have the potential to improve the health of underserved communities, shape people's perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers' market located at a federally qualified health center. Although provider communication about diet decreased over time, communication strategies included: providing patients with "prescriptions" and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed that the market had potential to improve the health of staff and patients of the federally qualified health center. Provider modeling of healthy behaviors may influence patients' food-related perceptions and dietary behaviors.

  6. Emergency health planning.

    PubMed

    HARDMAN, A C

    1962-12-01

    This paper outlines the development of emergency health planning as a function of government. Ten provinces have the basic responsibility for the organization, preparation and operation of medical, nursing, hospital and public health services in an emergency. The Department of National Health and Welfare is responsible for the provision of advice and assistance to the provincial and municipal governments in such matters. Eight provinces have now hired full-time planning staffs to co-ordinate the health planning of the Provincial Departments of Health and Provincial Emergency Measures Organization.Four major programs have been established. The first program provides for the continuity of leadership and guidance by health authorities at the federal, provincial and municipal level. Essential records have been developed and emergency legislation prepared. This program, however, will be of little use unless health services are organized at the municipal level. In this organizational program, advice and assistance have been provided to existing hospitals and departments of health in the conduct of disaster planning. The efforts of these agencies are co-ordinated by municipal health authorities into a community disaster plan. The third program deals with information and education of the general public and the health workers. This program is designed to make the family unit self-sufficient for up to seven days and the health worker prepared to undertake his emergency role. The first three programs are directed to the organization and training of manpower; the fourth program provides the necessary supplies. From the national medical stockpile of $18,000,000, some $12,000,000 has been received, packaged for long-term storage and distributed to regional depots across the country. To ensure their ready availability in time of emergency an agreement has been reached with seven provinces for the release of hospital disaster kits.

  7. 42 CFR 436.121 - Qualified family members.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Qualified family members. 436.121 Section 436.121 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS Mandatory...

  8. Introduction to Health Planning.

    ERIC Educational Resources Information Center

    Bergwall, David F.; And Others

    This fundamental text is designed for students of both health care administration and comprehensive health planning. It is intended as a resource on the theory and process of health project planning with some mention of possible sources for further exploration. The emphasis is on how to develop a plan when the planner also has the authority to…

  9. Advanced research to qualify man for long term weightlessness.

    NASA Technical Reports Server (NTRS)

    Jones, W. L.

    1972-01-01

    NASA is in the process of conducting a broad program of research and development of technology to qualify, support, and permit the successful use of man in long-term space flight. The technological tasks include human engineering, extravehicular engineering, life support, and human research to assess the effect of space stresses on human physiology and psychology. Various testing techniques that are being used may have future relevance to world health. These include a biocybernetic approach to the study of cardiovascular stresses, measurement of blood flow by means of the Doppler effect, and a device for simulating radiation dosages similar to those produced in solar flares. The planned program includes a study of both humans and animals.

  10. [Planning driven by health priorities. Master planning criteria].

    PubMed

    Tresserras, Ricard

    2008-12-01

    With the aim of responding to a number of problems detected in health plan evaluations, a new direction has been proposed in Catalonia which would lead to the improved unification of the strategic and operational approaches, and leadership. The master plans that tackle those health problems with the greatest impact were created along these lines. This article presents the most salient aspects of the master plans for oncology, circulatory diseases, mental health and addictions, immigration and the field of social healthcare. Their organisational structure, mission and functions are presented, commenting on the prioritisation of activities and the principal benchmark elements of the healthcare model in the definition of planning criteria for services incorporated into the Health Map. Finally, mention is made of the evaluation procedures. The in-depth study of priority settings has resulted in significant progress towards unifying health and service planning.

  11. Self-insured health plans

    PubMed Central

    McDonnell, Patricia; Guttenberg, Abbie; Greenberg, Leonard; Arnett, Ross H.

    1986-01-01

    Nationwide, 8 percent of all employment-related health plans were self-insured in 1984, which translates into more than 175,000 self-insured plans according to our latest study of independent health plans. The propensity of an organization to self-insure differs primarily by its size, with large establishments more likely to self-insure. In the overwhelming majority of cases, the self-insured benefit was hospital and/or medical. Among employers who self-insure, 23 percent self-administer, and the remaining 77 percent hire a commercial insurance company, Blue Cross/Blue Shield plan, or an independent third-party administrator to administer the health plan. PMID:10312008

  12. 42 CFR 435.1007 - Categorically needy, medically needy, and qualified Medicare beneficiaries.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Categorically needy, medically needy, and qualified Medicare beneficiaries. 435.1007 Section 435.1007 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Limitations on Ffp § 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries. (a...

  13. 26 CFR 1.401(a)-14 - Commencement of benefits under qualified trusts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Commencement of benefits under qualified trusts.... § 1.401(a)-14 Commencement of benefits under qualified trusts. (a) In general. Under section 401(a)(14... section 401 unless the plan of which such trust is a part provides that the payment of benefits under the...

  14. Plan Selection in the Non-Group Market in the First Year of the Health Insurance Marketplace.

    PubMed

    Gillen, Emily; Lich, Kristen Hassmiller; Trantham, Laurel; Silberman, Pam; Weinberger, Morris; Holmes, Mark

    2017-01-01

    BACKGROUND The Affordable Care Act (ACA)-created Marketplaces reduced barriers to entry in the non-group health insurance market. Although tax credits were available to individuals who enrolled in qualified health plans (QHPs) beginning in 2014, many individuals chose not to switch plans. We examined characteristics associated with switching from a non-ACA compliant plan to a QHP in 2014 and, conditional on switching, the characteristics associated with selection of a specific plan level. METHODS Using claims data from a large commercial insurer, we examined characteristics associated with switching to a QHP in 2014. For those who did switch, we used a multinomial logit model to estimate odds of selecting different metal levels-representing varying degrees of coverage-for a group of the highest and lowest risk individuals. RESULTS We found individuals most likely to benefit from the premium and benefit requirements on QHPs were more likely to switch to QHPs. Individuals at high-risk for high health care expenditures who had advance premium tax credits (APTCs) had lower odds of choosing a less generous plan compared to individuals without APTCs (odds of bronze plan over silver: 0.40, CI: 0.30 - 0.55), while individuals at low-risk of being high cost with APTCs were more likely to select a plan with a lower premium (odds bronze plan over silver: 1.35, CI: 1.09 - 1.66). LIMITATIONS This study was conducted with data from 1 health plan, limiting its national generalizability; however, this study is a good representation of activity within the state. CONCLUSIONS APTCs are important for ensuring that less healthy individuals are able to afford adequate levels of coverage. ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  15. Access to Oral Health Care: The Role of Federally Qualified Health Centers in Addressing Disparities and Expanding Access

    PubMed Central

    Shi, Leiyu; Hayashi, Arthur Seiji; Sharma, Ravi; Daly, Charles; Ngo-Metzger, Quyen

    2013-01-01

    Objectives. We examined utilization, unmet need, and satisfaction with oral health services among Federally Qualified Health Center patients. We examined correlates of unmet need to guide efforts to increase access to oral health services among underserved populations. Methods. Using the 2009 Health Center Patient Survey, we performed multivariate logistic regressions to examine factors associated with access to dental care at health centers, unmet need, and patient experience. Results. We found no racial or ethnic disparities in access to timely oral health care among health center patients; however, uninsured patients and those whose insurance does not provide dental coverage experienced restricted access and greater unmet need. Slightly more than half of health center patients had a dental visit in the past year, but 1 in 7 reported that their most recent visit was at least 5 years ago. Among health center patients who accessed dental care at their health center, satisfaction was high. Conclusions. These results underscore the critical role that health centers play in national efforts to improve oral health status and eliminate disparities in access to timely and appropriate dental services. PMID:23327254

  16. 29 CFR 2520.104-46 - Waiver of examination and report of an independent qualified public accountant for employee...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include within...

  17. 29 CFR 2520.104-46 - Waiver of examination and report of an independent qualified public accountant for employee...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include within...

  18. 29 CFR 2520.104-46 - Waiver of examination and report of an independent qualified public accountant for employee...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include within...

  19. 29 CFR 2520.104-46 - Waiver of examination and report of an independent qualified public accountant for employee...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include within...

  20. 29 CFR 2520.104-46 - Waiver of examination and report of an independent qualified public accountant for employee...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... qualified public accountant for employee benefit plans with fewer than 100 participants. 2520.104-46 Section... Requirements § 2520.104-46 Waiver of examination and report of an independent qualified public accountant for... public accountant to conduct an examination of the financial statements of the plan; (2) Include within...

  1. How health plans promote health IT to improve behavioral health care.

    PubMed

    Quinn, Amity E; Reif, Sharon; Evans, Brooke; Creedon, Timothy B; Stewart, Maureen T; Garnick, Deborah W; Horgan, Constance M

    2016-12-01

    Given the large numbers of providers and enrollees with which they interact, health plans can encourage the use of health information technology (IT) to advance behavioral health care. The manner and extent to which commercial health plans promote health IT to improve behavioral health care is unknown. This study aims to address that gap. Cross-sectional study. Data are from a nationally representative survey of commercial health plans regarding administrative and clinical dimensions of behavioral health services in 2010. Data are weighted to be representative of commercial managed care products in the United States (n = 8427; 88% response rate). Approaches within the domains of provider support, access to care, and assessment and treatment were investigated as examples of how health plans can promote health IT to improve behavioral health care delivery. Health plans were using health IT approaches in each domain. About a quarter of products offered financial support for electronic health records, but technical assistance was rare. Primary care providers could bill for e-mail contact with patients for behavioral health in about a quarter of products. Few products offered member-provider e-mail, and none offered online appointment scheduling. However, online referral systems and online provider directories were common, and nearly all offered an online self-assessment tool; most offered online counseling and online personalized responses to questions or problems. In 2010, commercial health plans encouraged the use of health IT strategies for behavioral health care. Health plans have an important role to play for increasing health IT as a tool for behavioral health care.

  2. Accessing specialty behavioral health treatment in private health plans.

    PubMed

    Merrick, Elizabeth L; Horgan, Constance M; Garnick, Deborah W; Reif, Sharon; Stewart, Maureen T

    2009-10-01

    Connecting people to mental health and substance abuse services is critical, given the extent of unmet need. The way health plans structure access to care can play a role. This study examined treatment entry procedures for specialty behavioral health care in private health plans and their relationship with behavioral health contracting arrangements, focusing primarily on initial entry into outpatient treatment. The data source was a nationally representative health plan survey on behavioral health services in 2003 (N = 368 plans with 767 managed care products; 83% response rate). Most health plan products initially authorized six or more outpatient visits if authorization was required, did not routinely conduct telephonic clinical assessment, had standards for timely access, and monitored wait time. Products with carve-outs differed on several treatment entry dimensions. Findings suggest that health plans focus on timely access and typically do not heavily manage initial entry into outpatient treatment.

  3. 7 CFR 1466.11 - Technical services provided by qualified personnel not affiliated with USDA.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... not affiliated with USDA. 1466.11 Section 1466.11 Agriculture Regulations of the Department of... provided by qualified personnel not affiliated with USDA. (a) NRCS may use the services of qualified TSPs... affiliated with USDA may include, but are not limited to: conservation planning; conservation practice survey...

  4. 7 CFR 1466.11 - Technical services provided by qualified personnel not affiliated with USDA.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... not affiliated with USDA. 1466.11 Section 1466.11 Agriculture Regulations of the Department of... provided by qualified personnel not affiliated with USDA. (a) NRCS may use the services of qualified TSPs... affiliated with USDA may include, but are not limited to: conservation planning; conservation practice survey...

  5. 26 CFR 1.46-5 - Qualified progress expenditures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 1 2011-04-01 2009-04-01 true Qualified progress expenditures. 1.46-5 Section 1... planning, designing, preparing blueprints, exploring, or securing financing. (ii) The determination of the... construction also does not include research and development activities in a laboratory or experimental setting...

  6. 26 CFR 1.46-5 - Qualified progress expenditures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified progress expenditures. 1.46-5 Section 1... planning, designing, preparing blueprints, exploring, or securing financing. (ii) The determination of the... construction also does not include research and development activities in a laboratory or experimental setting...

  7. 26 CFR 1.46-5 - Qualified progress expenditures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 1 2014-04-01 2013-04-01 true Qualified progress expenditures. 1.46-5 Section 1... planning, designing, preparing blueprints, exploring, or securing financing. (ii) The determination of the... construction also does not include research and development activities in a laboratory or experimental setting...

  8. Assessing health plan ownership.

    PubMed

    Eyestone, Katherine M; Moore, Keith D; Coddington, Dean C

    2014-01-01

    In the emerging healthcare environment, providers will require many capabilities of traditional health plans simply to remain viable. Providers that are contemplating entering the health plan business should consider the likely strategic, structural, and cultural effects of such a strategy on their organizations. Providers that own health plans will need to determine how they will differentiate themselves in the markets to foster patient loyalty and which insurance lines of business they will pursue (e.g., individual, small group, large group, or other).

  9. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. [55 FR 36820...

  10. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. [55 FR 36820...

  11. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. [55 FR 36820...

  12. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. [55 FR 36820...

  13. 42 CFR 436.128 - Coverage for certain qualified aliens.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Coverage for certain qualified aliens. 436.128... Mandatory Coverage of the Categorically Needy § 436.128 Coverage for certain qualified aliens. The agency... § 440.255(c) of this chapter to those aliens described in § 436.406(c) of this subpart. [55 FR 36820...

  14. 42 CFR 68.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) LOAN REPAYMENT PROGRAMS (LRPs) § 68.9 What loans qualify for...) Undergraduate, graduate, and health professional school tuition expenses; (b) Other reasonable educational...

  15. 42 CFR 68.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) LOAN REPAYMENT PROGRAMS (LRPs) § 68.9 What loans qualify for...) Undergraduate, graduate, and health professional school tuition expenses; (b) Other reasonable educational...

  16. Health measurement using the ICF: Test-retest reliability study of ICF codes and qualifiers in geriatric care

    PubMed Central

    Okochi, Jiro; Utsunomiya, Sakiko; Takahashi, Tai

    2005-01-01

    Background The International Classification of Functioning, Disability and Health (ICF) was published by the World Health Organization (WHO) to standardize descriptions of health and disability. Little is known about the reliability and clinical relevance of measurements using the ICF and its qualifiers. This study examines the test-retest reliability of ICF codes, and the rate of immeasurability in long-term care settings of the elderly to evaluate the clinical applicability of the ICF and its qualifiers, and the ICF checklist. Methods Reliability of 85 body function (BF) items and 152 activity and participation (AP) items of the ICF was studied using a test-retest procedure with a sample of 742 elderly persons from 59 institutional and at home care service centers. Test-retest reliability was estimated using the weighted kappa statistic. The clinical relevance of the ICF was estimated by calculating immeasurability rate. The effect of the measurement settings and evaluators' experience was analyzed by stratification of these variables. The properties of each item were evaluated using both the kappa statistic and immeasurability rate to assess the clinical applicability of WHO's ICF checklist in the elderly care setting. Results The median of the weighted kappa statistics of 85 BF and 152 AP items were 0.46 and 0.55 respectively. The reproducibility statistics improved when the measurements were performed by experienced evaluators. Some chapters such as genitourinary and reproductive functions in the BF domain and major life area in the AP domain contained more items with lower test-retest reliability measures and rated as immeasurable than in the other chapters. Some items in the ICF checklist were rated as unreliable and immeasurable. Conclusion The reliability of the ICF codes when measured with the current ICF qualifiers is relatively low. The result in increase in reliability according to evaluators' experience suggests proper education will have positive

  17. 45 CFR 157.200 - Eligibility of qualified employers to participate in a SHOP.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... in a SHOP. 157.200 Section 157.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.200 Eligibility of qualified employers to participate in a SHOP. (a...

  18. 45 CFR 157.200 - Eligibility of qualified employers to participate in a SHOP.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... in a SHOP. 157.200 Section 157.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.200 Eligibility of qualified employers to participate in a SHOP. (a...

  19. 45 CFR 157.200 - Eligibility of qualified employers to participate in a SHOP.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... in a SHOP. 157.200 Section 157.200 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION Standards for Qualified Employers § 157.200 Eligibility of qualified employers to participate in a SHOP. (a...

  20. Oral Health Integration Into a Pediatric Practice and Coordination of Referrals to a Colocated Dental Home at a Federally Qualified Health Center.

    PubMed

    Sengupta, Nandini; Nanavati, Sonal; Cericola, Maria; Simon, Lisa

    2017-10-01

    We have integrated preventive oral health measures into preventive care visits for children at a federally qualified health center in Boston, Massachusetts. The program, started in 2015, covers 3400 children and has increased universal caries risk screening in primary care to 85%, fluoride varnish application rates to 80%, and referrals to a dental home to 35%. We accomplished this by minimizing pressures on providers' workflow, empowering medical assistants to lead the initiative, and utilizing data-driven improvement strategies, alongside colocated coordinated care.

  1. 26 CFR 1.414(r)-1 - Requirements applicable to qualified separate lines of business.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating qualified...

  2. Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured.

    PubMed

    DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah

    2014-01-01

    Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.

  3. 36 CFR 908.13 - Rights of Qualified Persons.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... POLICY AND PROCEDURES TO FACILITATE THE RETENTION OF DISPLACED BUSINESSES AND RESIDENTS IN THE... leasing plan which are, in the Corporation's opinion, major. (c) Each Qualified Person on the List, who is... opportunity to occupy Newly Developed Space shall not be limited to the square on which its previous location...

  4. Insufficient dollars and qualified personnel to meet United States mental health needs.

    PubMed

    Weil, Thomas P

    2015-04-01

    The American populace currently supports the need for providing additional mental health services for adolescents who frequently express anger and mood instability and maybe are at risk for major psychiatric disorders and behavioral problems; Vietnam, Iraqi, and Afghanistan veterans or military personnel still on duty diagnosed with posttraumatic stress disorder, depression, or other similar combat-related disabilities; the approximately 1 million prisoners currently incarcerated primarily because of substance abuse and needing medically related rehabilitative services; and senior citizens who experience dementia and depression and require improved therapeutics. The problems outlined herein are as follows: far too limited monies are being spent for mental health services (5.6% of total US expenditures for health or roughly one fifth of what is consumed for hospital care); effective therapies are often lacking; and there is a shortage of qualified mental health personnel except in upscale urban and suburban areas. Unfortunately, these problems are so immense that, even with enhanced prioritization of our available resources, they are still not entirely solvable. The American public may continue to impart lip service when attempting to respond to our nation's mental health needs or may decide to spend vastly more money for such care. The latter choice may not be forthcoming in the near future for various cultural-societal-clinical-fiscal reasons.

  5. 77 FR 28883 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ...-2012-0004] Draft Public Health Action Plan--A National Public Health Action Plan for the Detection...), Department of Health and Human Services (HHS). ACTION: Notice of availability and request for public comment..., Division of Reproductive Health, Attn: National Public Health Action Plan for the Detection, Prevention...

  6. 42 CFR 417.410 - Qualifying conditions: General rules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... groups and to deliver a specified comprehensive range of high quality services efficiently, effectively... services, and a quality assurance program. (c) Standards. Generally, each qualifying condition is... Section 417.410 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  7. 5 CFR 1653.2 - Qualifying retirement benefits court orders.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Qualifying retirement benefits court orders. 1653.2 Section 1653.2 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD COURT ORDERS AND LEGAL PROCESSES AFFECTING THRIFT SAVINGS PLAN ACCOUNTS Retirement Benefits Court Orders § 1653...

  8. Retrospective database analysis of the impact of prior authorization for type 2 diabetes medications on health care costs in a Medicare Advantage Prescription Drug Plan population.

    PubMed

    Bergeson, Joette Gdovin; Worley, Karen; Louder, Anthony; Ward, Melea; Graham, John

    2013-06-01

    Health plans and pharmacy benefit managers have implemented utilization management strategies for newer type 2 diabetes mellitus (T2DM) medications to control pharmacy expenditures. Little is known about the impact of utilization management strategies on overall health care costs and subsequent use of T2DM medications among members who request, but do not receive, a T2DM medication requiring prior authorization (PA).  To examine the relationship between the receipt of a T2DM medication requiring PA, health care costs, and subsequent treatment for T2DM.  A retrospective cohort study using pharmacy, medical, and laboratory claims data was conducted among Medicare Advantage Prescription Drug plan members with a denied claim for a T2DM medication requiring PA (sitagliptin, a dipeptidyl peptidase-4 inhibitor [DPP-4i], and exenatide, an incretin mimetic) between January 1, 2008, and June 30, 2009. Subjects were required to have 12 months of continuous enrollment both before and after the index date. The entire study period was 24 months in duration, including a 12-month pre-index and 12-month post-index period. Three cohorts were identified: 1 that received a medication requiring PA (denied claim, subsequent fill) and 2 nonfilling control groups. Both control groups requested a medication requiring PA, as evidenced by the denied claim, but neither received the medication, either because the medication was not authorized or the member chose not to fill. Claims-based estimates were used to infer whether the individual likely met the criteria for PA, with 1 control group designated as having met the claims-based criteria (qualifying nonfilling cohort) and the other not having done so (nonqualifying nonfilling cohort.) The primary endpoint evaluated was the relationship between PA medication fill status and plan-paid costs (medical [including laboratory] and pharmacy) over the 12-month post-denial period, with generalized linear models adjusting for key covariates

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

    PubMed

    2013-02-25

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

  10. 17 CFR 240.3b-8 - Definitions of “Qualified OTC Market Maker, Qualified Third Market Maker” and “Qualified Block...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Market Maker, Qualified Third Market Makerâ and âQualified Block Positionerâ. 240.3b-8 Section 240.3b-8... “Qualified Block Positioner”. For the purposes of Regulation U under the Act (12 CFR part 221): (a) The term... inventory turnover in such security. (c) The term Qualified Block Positioner means a dealer who (1) is a...

  11. Health Sciences Planning.

    ERIC Educational Resources Information Center

    Nelson, Arthur D.

    "How will recent health care trends affect health sciences campus planning?" was the question put forth by Dr. Nelson at the Society of College and University Planners conference, August 12, 1970. He outlined the status of health care in this country, including the financial state of medical affairs, particularly for university health sciences…

  12. 26 CFR 54.4980B-3 - Qualified beneficiaries.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... employee, or a dependent child of the covered employee; or (ii) Any child who is born to or placed for... any spouse, surviving spouse, or dependent child of such a covered employee if, on the day before the bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

  13. 26 CFR 54.4980B-3 - Qualified beneficiaries.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... employee, or a dependent child of the covered employee; or (ii) Any child who is born to or placed for... any spouse, surviving spouse, or dependent child of such a covered employee if, on the day before the bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

  14. [Occupational health protection in business economics--business plan for health intervention].

    PubMed

    Rydlewska-Liszkowska, Izabela

    2011-01-01

    One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees

  15. 77 FR 38296 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-27

    ...-2012-0004] Draft Public Health Action Plan--A National Public Health Action Plan for the Detection...), Department of Health and Human Services (HHS). ACTION: Extension of public comment period. SUMMARY: On May 16... National Public Health Action Plan for the Detection, Prevention, and Management of Infertility (77 FR...

  16. Educating the Public About Health: A Planning Guide. Health Planning Methods and Technology Series.

    ERIC Educational Resources Information Center

    Sullivan, Daniel

    A comprehensive overview of major issues involved in educating the public about health, with emphasis on methods and approaches designed to foster community participation in health planning, is presented in this guide. It is intended to provide ideas for those engaged in health education program development with ideas for use in planning,…

  17. 26 CFR 1.414(r)-7 - Determination of the employees of an employer's qualified separate lines of business.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE...-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's qualified... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single qualified...

  18. 42 CFR 68c.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Program, Public Health and National Health Service Corps Scholarship Training Program, National Health..., INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.9 What loans qualify for repayment? (a) The CIR-LRP will repay...

  19. 42 CFR 68c.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Program, Public Health and National Health Service Corps Scholarship Training Program, National Health..., INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY RESEARCH LOAN REPAYMENT PROGRAM § 68c.9 What loans qualify for repayment? (a) The CIR-LRP will repay...

  20. 42 CFR 68c.9 - What loans qualify for repayment?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What loans qualify for repayment? 68c.9 Section 68c.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT CONTRACEPTION AND INFERTILITY...

  1. 75 FR 45584 - Planning and Establishment of State-Level Exchanges; Request for Comments Regarding Exchange...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-03

    ... Act): (1) Facilitate the purchase of qualified health plans (QHPs); (2) provide for the establishment... Federal government for their State? When will this decision be made? Can planning grants assist in identifying and assessing relevant factors and making this decision? 2. To what extent have States already...

  2. Behavioral Health Services in the Changing Landscape of Private Health Plans.

    PubMed

    Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

    2016-06-01

    Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

  3. Status report, The Public Health and Planning 101 project: strengthening collaborations between the public health and planning professions.

    PubMed

    Mahendra, A; Vo, T; Einstoss, C; Weppler, J; Gillen, P; Ryan, L; Haley, K

    2017-01-01

    Land use planning is a complex field comprised of legislation, policies, processes and tools. A growing body of evidence supports the relationship between land use planning decisions, community design and health. The built environment has been shown to be associated with physical inactivity, obesity, cardiovascular disease, respiratory disease and mental illness. Consequently, there is a growing interest within public health to work with planners on land use planning initiatives such as official plans and transportation master plans. Two surveys were developed: one for public health professionals and the other for planning professionals (survey questions available upon request to the corresponding author). The surveys were pilot tested in two separate focus group sessions with public health and planning professionals. Focus group volunteers helped to validate the surveys by verifying survey questions, design and overall flow. In early 2012, 304 public health professionals and 301 planning professionals completed the two separate surveys, comprising the total survey respondents for each respective profession used to calculate proportions. The survey results represent a convenience sample and are not generalizable to the entire population of public health and planning professionals in Ontario. Results compare survey responses from both groups where appropriate. Most respondents worked either as public health staff (78%) or planners/senior planners (58%). A smaller percentage of public health and planning professionals worked either as managers (15% and 11%, respectively) or directors (5% and 9%, respectively). Health is associated with how communities are planned and built, and the services and resources provided within them. Inspired by the results of our survey and based on user feedback from the pilot tests, a free online training program entitled "Public Health and Planning 101: An Online Course for Public Health and Planning Professionals to Create Healthier

  4. What do health coaches do? Direct observation of health coach activities during medical and patient-health coach visits at 3 federally qualified health centers.

    PubMed

    Johnson, Christopher; Saba, George; Wolf, Jessica; Gardner, Heather; Thom, David H

    2018-05-01

    To examine activities of health coaches during patient medical visits and when meeting one-on-one with patients at 3 urban federally qualified health centers. Encounters were videotaped and transcribed. Data was analyzed using a matrix analysis approach that allowed a priori identification of expected categories of activity, based on the health coach training model and previously developed conceptual framework, which were modified based on activities observed. A total of 10 medical visits (patient, clinician and health coach), and 8 patient-coach visits were recorded. We identified 9 categories common to both medical and patient-coach visits and 2 categories unique to the medical visit. While observed activities were generally consistent with expected categories, some activities were observed infrequently or not at all. We also observed additional activity categories, including information gathering and personal conversation. The average amount of time spent on some categories of coaching activities differed substantially between medical visits and patient-coach visits. Health coaching activities observed differed in several respects to those expected, and differed between medical visits and coaching only visits. These results provide insights into health coaching behaviors that can be used to inform training and improve utilization of health coaches in practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. 42 CFR 417.101 - Health benefits plan: Basic health services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Health benefits plan: Basic health services. 417.101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS...

  6. 42 CFR 417.101 - Health benefits plan: Basic health services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Health benefits plan: Basic health services. 417.101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS...

  7. High-deductible health plans.

    PubMed

    2014-05-01

    High-deductible health plans (HDHPs) are insurance policies with higher deductibles than conventional plans. The Medicare Prescription Drug Improvement and Modernization Act of 2003 linked many HDHPs with tax-advantaged spending accounts. The 2010 Patient Protection and Affordable Care Act continues to provide for HDHPs in its lower-level plans on the health insurance marketplace and provides for them in employer-offered plans. HDHPs decrease the premium cost of insurance policies for purchasers and shift the risk of further payments to the individual subscriber. HDHPs reduce utilization and total medical costs, at least in the short term. Because HDHPs require out-of-pocket payment in the initial stages of care, primary care and other outpatient services as well as elective procedures are the services most affected, whereas higher-cost services in the health care system, incurred after the deductible is met, are unaffected. HDHPs promote adverse selection because healthier and wealthier patients tend to opt out of conventional plans in favor of HDHPs. Because the ill pay more than the healthy under HDHPs, families with children with special health care needs bear an increased cost burden in this model. HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care.This policy statement provides background information on HDHPs, discusses the implications for families and pediatric care providers, and suggests courses of action. Copyright © 2014 by the American Academy of Pediatrics.

  8. Is health systems integration being advanced through Local Health District planning?

    PubMed

    Saunders, Carla; Carter, David J

    2017-05-01

    Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of

  9. Successful preceptorship of newly qualified nurses.

    PubMed

    Price, Bob

    There is widespread recognition that many newly qualified nurses find it difficult to make the transition from completing their university course to taking up their first registered nurse post. Preceptorship programmes during the first year of registered nurse practice have been recommended by the Department of Health. Preceptors have an important role in ensuring successful transition of the newly qualified nurse; however they also require practical guidance on how best to support the nurse. This article identifies aspects that need to be considered when guiding a registered nurse colleague rather than a student. Preceptorship concerns four main areas: orientation to patients and services provided locally, real-time clinical reasoning, skill review and refinement, and socialisation within the healthcare team. The article will explore each of these areas.

  10. Guidelines for Analysis of Socio-Cultural Factors in Health. Volume 4: Socio-Cultural Factors in Health Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Fraser, Renee White

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this fourth of ten manuals in the International Health Planning Methods Series deals with sociocultural, psychological, and behavioral factors that affect the planning…

  11. Eliciting consumer preferences for health plans.

    PubMed

    Booske, B C; Sainfort, F; Hundt, A S

    1999-10-01

    To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important. A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period. We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them. Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed. The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes. Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.

  12. Forward Plan for Health

    ERIC Educational Resources Information Center

    Graham, Robert

    1976-01-01

    The forward plan for health for 1978-1982 represents the Public Health Service's view of the health world for the next five-year period. Six main themes are outlined: knowledge development; prevention of illness; improving the health-care system; assuring the quality of health care; health-care financing; and tracking and evaluation. (LBH)

  13. [Strategic planning and mental health policies].

    PubMed

    Tonini, Nelsi Salete; Kantorski, Luciane Prado

    2007-03-01

    This article discusses how mental health policies are prioritized in the process of strategic planning of mental health actions within the context of Brazilian psychiatric reform. The theoretical support of strategic planning provide health professionals, particularly those involved in metal health, with elements fir deepening discussions on existing mental health actions and policies.

  14. 26 CFR 20.2039-2 - Annuities under “qualified plans” and section 403(b) annuity contracts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Annuities under âqualified plansâ and section 403(b) annuity contracts. 20.2039-2 Section 20.2039-2 Internal Revenue INTERNAL REVENUE SERVICE... AUGUST 16, 1954 Gross Estate § 20.2039-2 Annuities under “qualified plans” and section 403(b) annuity...

  15. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for qualifying MA-EPs and qualifying MA...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... methodological proposal for estimating the portion of each qualifying MA EP's salary or revenue attributable to... enrollees of the MA organization in the payment year. The methodological proposal— (i) Must be approved by... account for the MA-enrollee related Part B practice costs of the qualifying MA EP. (iii) Methodological...

  16. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for qualifying MA-EPs and qualifying MA...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... methodological proposal for estimating the portion of each qualifying MA EP's salary or revenue attributable to... enrollees of the MA organization in the payment year. The methodological proposal— (i) Must be approved by... account for the MA-enrollee related Part B practice costs of the qualifying MA EP. (iii) Methodological...

  17. 76 FR 43237 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-20

    ... General OMB Office of Management and Budget PHS Act Public Health Service Act QHP Qualified Health Plan...) performs some of the issuer's management functions under contract or delegation. Thus, CMS would permit a... billing, and case management from a health insurance issuer that existed on July 16, 2009, as long as the...

  18. Consumer perceptions of graded, graphic and text label presentations for qualified health claims.

    PubMed

    Kapsak, Wendy Reinhardt; Schmidt, David; Childs, Nancy M; Meunier, John; White, Christy

    2008-03-01

    On December 18, 2002, the Food and Drug Administration (FDA) announced the Consumer Health Information for Better Nutrition Initiative. The initiative's goal is to make available more and better information about conventional foods and dietary supplements to help Americans improve their health and reduce risk of disease by making sound dietary decisions. It included a rating system to assess the "weight of the publicly available evidence." It assigns one of four ranked levels to the claim thus resulting in qualified health claims. Two phases of research were conducted by the International Food Information Council (IFIC) Foundation. Qualitative research to assess consumer understanding, vocabulary, and familiarity with claims helped with the design and orientation of the second quantitative research phase. The quantitative phase employed a Web-based survey. The claim formats included: report card graphic, report card text, embedded claim text, point-counterpoint, structure/function claim, and nutrient content claim. Respondents were asked to rate the product for perceived strength of scientific evidence provided to support the claim, and questions about the product's perceived healthfulness, quality, safety, and purchase intent. Consumers found it difficult to discriminate across four levels and showed inclination to project the scientific validity grade onto other product attributes. Consumers showed preference for simpler messages.

  19. A public health hazard mitigation planning process.

    PubMed

    Griffith, Jennifer M; Kay Carpender, S; Crouch, Jill Artzberger; Quiram, Barbara J

    2014-01-01

    The Texas A&M Health Science Center School of Rural Public Health, a member of the Training and Education Collaborative System Preparedness and Emergency Response Learning Center (TECS-PERLC), has long-standing partnerships with 2 Health Service Regions (Regions) in Texas. TECS-PERLC was contracted by these Regions to address 2 challenges identified in meeting requirements outlined by the Risk-Based Funding Project. First, within Metropolitan Statistical Areas, there is not a formal authoritative structure. Second, preexisting tools and processes did not adequately satisfy requirements to assess public health, medical, and mental health needs and link mitigation strategies to the Public Health Preparedness Capabilities, which provide guidance to prepare for, respond to, and recover from public health incidents. TECS-PERLC, with its partners, developed a framework to interpret and apply results from the Texas Public Health Risk Assessment Tool (TxPHRAT). The 3-phase community engagement-based TxPHRAT Mitigation Planning Process (Mitigation Planning Process) and associated tools facilitated the development of mitigation plans. Tools included (1) profiles interpreting TxPHRAT results and identifying, ranking, and prioritizing hazards and capability gaps; (2) a catalog of intervention strategies and activities linked to hazards and capabilities; and (3) a template to plan, evaluate, and report mitigation planning efforts. The Mitigation Planning Process provided a framework for Regions to successfully address all funding requirements. TECS-PERLC developed more than 60 profiles, cataloged and linked 195 intervention strategies, and developed a template resulting in 20 submitted mitigation plans. A public health-focused, community engagement-based mitigation planning process was developed by TECS-PERLC and successfully implemented by the Regions. The outcomes met all requirements and reinforce the effectiveness of academic practice partnerships and importance of

  20. Employer health care plan design and its effect on plan costs.

    PubMed

    Custer, W S

    1991-01-01

    This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.

  1. 42 CFR 495.202 - Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals. 495.202 Section 495.202 Public Health CENTERS FOR MEDICARE... Advantage (MA) Organizations § 495.202 Identification of qualifying MA organizations, MA-EPs and MA...

  2. 42 CFR 495.202 - Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals. 495.202 Section 495.202 Public Health CENTERS FOR MEDICARE... Advantage (MA) Organizations § 495.202 Identification of qualifying MA organizations, MA-EPs and MA...

  3. 42 CFR 495.202 - Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals. 495.202 Section 495.202 Public Health CENTERS FOR MEDICARE... Advantage (MA) Organizations § 495.202 Identification of qualifying MA organizations, MA-EPs and MA...

  4. 42 CFR 495.202 - Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals. 495.202 Section 495.202 Public Health CENTERS FOR MEDICARE... Advantage (MA) Organizations § 495.202 Identification of qualifying MA organizations, MA-EPs and MA...

  5. 42 CFR 495.202 - Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Identification of qualifying MA organizations, MA-EPs and MA-affiliated eligible hospitals. 495.202 Section 495.202 Public Health CENTERS FOR MEDICARE... Advantage (MA) Organizations § 495.202 Identification of qualifying MA organizations, MA-EPs and MA...

  6. CONSUMER ASSESSMENT OF HEALTH PLANS SURVEY (CAHPS)

    EPA Science Inventory

    This 5-year project has been used for consumers to identify the best health care plans and services for their needs. The goals of the Consumer Assessment of Health Plans (CAHPS?) are to (1) develop and test questionnaires that assess health plans and services, (2) produce easily ...

  7. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT...

  8. 21 CFR 516.141 - Qualified expert panels.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS NEW ANIMAL DRUGS FOR MINOR USE AND MINOR SPECIES Index of Legally... of requesting the addition of a new animal drug to the index. A qualified expert panel may not be...

  9. Federal supports for state oral health plans.

    PubMed

    Edelstein, Burton L

    2012-01-01

    The past decade has witnessed both a proliferation of state oral health plans that include very specific proposals for action and an emergence of federal laws that include support for oral health. This paper provides an overview of state oral health priorities for action as reflected in 40 oral health plans that were developed independently by states. It examines four federal laws - the 2002 Safety Net Improvement Act, the 2009 CHIP Reauthorization Act, the 2009 economic stimulus law, and the 2010 health reform law - to identify opportunities for alignment with action steps proposed in state plans. This analysis identifies 23 categories of activity proposed by states in their action plans and determines that all but six of these activities are now supported by one or more of these four federal laws. State activities undertaken through grants provided under the 2002 Safety Net Improvement Act are analyzed as an example of how states can leverage federal legislation to advance their oral health plans. The paper concludes with consideration of the steps needed for states to promote their oral health plans by leveraging the full capacity of federal legislation. © 2012 American Association of Public Health Dentistry.

  10. Intersectoral planning for city health development.

    PubMed

    Green, Geoff

    2012-04-01

    The article reviews the evolution and process of city health development planning (CHDP) in municipalities participating in the European Network of Healthy Cities organized by the European Region of the World Health Organization. The concept of CHDP combines elements from three theoretical domains: (a) health development, (b) city governance, and (c) urban planning. The setting was the 77 cities which participated in Phase IV (2003-2008) of the network. Evidence was gathered principally from a general evaluation questionnaire sent to all network cities. CHDPs are strategic documents giving direction to municipalities and partner agencies. Analysis revealed a trend away from "classic" CHDPs with a primary focus on health development towards ensuring a health dimension to other sector plans, and into the overarching strategies of city governments. Linked to the Phase IV priority themes of Healthy aging and healthy urban planning, cities further developed the concept and application of human-centered sustainability. More work is required to utilize cost-benefit analysis and health impact assessment to unmask the synergies between health and economic prosperity.

  11. Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers.

    PubMed

    Cottrell, Erika K; Hall, Jennifer D; Kautz, Glenn; Angier, Heather; Likumahuwa-Ackman, Sonja; Sisulak, Laura; Keller, Sara; Cameron, David C; DeVoe, Jennifer E; Cohen, Deborah J

    Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

  12. Making it work: health care provider perspectives on strategies to increase colorectal cancer screening in federally qualified health centers.

    PubMed

    Gwede, Clement K; Davis, Stacy N; Quinn, Gwendolyn P; Koskan, Alexis M; Ealey, Jamila; Abdulla, Rania; Vadaparampil, Susan T; Elliott, Gloria; Lopez, Diana; Shibata, David; Roetzheim, Richard G; Meade, Cathy D

    2013-12-01

    Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health care providers' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health care providers practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs.

  13. Behavioral healthcare services use in health savings accounts versus traditional health plans.

    PubMed

    Hardie, Nancy A; Lo Sasso, Anthony T; Shah, Mona; Levin, Regina A

    2010-12-01

    Numerous studies have examined behavioral health services via employer-sponsored health insurance cost-sharing measures. Their results clearly indicate that health plan design matters a great deal with respect to behavioral health utilization. It is also clear that there remain a number of unresolved issues, particularly with respect to the effects of a switch from traditional plan designs to high deductible, consumer-driven policies. Health Savings Accounts (HSA) have been well described in the literature with some comparisons to traditional healthcare plans, however no reports have been made about their use for behavioral health treatment. We sought to estimate the impact switching to a consumer driven health plan (CDHP) with a health savings account had upon the utilization of behavioral health care. Utilization of behavioral health services were reviewed from claims data over three years (2005 through 2007). Comparisons were made between members who switched from traditional health plans to consumer driven health plans in 2007 with health savings accounts and members who remained in traditional health plans. A pre-post study design was applied to two cohorts, stayers and switchers. The stayer cohort consisted of traditional health plan members enrolled from 2005 through 2007. Stayers were offered a health savings account in 2006 and 2007, but opted to remain in traditional health plans. The switcher cohort consisted of members enrolled in traditional plans in 2005 who opted to switch to a health savings account for two years thereafter (2006 and 2007). The use and intensity of behavioral health services in each study year were generated from claims data. Logistic and OLS regression analyses were applied to behavioral health services use and outpatient intensity measures respectively with independent variables post years, cohort and their interaction terms. Both analyses controlled for demographic variables. Additional behavioral disorder variables were added to

  14. Qualified and Unqualified (N-R C) mental health nursing staff--minor differences in sources of stress and burnout. A European multi-centre study.

    PubMed

    Sorgaard, Knut W; Ryan, Peter; Dawson, Ian

    2010-06-14

    Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care. A total of 196 nursing staff --124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds--working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ). (a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems. The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard

  15. Qualified and Unqualified (N-R C) mental health nursing staff - minor differences in sources of stress and burnout. A European multi-centre study

    PubMed Central

    2010-01-01

    Background Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care. Methods A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ). Results (a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems. Conclusion The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures

  16. Family planning and health: the Narangwal experiment.

    PubMed

    Faruqee, R

    1983-06-01

    The findings of a 7-year field experiment conducted in the Indian Punjab show that integrating family planning with health services is more effective and efficient than providing family planning separately. The field experiment was conducted between 1968 and 1974 at Narangwal in the Indian State of Punjab. It involved 26 villages, with a total population of 35,000 in 1971-72. The demographic characteristics of the villages were found to be typical of the area. 5 groups of villages were provided with different combinations of services for health, nutrition and family planning. A control group received no project services. A population study was made of the effects of integrating family planning with maternal and child health services. A nutritional study looked at the results of integrating nutritional care and health services. The effectiveness of integration was evaluated by identifying it both with increased use of family planning and improved health. Efficiency was judged by relating effectiveness to input costs. Distribution of the benefits was also examined. The effectiveness of these different combinations of services on the use of family planning was measured: 1) by all changes in the use of modern methods of family planning, 2) by the number of new acceptors, 3) by the changes in the proportion of eligible women using contraceptives, and 4) by how many people started to use the more effective methods. Results showed the use of family planning increased substantially in the experimental groups, whereas the control group remained constant. It was also found that, though the services combining family planning with maternal health care stimulated more use of family planning, they were more costly than the more integrated srevices. The Narangwal experiment provides significant evidence in favor of combining the provision of family planning and health services, but its potential for replication on a large scale needs to be studied.

  17. [Consumer satisfaction study in philanthropic hospital health plans].

    PubMed

    Gerschman, Silvia; Veiga, Luciana; Guimarães, César; Ugá, Maria Alicia Dominguez; Portela, Margareth Crisóstomo; Vasconcellos, Miguel Murat; Barbosa, Pedro Ribeiro; Lima, Sheyla Maria Lemos

    2007-01-01

    This paper presents the findings of research aimed at identifying and analyzing the argumentation and rationale that justify the satisfaction of consumers with their health plans. The qualitative method applied used the focus group technique, for which the following aspects were defined: the criteria for choosing the health plans which were considered, the composition of the group and its distribution, recruitment strategy, and infrastructure and dynamics of the meetings. The health plan beneficiaries were classified into groups according to their social class, the place where they lived, mainly, the relationship that they established with the health plan operators which enabled us to develop a typology for the plan beneficiaries. Initially, we indicated how the health plan beneficiaries assess and use the Brazilian Unified Health System (SUS), and, then, considering the types of plans defined, we evaluated their degree of satisfaction with the different aspects of health care, and identified which aspects mostly contributed explain their satisfaction.

  18. How to choose a health plan

    MedlinePlus

    ... please enable JavaScript. When it comes to getting health insurance, you may have more than one option. Many ... one plan. If you are buying from the Health Insurance Marketplace, you may have several plans to choose ...

  19. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  20. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  1. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  2. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  3. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  4. Urban planning and public health at CDC.

    PubMed

    Kochtitzky, Chris S; Frumkin, H; Rodriguez, R; Dannenberg, A L; Rayman, J; Rose, K; Gillig, R; Kanter, T

    2006-12-22

    Urban planning, also called city and regional planning, is a multidisciplinary field in which professionals work to improve the welfare of persons and communities by creating more convenient, equitable, healthful, efficient, and attractive places now and for the future. The centerpiece of urban planning activities is a "master plan," which can take many forms, including comprehensive plans, neighborhood plans, community action plans, regulatory and incentive strategies, economic development plans, and disaster preparedness plans. Traditionally, these plans include assessing and planning for community needs in some or all of the following areas: transportation, housing, commercial/office buildings, natural resource utilization, environmental protection, and health-care infrastructure. Urban planning and public health share common missions and perspectives. Both aim to improve human well-being, emphasize needs assessment and service delivery, manage complex social systems, focus at the population level, and rely on community-based participatory methods. Both fields focus on the needs of vulnerable populations. Throughout their development, both fields have broadened their perspectives. Initially, public health most often used a biomedical model (examining normal/abnormal functioning of the human organism), and urban planning often relied on a geographic model (analysis of human needs or interactions in a spatial context). However, both fields have expanded their tools and perspectives, in part because of the influence of the other. Urban planning and public health have been intertwined for most of their histories. In 1854, British physician John Snow used geographic mapping of an outbreak of cholera in London to identify a public water pump as the outbreak's source. Geographic analysis is a key planning tool shared by urban planning and public health. In the mid-1800s, planners such as Frederick Law Olmsted bridged the gap between the fields by advancing the concept

  5. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  6. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  7. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  8. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  9. 20 CFR 302.3 - Qualifying conditions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Qualifying conditions. 302.3 Section 302.3 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT QUALIFIED EMPLOYEE § 302.3 Qualifying conditions. (a) Basic requirements. To qualify for benefits with...

  10. 26 CFR 54.4980B-2 - Plans that must comply.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... exception for qualified long-term care services is set forth in paragraph (e) of this Q&A-1, and for medical... all of the coverage provided under the plan is for qualified long-term care services (as defined in... whether substantially all of the coverage provided under the plan is for qualified long-term care services...

  11. State of emergency preparedness for US health insurance plans.

    PubMed

    Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

    2015-01-01

    Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

  12. The strategic planning of health management information systems.

    PubMed

    Smith, J

    1995-01-01

    This paper discusses the roles and functions of strategic planning of information systems in health services. It selects four specialised methodologies of strategic planning for analysis with respect to their applicability in the health field. It then examines the utilisation of information planning in case studies of three health organisations (two State departments of health and community services and one acute care institution). Issues arising from the analysis concern the planning process, the use to which plans are put, and implications for management.

  13. The pitfalls of qualified moral veganism. A critique of Jan Deckers' holistic health approach to animal ethics.

    PubMed

    Paez, Eze

    2017-10-01

    I critically examine Jan Deckers' position in Animal (De)liberation, where he defends two main views. The first is "qualified moral veganism": Most humans have a duty to abstain from consuming animal products, even if there are circumstances in which doing so is justified. The author argues, on the one hand, from a pan-sentientist view that attributes sentience to all elementary entities and their compounds. Thus, all living things (such as animals and plants) have a capacity for positive and negative experiences. On the other hand, he develops a consequentialist view that assigns moral agents the unconditional duty to promote their own "holistic health." This is partly constituted by the agent's "moral health," that is, her acting in a morally justified way. On Deckers' view, moral agents must care for the health of all living entities, give greater weight to the interests of organisms to which they are more closely biologically related, and respect the integrity of nature. Diets containing animal products have a very high negative health impact, because of how they affect the environment, human food security, and the well-being of nonhuman animals. In addition, even though plants are sentient, they are likely less so than animals, and their interests must be given less weight. Therefore, most humans should shift to a vegan diet. Deckers' second proposal is that a qualified ban on the consumption of animal products should be enacted. After discarding other alternative strategies, Deckers defends its feasibility relying on data obtained via a series of surveys. Though the argument partly succeeds in developing a coherent account accommodating the author's intuitions, I conclude that his ontological and normative frameworks remain too underdeveloped, his appeal to biological relatedness has implausible implications, and the methodology he uses in defence of his political position is problematic. © 2017 John Wiley & Sons, Ltd.

  14. 48 CFR 1602.170-9 - Health benefits plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Health benefits plan. 1602... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract...

  15. 48 CFR 1602.170-9 - Health benefits plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Health benefits plan. 1602... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract...

  16. 48 CFR 1602.170-9 - Health benefits plan.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Health benefits plan. 1602... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract...

  17. 48 CFR 1602.170-9 - Health benefits plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Health benefits plan. 1602... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract...

  18. 48 CFR 1602.170-9 - Health benefits plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Health benefits plan. 1602... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract...

  19. Future career plans of a cohort of senior doctors working in the National Health Service.

    PubMed

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2008-04-01

    To report on the future career plans of senior doctors working in the NHS. Postal questionnaires. All doctors who qualified in 1977 from all UK medical schools. Future plans and whether participants had any unmet needs for advice on how to put their future plans into effect. 25% definitely intended to continue with their current employment on the same basis until they retired; 75% hoped for change. A reduction in working hours was the most commonly desired change; but a substantial percentage also wanted changes in job content. 50% of respondents intended definitely (17%) or probably (33%) to work in the NHS to their normal retirement age; and 37% definitely (20%) or probably (17%) intended to retire early. 48% had made plans, in addition to the standard pension, to facilitate early retirement. The main factors given for considering early retirement were family reasons and wanting more time for leisure, a desire to maintain good health, excessive pressure of work, and disillusionment with NHS changes. A reduction in workload would be the greatest inducement to stay. 31% of respondents reported that they had unmet needs for advice about their future plans. Of these, about half were needs for advice about planning for retirement. Many senior NHS doctors would like to reduce their working hours. Less than a quarter definitely intend to work in the NHS to normal retirement age. Even for senior doctors, advice on career development is needed.

  20. Pragmatism and Feminism as Qualified Relativism.

    ERIC Educational Resources Information Center

    Thayer-Bacon, Barbara

    2003-01-01

    Explores pragmatism's association with relativism in order to highlight how aspects of the classis pragmatists' positions support qualified relativism. Addresses qualified relativism and the characteristics of qualified relativists. States that qualified relativists can claim roots to their position in Peirce, James, and Dewey, some of the…

  1. 26 CFR 1.401-1 - Qualified pension, profit-sharing, and stock bonus plans.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... employees or their beneficiaries to participate in the profits of the employer's trade or business, or in... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Qualified pension, profit-sharing, and stock... TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus...

  2. 26 CFR 1.401-1 - Qualified pension, profit-sharing, and stock bonus plans.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... employees or their beneficiaries to participate in the profits of the employer's trade or business, or in... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Qualified pension, profit-sharing, and stock... TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus...

  3. 26 CFR 1.401-1 - Qualified pension, profit-sharing, and stock bonus plans.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... employees or their beneficiaries to participate in the profits of the employer's trade or business, or in... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Qualified pension, profit-sharing, and stock... TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus...

  4. 26 CFR 1.401-1 - Qualified pension, profit-sharing, and stock bonus plans.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... employees or their beneficiaries to participate in the profits of the employer's trade or business, or in... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Qualified pension, profit-sharing, and stock... TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus...

  5. Health care's new game changer. Thinking like a health plan.

    PubMed

    Eggbeer, Bill; Bowers, Krista

    2014-10-01

    The transition for hospitals from having only a provider's perspective to thinking more like a health plan will require strategic alignment on four fronts: Health plan alignment. Hospital and physician alignment. Leadership alignment. Organizational alignment.

  6. A long and winding road: federally qualified health centers, community variation and prospects under reform.

    PubMed

    Katz, Aaron B; Felland, Laurie E; Hill, Ian; Stark, Lucy B

    2011-11-01

    Community health centers have evolved from fringe providers to mainstays of many local health care systems. Those designated as federally qualified health centers (FQHCs), in particular, have largely established themselves as key providers of comprehensive, efficient, high-quality primary care services to low-income people, especially Medicaid and uninsured patients. The Center for Studying Health System Change's (HSC's) site visits to 12 nationally representative metropolitan communities since 1996 document substantial growth in FQHC capacity, based on growing numbers of Medicaid enrollees and uninsured people, increased federal support, and improved managerial acumen. At the same time, FQHC development has varied considerably across communities because of several important factors, including local health system characteristics and financial and political support at federal, state and local levels. Some communities--Boston; Syracuse, N.Y.; Miami; and Seattle--have relatively extensive FQHC capacity for their Medicaid and uninsured populations, while other communities--Lansing, Mich.; northern New Jersey; Indianapolis; and Greenville, S.C.--fall in the middle. FQHC growth in Phoenix; Little Rock, Ark.; Cleveland; and Orange County, Calif.; has lagged in comparison. Today, FQHCs seem poised to play a key role in federal health care reform, including coverage expansions and the emphasis on primary care and medical homes.

  7. Federal Parity and Access to Behavioral Health Care in Private Health Plans.

    PubMed

    Hodgkin, Dominic; Horgan, Constance M; Stewart, Maureen T; Quinn, Amity E; Creedon, Timothy B; Reif, Sharon; Garnick, Deborah W

    2018-04-01

    The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.

  8. Strategic planning: health plan perspective.

    PubMed

    Mills, P S

    1990-01-01

    The managed care industry is one of the most dynamic industries in the health care business. The development of new products, formation of alliances, changes in legislation and other types of changes are regular occurrences. This kind of dynamic environment makes it more important than ever to use strategic planning to guide management decisions.

  9. Health Planning Under Way. Annual Report, Fiscal 1978.

    ERIC Educational Resources Information Center

    Health Resources Administration (DHEW/PHS), Rockville, MD. Bureau of Health Planning and Resources Development.

    Fiscal year 1978 activities of the Bureau of Health Planning are presented in this annual report. The report is organized into areawide planning (e.g., health planning was established in 213 geographic regions, including 205 health service areas served by Health Systems Agencies and eight states, territories, and the District of Columbia);…

  10. Program Planning in Health Professions Education

    ERIC Educational Resources Information Center

    Schmidt, Steven W.; Lawson, Luan

    2018-01-01

    In this chapter, the major concepts from program planning in adult education will be applied to health professions education (HPE). Curriculum planning and program planning will be differentiated, and program development and planning will be grounded in a systems thinking approach.

  11. 26 CFR 1.414(r)-7 - Determination of the employees of an employer's qualified separate lines of business.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single qualified...

  12. 26 CFR 1.414(r)-7 - Determination of the employees of an employer's qualified separate lines of business.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single qualified...

  13. 26 CFR 1.414(r)-7 - Determination of the employees of an employer's qualified separate lines of business.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single qualified...

  14. 26 CFR 1.414(r)-7 - Determination of the employees of an employer's qualified separate lines of business.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... qualified separate lines of business. 1.414(r)-7 Section 1.414(r)-7 Internal Revenue INTERNAL REVENUE..., Profit-Sharing, Stock Bonus Plans, Etc. § 1.414(r)-7 Determination of the employees of an employer's... residual shared employee as defined in § 1.414(r)-11(b)(2) and (4)) is assigned to a single qualified...

  15. Consumer health plan choice: current knowledge and future directions.

    PubMed

    Scanlon, D P; Chernew, M; Lave, J R

    1997-01-01

    A keystone of the competitive strategy in health insurance markets is the assumption that "consumers" can make informed choices based on the costs and quality of competing health plans, and that selection effects are not large. However, little is known about how individuals use information other than price in the decision making process. This review summarizes the state of knowledge about how individuals make choices among health plans and outlines an agenda for future research. We find that the existing literature on health plan choice is no longer sufficient given the widespread growth and acceptance of managed care, and the increased proportion of consumers' income now going toward the purchase of health plans. Instead, today's environment of health plan choice requires better understanding of how plan attributes other than price influence plan choice, how other variables such as health status interact with plan attributes in the decision making process, and how specific populations differ from one another in terms of the sensitivity of their health plan choices to these different types of variables.

  16. Nursing educator perspectives of overseas qualified nurses' intercultural clinical communication: barriers, enablers and engagement strategies.

    PubMed

    Philip, Susan; Manias, Elizabeth; Woodward-Kron, Robyn

    2015-09-01

    To understand the intercultural communication experiences and associated communication training needs of overseas qualified nurses in the Australian healthcare system from the unique perspectives of nurse educators teaching in accredited bridging programmes. Overseas qualified nurses are an integral part of the nursing workforce in migration destination countries. Communication training needs are more complex when there are cultural, ethnic and language differences between nurses, other health professionals and patients. A qualitative, exploratory research design using semi-structured interviews. All (nine) organisations involved in conducting the Australian Health Practitioner Regulation Agency approved preregistration bridging programmes for overseas qualified nurses within the state of Victoria, Australia, were involved in the study. Participants were 12 nurse educators employed in these organisations. Thematic analysis was undertaken. Three macro themes emerged about the overseas qualified nurses' intercultural communication: (1) pre-existing barriers and enablers to intercultural communication, for example, nurses' reluctance to engage in communicative strategies that build rapport with patients, (2) transitional behaviours and impact on communication, including maintenance of perceived cultural hierarchies between health professionals and (3) development of communicative competence, including expanding one's repertoire of conversational gambits. The findings point to the domains and causes of communication challenges facing overseas qualified nurses in new healthcare settings as well as strategies that the nurse educators and nurses can adopt. Communication cannot be merely regarded as a skill that can be taught in a didactic programme. Comprehensive understanding is needed about the sociocultural dimensions of these nurses' orientation, which can impact on how they communicate in their new healthcare settings. The findings can act as triggers for discussion

  17. 42 CFR § 414.1435 - Qualifying APM participant determination: Medicare option.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1435 Qualifying APM participant determination: Medicare option. (a) Payment amount method. The...

  18. Justice in Health Care Decision-Making: Patients’ Appraisals of Health Care Providers and Health Plan Representatives

    PubMed Central

    Fondacaro, Mark; Frogner, Bianca; Moos, Rudolf

    2010-01-01

    This study describes the development of two versions of a Health Care Justice Inventory (HCJI). One version focuses on patients’ interactions with their providers (HCJI-P) and the other focuses on patients’ interactions with the representatives of their health plans (HCJI-HP). Each version of the HCJI assesses patients’ appraisals of their interactions (with either their Provider or representatives of their Health Plan) along three common dimensions of procedural justice: Trust, Impartiality, and Participation. Both the Provider and Health Plan scales assess indices that are relatively independent of patients’ demographic characteristics. In addition, patients’ appraisals of their interactions with their provider were only moderately related to their appraisals of their interactions with representatives of their health plan, indicating that the Provider and Health Plan scales tap distinct aspects of patients’ overall experience with the health care system. Overall, procedural justice dimensions were significantly related to patient satisfaction in both the Provider and the Health Plan contexts. As predicted, procedural justice factors were more strongly tied to patient satisfaction in the Provider than in the Health Plan context, and health care decisions based on distributive justice principles of Need (rather than Equity or Equality) were most closely tied to patient satisfaction in both contexts. PMID:16021741

  19. Health Maintenance Organization (HMO) Plan

    MedlinePlus

    ... Find & compare doctors, hospitals, & other providers Health Maintenance Organization (HMO) Plan In most HMO Plans, you generally ... certain service when needed. Related Resources Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs ...

  20. Health plans' disease management programs: extending across the medical and behavioral health spectrum?

    PubMed

    Merrick, Elizabeth Levy; Horgan, Constance M; Garnick, Deborah W; Hodgkin, Dominic; Morley, Melissa

    2008-01-01

    Although the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health and depression program characteristics are highly variable.

  1. Health Plans' Disease Management Programs: Extending across the Medical and Behavioral Health Spectrum?

    PubMed Central

    Merrick, Elizabeth Levy; Horgan, Constance M.; Garnick, Deborah W.; Hodgkin, Dominic; Morley, Melissa

    2015-01-01

    While the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes, but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health, and depression program characteristics are highly variable. PMID:18806594

  2. 42 CFR 486.102 - Condition for coverage: Supervision by a qualified physician.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition for coverage: Supervision by a qualified physician. 486.102 Section 486.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE OF SPECIALIZED...

  3. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Incentive payments to qualifying MA organizations for MA-EPs and MA-affiliated eligible hospitals. 495.204 Section 495.204 Public Health CENTERS FOR... Medicare Advantage (MA) Organizations § 495.204 Incentive payments to qualifying MA organizations for MA...

  4. 42 CFR 495.204 - Incentive payments to qualifying MA organizations for MA-EPs and MA-affiliated eligible hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Incentive payments to qualifying MA organizations for MA-EPs and MA-affiliated eligible hospitals. 495.204 Section 495.204 Public Health CENTERS FOR... Medicare Advantage (MA) Organizations § 495.204 Incentive payments to qualifying MA organizations for MA...

  5. Health plan competition in local markets.

    PubMed

    Grossman, J M

    2000-04-01

    To examine the structure of local health insurance markets and the strategies health plans were using to respond to competitive pressures in local markets in 1996/1997. Community Tracking Study site visits conducted between May 1996 and April 1997 in 12 U.S. markets selected to be nationally representative. In each site, 36 to 60 interviews on local health system change were conducted with healthcare industry informants representing health plans, providers, and purchasers. Relevant data for this article were abstracted from standardized protocols administered to multiple respondents in each site. Although the competitive threat from national plans was pervasive, local plans in most sites continued to retain strong, often dominant, positions in historically concentrated markets. In all sites, in response to purchaser pressures for stable premiums and provider choice, and the threat of entry and to plans were using three strategies to increase market share and market power: (1) consolidation/geographic expansion, (2) price competition, and (3) product line/segment diversification that focused on broad networks and open-access products. In most markets, in response to the demand for provider choice, the trend was away from ownership and exclusive arrangements with providers. Although local plans were moving to become full-service regional players, there was uncertainty about the abilities of all plans to sustain growth strategies at the expense of margins and organizational stability, and to effectively manage care with broad networks.

  6. Retrospective analysis of census data on general practitioners who qualified in South Asia: who will replace them as they retire?

    PubMed Central

    Taylor, Donald H; Esmail, Aneez

    1999-01-01

    Objectives To determine the number and geographical distribution of general practitioners in the NHS who qualified medically in South Asia and to project their numbers as they retire. Design Retrospective analysis of yearly data and projection of future trends. Setting England and Wales. Subjects General practitioners who qualified medically in the countries of Bangladesh, India, Pakistan, and Sri Lanka and who were practising in the NHS on 1 October 1992. Main outcome measures Proportion and age of general practitioners who qualified in South Asia by health authority; the Benzeval and Judge measure of population need at the health authority level. Results 4192 of 25 333 (16.5%) of all unrestricted general practitioners practising full time on 1 October 1992 qualified in South Asian medical schools. The proportion varied by health authority from 0.007% to 56.5%. Roughly two thirds who were practising in 1992 will have retired by 2007; in some health authorities this will represent a loss of one in four general practitioners. The practices that these doctors will leave seem to be in relatively deprived areas as measured by deprivation payments and a health authority measure of population need. Conclusion Many general practitioners who qualified in South Asian medical schools will retire within the next decade. The impact will vary greatly by health authority. Those health authorities with the greatest number of such doctors are in some of the most deprived areas in the United Kingdom and have experienced the most difficulty in filling vacancies. Various responses will be required by workforce planners to mitigate the impact of these retirements. Key messagesCurrently, one in six general practitioners practising full time in the NHS qualified medically in a South Asian medical school; two thirds are likely to retire by 2007It is unlikely that doctors who qualify in South Asia will be a source of general practice recruitment in the futureThe posts from which South

  7. Health insurance premium tax credit. Final regulations.

    PubMed

    2013-02-01

    This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.

  8. Improving Olympic health services: what are the common health care planning issues?

    PubMed

    Kononovas, Kostas; Black, Georgia; Taylor, Jayne; Raine, Rosalind

    2014-12-01

    Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts. A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report. The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host

  9. Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

    PubMed

    Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

    2009-06-01

    Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

  10. 40 CFR 112.6 - Qualified Facilities Plan Requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Self-Certification of the Plan. If you are an owner or operator of a facility that meets the Tier I... unloading equipment, tank overflow, rupture, or leakage, or any other equipment known to be a source of... the system or procedure in the SPCC Plan and regularly test to ensure proper operation or efficacy. (b...

  11. 40 CFR 112.6 - Qualified Facilities Plan Requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Self-Certification of the Plan. If you are an owner or operator of a facility that meets the Tier I... unloading equipment, tank overflow, rupture, or leakage, or any other equipment known to be a source of... the system or procedure in the SPCC Plan and regularly test to ensure proper operation or efficacy. (b...

  12. 40 CFR 112.6 - Qualified Facilities Plan Requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Self-Certification of the Plan. If you are an owner or operator of a facility that meets the Tier I... unloading equipment, tank overflow, rupture, or leakage, or any other equipment known to be a source of... the system or procedure in the SPCC Plan and regularly test to ensure proper operation or efficacy. (b...

  13. 40 CFR 112.6 - Qualified Facilities Plan Requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Self-Certification of the Plan. If you are an owner or operator of a facility that meets the Tier I... unloading equipment, tank overflow, rupture, or leakage, or any other equipment known to be a source of... the system or procedure in the SPCC Plan and regularly test to ensure proper operation or efficacy. (b...

  14. 40 CFR 112.6 - Qualified Facilities Plan Requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Self-Certification of the Plan. If you are an owner or operator of a facility that meets the Tier I... unloading equipment, tank overflow, rupture, or leakage, or any other equipment known to be a source of... the system or procedure in the SPCC Plan and regularly test to ensure proper operation or efficacy. (b...

  15. 42 CFR 56.105 - Accord with health planning.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Accord with health planning. 56.105 Section 56.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR MIGRANT HEALTH SERVICES General Provisions § 56.105 Accord with health planning. A grant may be made under this...

  16. 42 CFR 56.105 - Accord with health planning.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Accord with health planning. 56.105 Section 56.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR MIGRANT HEALTH SERVICES General Provisions § 56.105 Accord with health planning. A grant may be made under this...

  17. 42 CFR 56.105 - Accord with health planning.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Accord with health planning. 56.105 Section 56.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR MIGRANT HEALTH SERVICES General Provisions § 56.105 Accord with health planning. A grant may be made under this...

  18. 42 CFR 56.105 - Accord with health planning.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Accord with health planning. 56.105 Section 56.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR MIGRANT HEALTH SERVICES General Provisions § 56.105 Accord with health planning. A grant may be made under this...

  19. Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

    PubMed

    Rosenthal, Meredith; Milstein, Arnold

    2004-08-01

    Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans-health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models-were being influenced by consumerism. Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. The majority of enrollees in

  20. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... for each year is equal to the annual percentage increase in average per capita aggregate expenditures... 42 Public Health 3 2014-10-01 2014-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  1. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... percentage increase in average per capita aggregate expenditures for Part D drugs in the United States for... 42 Public Health 3 2011-10-01 2011-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  2. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... for each year is equal to the annual percentage increase in average per capita aggregate expenditures... 42 Public Health 3 2012-10-01 2012-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  3. 42 CFR 423.104 - Requirements related to qualified prescription drug coverage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... for each year is equal to the annual percentage increase in average per capita aggregate expenditures... 42 Public Health 3 2013-10-01 2013-10-01 false Requirements related to qualified prescription drug coverage. 423.104 Section 423.104 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

  4. Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas.

    PubMed

    Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

    To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

  5. Reducing Cancer Disparities Through Innovative Partnerships: A Collaboration of the South Carolina Cancer Prevention and Control Research Network and Federally Qualified Health Centers

    PubMed Central

    Young, Vicki M.; Freedman, Darcy A.; Adams, Swann Arp; Brandt, Heather M.; Xirasagar, Sudha; Felder, Tisha M.; Ureda, John R.; Hurley, Thomas; Khang, Leepao; Campbell, Dayna; Hébert, James R.

    2011-01-01

    The South Carolina Cancer Prevention and Control Research Network, in partnership with the South Carolina Primary Health Care Association, and Federally Qualified Health Centers (FQHCs), aims to promote evidence-based cancer interventions in community-based primary care settings. Partnership activities include (1) examining FQHCs’ readiness and capacity for conducting research, (2) developing a cancer-focused data sharing network, and (3) integrating a farmers’ market within an FQHC. These activities identify unique opportunities for public health and primary care collaborations. PMID:21932143

  6. 45 CFR 264.82 - What expenditures qualify for meeting the Matching Grant FAG amount requirement?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 2 2014-10-01 2012-10-01 true What expenditures qualify for meeting the Matching..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Rules Pertain Specifically to the Spending Levels of the Territories? § 264.82 What expenditures qualify for meeting the Matching...

  7. 45 CFR 264.82 - What expenditures qualify for meeting the Matching Grant FAG amount requirement?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false What expenditures qualify for meeting the Matching..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Rules Pertain Specifically to the Spending Levels of the Territories? § 264.82 What expenditures qualify for meeting the Matching...

  8. 45 CFR 264.82 - What expenditures qualify for meeting the Matching Grant FAG amount requirement?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false What expenditures qualify for meeting the Matching..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Rules Pertain Specifically to the Spending Levels of the Territories? § 264.82 What expenditures qualify for meeting the Matching...

  9. 45 CFR 264.82 - What expenditures qualify for meeting the Matching Grant FAG amount requirement?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 2 2012-10-01 2012-10-01 false What expenditures qualify for meeting the Matching..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Rules Pertain Specifically to the Spending Levels of the Territories? § 264.82 What expenditures qualify for meeting the Matching...

  10. 45 CFR 264.82 - What expenditures qualify for meeting the Matching Grant FAG amount requirement?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 2 2013-10-01 2012-10-01 true What expenditures qualify for meeting the Matching..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Rules Pertain Specifically to the Spending Levels of the Territories? § 264.82 What expenditures qualify for meeting the Matching...

  11. Health for all--interpretation of meaning by newly qualified general and staff certified nurses.

    PubMed

    Ndlovu, R J

    1991-06-01

    Zimbabwe adopted P.H.C. approach in 1980 in order to provide equitable distribution of health services and to achieve H.F.A. In 1985 new Nursing education curriculae were introduced to orient student nurses and their teachers to this approach. Between 1986 and 1990 a study was conducted in which 416 newly qualified General and State Certified Nurses answered a comprehensive questionnaire relating to how the nurse training programme prepared them for their work. One question from the self administered questionnaire required them to state their interpretation of H.F.A. and indicate whether they believed that such a goal was achievable by the year 2000. Over 50 pc of respondents from the new curriculae interpreted H.F.A. as physical and financial accessibility of health services and that this goal was not achievable by the year 2000. The interpretation by candidates from the old curriculae was divided among four concepts and over 50% of the respondents believed that the goal was achievable by the target date.

  12. Health plan competition in local markets.

    PubMed Central

    Grossman, J M

    2000-01-01

    OBJECTIVE: To examine the structure of local health insurance markets and the strategies health plans were using to respond to competitive pressures in local markets in 1996/1997. DATA SOURCES/STUDY SETTING: Community Tracking Study site visits conducted between May 1996 and April 1997 in 12 U.S. markets selected to be nationally representative. STUDY DESIGN: In each site, 36 to 60 interviews on local health system change were conducted with healthcare industry informants representing health plans, providers, and purchasers. DATA COLLECTION/EXTRACTION METHOD: Relevant data for this article were abstracted from standardized protocols administered to multiple respondents in each site. PRINCIPAL FINDINGS: Although the competitive threat from national plans was pervasive, local plans in most sites continued to retain strong, often dominant, positions in historically concentrated markets. In all sites, in response to purchaser pressures for stable premiums and provider choice, and the threat of entry and to plans were using three strategies to increase market share and market power: (1) consolidation/geographic expansion, (2) price competition, and (3) product line/segment diversification that focused on broad networks and open-access products. In most markets, in response to the demand for provider choice, the trend was away from ownership and exclusive arrangements with providers. CONCLUSIONS: Although local plans were moving to become full-service regional players, there was uncertainty about the abilities of all plans to sustain growth strategies at the expense of margins and organizational stability, and to effectively manage care with broad networks. PMID:10778822

  13. Rules regarding the health insurance premium tax credit. Final and temporary regulations.

    PubMed

    2014-07-28

    This document contains final and temporary regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act of 2011 and the 3% Withholding Repeal and Job Creation Act. These regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit, and Exchanges that make qualified health plans available to individuals. The text of the temporary regulations in this document also serves as the text of proposed regulations set forth in a notice of proposed rulemaking (REG-104579-13) on this subject in the Proposed Rules section in this issue of the Federal Register.

  14. Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

    PubMed

    Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H

    2008-12-01

    To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

  15. Consumer-directed health plans: what happened?

    PubMed

    Goldsmith, Jeff

    2007-08-01

    CDHPs can stabilize growth in health costs, but the health plan-subscriber relationship should be more transparent. CFOs should ensure that increased cost exposure in CDHPs is paired with broad, deep disease management and employee assistance support. Hospitals should plan for the likelihood that, one way or another, consumers will be paying more of their healthcare bill.

  16. Dissemination of a Web-Based Tool for Supporting Health Insurance Plan Decisions (Show Me Health Plans): Cross-Sectional Observational Study.

    PubMed

    Zhao, Jingsong; Mir, Nageen; Ackermann, Nicole; Kaphingst, Kimberly A; Politi, Mary C

    2018-06-20

    The rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public. The purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT. This study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined. During the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more

  17. 20 CFR 416.640a - Compensation for qualified organizations serving as representative payees.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... An example of an appropriately licensed organization is a community mental health center holding a State license to provide community mental health services. (b) Requirements qualified organizations must... responsibilities or whose mission is to carry out income maintenance, social service, or health care-related...

  18. Iran's Health Reform Plan: Measuring Changes in Equity Indices.

    PubMed

    Assari Arani, Abbas; Atashbar, Tohid; Antoun, Joseph; Bossert, Thomas

    2018-03-01

    Two years after the implementation of the Health Sector Evolution Plan (HSEP), this study evaluated the effects of the plan on health equity indices. The main indices assessed by the study were the Out-of-Pocket (OOP) health expenditures, the Fairness in Financial Contribution (FFC) to the health system index, the index of households' Catastrophic Health Expenditure (CHE) and the headcount ratio of Impoverishing Health Expenditure (IHE). The per capita share of costs for total health services has been decreased. The lowered costs have been more felt in rural areas, generally due to sharp decrease in inpatient costs. Per capita pay for outpatient services is almost constant or has slightly increased. The reform plan has managed to improve households' Catastrophic Health Expenditure (CHE) index from an average of 2.9% before the implementation of the plan to 2.3% after the plan. The Fairness in Financial Contribution (FFC) to the health system index has worsened from 0.79 to 0.76, and the headcount ratio of Impoverishing Health Expenditure (IHE) index deteriorated after the implementation of plan from 0.34 to 0.50. Considerable improvement, in decreasing the burden of catastrophic hospital costs in low income strata which is about 26% relative to the time before the implementation of the plan can be regarded as the main achievement of the plan, whereas the worsening in the headcount ratio of IHE and FFC are the equity bottlenecks of the plan.

  19. 26 CFR 1.401(a)-1 - Post-ERISA qualified plans and qualified trusts; in general.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... of normal retirement age (subject to paragraph (b)(2) of this section). A plan does not fail to...), that a distribution may be made from the plan to an employee who has attained age 62 and who is not separated from employment at the time of such distribution. (ii) Section 1.401-1(b)(1)(i), a pre-ERISA...

  20. 45 CFR 162.1701 - Health plan premium payments transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health plan premium payments transaction. 162.1701 Section 162.1701 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Plan Premium Payments § 162.1701 Health plan...

  1. 45 CFR 162.1701 - Health plan premium payments transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health plan premium payments transaction. 162.1701 Section 162.1701 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Plan Premium Payments § 162.1701 Health plan...

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

    PubMed

    2013-07-15

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

  3. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

  4. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

  5. 7 CFR 1150.109 - Qualified program.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE DAIRY PROMOTION PROGRAM Dairy Promotion and Research Order Definitions § 1150.109 Qualified program. Qualified program means any dairy product promotion, research or nutrition education program which is certified as a qualified program pursuant to § 1150.153...

  6. 76 FR 21907 - Draft Action Plan-A Public Health Action Plan To Combat Antimicrobial Resistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-19

    ...-2011-0002] Draft Action Plan--A Public Health Action Plan To Combat Antimicrobial Resistance AGENCY: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (DHHS). ACTION... Federal Register requesting public comment on the draft, A Public Health Action Plan to Combat...

  7. 26 CFR 1.936-10 - Qualified investments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 10 2011-04-01 2011-04-01 false Qualified investments. 1.936-10 Section 1.936... (CONTINUED) INCOME TAXES (CONTINUED) Possessions of the United States § 1.936-10 Qualified investments. (a) In general. [Reserved] (b) Qualified investments in Puerto Rico. [Reserved] (c) Qualified investment...

  8. System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

    PubMed Central

    Levy, Barcey T.; Moss, Carol A.; Bay, Camden P.

    2015-01-01

    Objectives. We assessed the protocols and system processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHCs) in 4 midwestern states. Methods. We identified 49 FQHCs in 4 states. In January 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC. Results. Forty-four questionnaires (90%) were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percentage of patients up-to-date with CRC screening was 0.43 (P = .01). Conclusions. CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain, to help prevent, or to cure many cases of CRC, the second leading cause of cancer in the United States. PMID:24832146

  9. Awakening Consumer Stewardship of Health Benefits: Prevalence and Differentiation of New Health Plan Models

    PubMed Central

    Rosenthal, Meredith; Milstein, Arnold

    2004-01-01

    Context Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. Objective We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans—health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models—were being influenced by consumerism. Data Sources/Study Setting Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. Study Design We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) Data Collection/Extraction Methods We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of

  10. Decriminalisation of abortion performed by qualified health practitioners under the Abortion Law Reform Act 2008 (Vic).

    PubMed

    Mendelson, Danuta

    2012-06-01

    In 2008, the Victorian Parliament enacted the Abortion Law Reform Act 2008 (Vic) and amended the Crimes Act 1958 (Vic) to decriminalise terminations of pregnancy while making it a criminal offence for unqualified persons to carry out such procedures. The reform legislation has imposed a civil regulatory regime on the management of abortions, and has stipulated particular statutory duties of care for registered qualified health care practitioners who have conscientious objections to terminations of pregnancy. The background to, and the structure of, this novel statutory regime is examined, with a focus on conscientious objection clauses and liability in the tort of negligence and the tort of breach of statutory duty.

  11. 48 CFR 1852.223-73 - Safety and Health Plan.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Safety and Health Plan... 1852.223-73 Safety and Health Plan. As prescribed in 1823.7001(c), insert the following provision: Safety and Health Plan (NOV 2004) (a) The offeror shall submit a detailed safety and occupational health...

  12. 48 CFR 1852.223-73 - Safety and Health Plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Safety and Health Plan... 1852.223-73 Safety and Health Plan. As prescribed in 1823.7001(c), insert the following provision: Safety and Health Plan (NOV 2004) (a) The offeror shall submit a detailed safety and occupational health...

  13. 48 CFR 1852.223-73 - Safety and Health Plan.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Safety and Health Plan... 1852.223-73 Safety and Health Plan. As prescribed in 1823.7001(c), insert the following provision: Safety and Health Plan (NOV 2004) (a) The offeror shall submit a detailed safety and occupational health...

  14. 45 CFR 162.925 - Additional requirements for health plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Additional requirements for health plans. 162.925 Section 162.925 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND... requirements for health plans. (a) General rules. (1) If an entity requests a health plan to conduct a...

  15. 48 CFR 1852.223-73 - Safety and Health Plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Safety and Health Plan... 1852.223-73 Safety and Health Plan. As prescribed in 1823.7001(c), insert the following provision: Safety and Health Plan (NOV 2004) (a) The offeror shall submit a detailed safety and occupational health...

  16. 45 CFR 162.925 - Additional requirements for health plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Additional requirements for health plans. 162.925 Section 162.925 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND... requirements for health plans. (a) General rules. (1) If an entity requests a health plan to conduct a...

  17. 48 CFR 1852.223-73 - Safety and Health Plan.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Safety and Health Plan... 1852.223-73 Safety and Health Plan. As prescribed in 1823.7001(c), insert the following provision: Safety and Health Plan (NOV 2004) (a) The offeror shall submit a detailed safety and occupational health...

  18. Study of the Subarea Approach to Health Manpower Planning.

    ERIC Educational Resources Information Center

    Comprehensive Health Planning, Inc., Chicago, IL.

    Recognizing the need for a health manpower planning system that would insure the recruitment, training, utilization, and retention of area residents as skilled providers of health care, Comprehensive Health Planning, Inc., Metropolitan Chicago (CHP), and the West Side Health Planning Organization (WSHPO) embarked on a 1-year project to demonstrate…

  19. 76 FR 14402 - Draft Action Plan-A Public Health Action Plan To Combat Antimicrobial Resistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-16

    ...-2011-0002] Draft Action Plan--A Public Health Action Plan To Combat Antimicrobial Resistance AGENCY: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (DHHS). ACTION... requesting public comment on the draft A Public Health Action Plan to Combat Antimicrobial Resistance. HHS...

  20. 42 CFR 417.101 - Health benefits plan: Basic health services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Health benefits plan: Basic health services. 417.101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  1. 42 CFR 417.102 - Health benefits plan: Supplemental health services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Health benefits plan: Supplemental health services. 417.102 Section 417.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS...

  2. 42 CFR 417.102 - Health benefits plan: Supplemental health services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Health benefits plan: Supplemental health services. 417.102 Section 417.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL...

  3. 42 CFR 417.101 - Health benefits plan: Basic health services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Health benefits plan: Basic health services. 417.101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  4. 42 CFR 417.101 - Health benefits plan: Basic health services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Health benefits plan: Basic health services. 417.101 Section 417.101 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE...

  5. 42 CFR 417.102 - Health benefits plan: Supplemental health services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Health benefits plan: Supplemental health services. 417.102 Section 417.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS...

  6. 42 CFR 417.102 - Health benefits plan: Supplemental health services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Health benefits plan: Supplemental health services. 417.102 Section 417.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS...

  7. 42 CFR 417.102 - Health benefits plan: Supplemental health services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Health benefits plan: Supplemental health services. 417.102 Section 417.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL...

  8. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. Link to an amendment..., that its current or proposed management team is qualified and has the knowledge, experience, and...

  9. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. An Applicant must show, to the satisfaction of the Secretary, that its current or proposed management team is qualified and has...

  10. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. An Applicant must show, to the satisfaction of the Secretary, that its current or proposed management team is qualified and has...

  11. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. An Applicant must show, to the satisfaction of the Secretary, that its current or proposed management team is qualified and has...

  12. 7 CFR 4290.110 - Qualified management.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Qualified management. 4290.110 Section 4290.110... Qualifications for the RBIC Program Organizing A Rbic § 4290.110 Qualified management. An Applicant must show, to the satisfaction of the Secretary, that its current or proposed management team is qualified and has...

  13. Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults.

    PubMed

    Wong, Charlene A; Asch, David A; Vinoya, Cjloe M; Ford, Carol A; Baker, Tom; Town, Robert; Merchant, Raina M

    2015-08-01

    We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. We observed young adults aged 19-30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses. We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits. Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  14. Competence of newly qualified registered nurses from a nursing college.

    PubMed

    Morolong, B G; Chabeli, M M

    2005-05-01

    The South African education and training system, through its policy of outcomes-based education and training, has made competency a national priority. In compliance to this national requirement of producing competent learners, the South African Nursing Council (1999 B) require that the beginner professional nurse practitioners and midwives have the necessary knowledge, skills, attitudes and values which will enable them to render efficient professional service. The health care system also demands competent nurse practitioners to ensure quality in health care. In the light of competency being a national priority and a statutory demand, the research question that emerges is, how competent are the newly qualified registered nurses from a specific nursing college in clinical nursing education? A quantitative, non-experimental contextual design was used to evaluate the competence of newly qualified registered nurses from a specific nursing college. The study was conducted in two phases. The first phase dealt with the development of an instrument together with its manual through the conceptualisation process. The second phase focused on the evaluation of the competency of newly qualified nurses using the instrument based on the steps of the nursing process. A pilot study was conducted to test the feasibility of the items of the instrument. During the evaluation phase, a sample of twenty-six newly qualified nurses was selected by simple random sampling from a target population of thirty-six newly qualified registered nurses. However, six participants withdrew from the study. Data was collected in two general hospitals where the newly qualified registered nurses were working. Observation and questioning were used as data collection techniques in accordance with the developed instrument. Measures were taken to ensure internal validity and reliability of the results. To protect the rights of the participants, the researcher adhered to DENOSA'S (1998:2.2.1) ethical standards

  15. Joining up health and planning: how Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning.

    PubMed

    Tomlinson, Paul; Hewitt, Stephen; Blackshaw, Neil

    2013-09-01

    There has been a welcome joining up of the rhetoric around health, the environment and land use or spatial planning in both the English public health white paper and the National Planning Policy Framework. However, this paper highlights a real concern that this is not being followed through into practical guidance needed by local authorities (LAs), health bodies and developers about how to deliver this at the local level. The role of Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the potential to provide a strong basis for integrated local policies for health improvement, to address the wider determinants of health and to reduce inequities. However, the draft JSNA guidance from the Department of Health falls short of providing a robust, comprehensive and practical guide to meeting these very significant challenges. The paper identifies some examples of good practice. It recommends that action should be taken to raise the standards of all JSNAs to meet the new challenges and that HWSs should be aligned spatially and temporally with local plans and other LA strategies. HWSs should also identify spatially targeted interventions that can be delivered through spatial planning or transport planning. Steps need to be taken to ensure that district councils are brought into the process.

  16. Consumer-directed health plans: mixed employer signals, complex market dynamics.

    PubMed

    Tynan, Ann; Christianson, Jon B

    2008-03-01

    Health plans have expanded consumer-directed health plan (CDHP) product offerings--typically high-deductible health plans coupled with a spending account--and more employers are offering these products to workers, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. In developing CDHPs, health plans are responding to a broader employer strategy to confer more responsibility on workers for their health care costs, lifestyle choices and treatment decisions. CDHP adoption by employers and consumers depends on a range of factors, including product features and employer characteristics, and varies across the 12 communities. While more large employers are introducing CDHPs into health benefit programs, adoption of CDHPs remains modest. Health plans and employers expect CDHP enrollment to grow as employers and employees become more knowledgeable about CDHP features, health plans develop more sophisticated support tools for plan enrollees, and there are more opportunities to learn from early adopters' experiences.early

  17. Manpower planning for oral health.

    PubMed

    Ross, C B

    1988-03-01

    The challenges to the dental profession include the unemployed dentists, the radical changes to the numbers of dental schools and their intake of new students; and the imbalance which exists on a global scale between oral health personnel and service need and demand. Workforce planning needs clearly defined goals which relate to the nature of disease, the shift from treatment to prevention and consumer expectations. A wide variety of information is required to facilitate communication and co-operation with elements of the political system, the educational system, professional bodies, health service agencies and consumers. It is essential that national planning and monitoring groups be established with membership from dental associations, educational institutions and government. In workforce planning there must be the ability to accept change, to be creative, to be positive, and to be decisive.

  18. 42 CFR 417.416 - Qualifying condition: Furnishing of services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... following services may be furnished without the direct personal supervision of a physician: (1) Services of physician assistants and nurse practitioners (as defined in § 491.2 of this chapter), and the services and... 42 Public Health 3 2014-10-01 2014-10-01 false Qualifying condition: Furnishing of services. 417...

  19. 42 CFR 417.416 - Qualifying condition: Furnishing of services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... following services may be furnished without the direct personal supervision of a physician: (1) Services of physician assistants and nurse practitioners (as defined in § 491.2 of this chapter), and the services and... 42 Public Health 3 2012-10-01 2012-10-01 false Qualifying condition: Furnishing of services. 417...

  20. 42 CFR 417.416 - Qualifying condition: Furnishing of services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... following services may be furnished without the direct personal supervision of a physician: (1) Services of physician assistants and nurse practitioners (as defined in § 491.2 of this chapter), and the services and... 42 Public Health 3 2010-10-01 2010-10-01 false Qualifying condition: Furnishing of services. 417...

  1. 42 CFR 417.416 - Qualifying condition: Furnishing of services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... following services may be furnished without the direct personal supervision of a physician: (1) Services of physician assistants and nurse practitioners (as defined in § 491.2 of this chapter), and the services and... 42 Public Health 3 2013-10-01 2013-10-01 false Qualifying condition: Furnishing of services. 417...

  2. Health plan switching among members of the Federal Employees Health Benefits Program.

    PubMed

    Atherly, Adam; Florence, Curtis; Thorpe, Kenneth E

    2005-01-01

    This paper examines factors associated with switching health plans in the Federal Employees Health Benefits Program. Switching plans is not uncommon, with 12% of members switching plans annually. Individuals switch out of plans with premium increases and benefit decreases relative to other plans in the market. Switching is negatively associated with age due to increasing switching costs associated with age rather than decreasing premium sensitivity. Individuals in preferred provider organizations are less likely to switch, but are more responsive to premium increases than those in the managed care sector. Those who do switch plans are likely to switch to a different plan in the same sector.

  3. Medication adherence and measures of health plan quality.

    PubMed

    Seabury, Seth A; Lakdawalla, Darius N; Dougherty, J Samantha; Sullivan, Jeff; Goldman, Dana P

    2015-06-01

    Medication adherence is increasingly being considered as a measure for performance-based reimbursement contracts in healthcare systems. However, the association between health outcomes and adherence at the plan level is unknown. Retrospective analysis of medical and pharmacy claims from a large private sector claims database from 2000 to 2009. We compared plan-level measures of medication adherence and health outcomes for patients with diabetes and congestive heart failure (CHF). Plan performance was based on average rates of disease complications. Medication adherence was calculated as the percent of patients having 80% of days covered for medications treating diabetes or CHF. Both adherence and outcomes were adjusted for patient differences using multivariate regression. Plans were stratified into low, moderate, and high adherence, based on adherence in the bottom quartile, middle 2 quartiles, and top quartile, respectively. Average adherence varied significantly across plans. Plans with low adherence to diabetes medications had adjusted rates of uncontrolled diabetes admissions of 13.2 per 1000 patients, compared with 11.2 in moderate adherence plans and 8.3 in high adherence plans (P < .001). The adjusted rate of CHF-related hospitalization was 15.3% in low adherence plans, compared with 12.4% in moderate adherence plans and 12.2% in high adherence plans (P < .001). These patterns were consistent across different types of complications for both diabetes and CHF. Private health plans vary considerably in average adherence to medications treating chronic diseases. Plans with higher average adherence had lower rates of disease complications, suggesting that medication adherence measures are potentially useful tools for improving the performance of health plans.

  4. Price-Shopping in Consumer-Directed Health Plans

    PubMed Central

    Sood, Neeraj; Wagner, Zachary; Huckfeldt, Peter; Haviland, Amelia

    2013-01-01

    We use health insurance claims data from 63 large employers to estimate the extent of price shopping for nine common outpatient services in consumer-directed health plans (CDHPs) compared to traditional health plans. The main measures of price-shopping include: (1) the total price paid on the claim, (2) the share of claims from low and high cost providers and (3) the savings from price shopping relative to choosing prices randomly. All analyses control for individual and zip code level demographics and plan characteristics. We also estimate differences in price shopping within CDHPs depending on expected health care costs and whether the service was bought before or after reaching the deductible. For 8 out of 9 services analyzed, prices paid by CDHP and traditional plan enrollees did not differ significantly; CDHP enrollees paid 2.3% less for office visits. Similarly, office visits was the only service where CDHP enrollment resulted in a significantly larger share of claims from low cost providers and greater savings from price shopping relative to traditional plans. There was also no evidence that, within CDHP plans, consumers with lower expected medical expenses exhibited more price-shopping or that consumers exhibited more price-shopping before reaching the deductible. PMID:25342936

  5. Characteristics of practitioners in a private managed behavioral health plan.

    PubMed

    Reif, Sharon; Torres, Maria E; Horgan, Constance M; Merrick, Elizabeth L

    2012-08-28

    Little is known about the practitioners in managed behavioral healthcare organization (MBHO) networks who are treating mental and substance use disorders among privately insured patients in the United States. It is likely that the role of the private sector in treating behavioral health will increase due to the recent implementation of federal parity legislation and the inclusion of behavioral health as a required service in the insurance exchange plans created under healthcare reform. Further, the healthcare reform legislation has highlighted the need to ensure a qualified workforce in order to improve access to quality healthcare, and provides an additional focus on the behavioral health workforce. To expand understanding of treatment of mental and substance use disorders among privately insured patients, this study examines practitioner types, experience, specialized expertise, and demographics of in-network practitioners providing outpatient care in one large national MBHO. Descriptive analyses used 2004 practitioner credentialing and other administrative data for one MBHO. The sample included 28,897 practitioners who submitted at least one outpatient claim in 2004. Chi-square and t-tests were used to compare findings across types of practitioners. About half of practitioners were female, 12% were bilingual, and mean age was 53, with significant variation by practitioner type. On average, practitioners report 15.3 years of experience (SD = 9.4), also with significant variation by practitioner type. Many practitioners reported specialized expertise, with about 40% reporting expertise for treating children and about 60% for treating adolescents. Overall, these results based on self-report indicate that the practitioner network in this large MBHO is experienced and has specialized training, but echo concerns about the aging of this workforce. These data should provide us with a baseline of practitioner characteristics as we enter an era that anticipates great

  6. 77 FR 70163 - Recognition of Entities for the Accreditation of Qualified Health Plans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-23

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES [CMS-9961-N] Recognition of Entities for the Accreditation... as recognized accrediting entities for the purposes of fulfilling the accreditation requirement as... a recognized accrediting entity on a uniform timeline established by the applicable Exchange. On...

  7. Guidelines for Analysis of Communicable Disease Control Planning in Developing Countries. Volume 1: Communicable Diseases Control Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Chin, James

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this first of ten manuals in the International Health Planning Methods Series deals with planning and evaluation of communicable disease control programs. The first…

  8. [The Health Plan for Catalonia: an instrument to transform the health system].

    PubMed

    Constante i Beitia, Carles

    2015-11-01

    The Department of Health of the Generalitat in Catalonia periodically draws up the Health Plan, which is the strategic document that brings together the reference framework for initiatives concerning public health in terms of the Catalan health administration. The 2011-2015 version of the Health Plan incorporates key care and system governance-related elements, which, in conjunction with health goals, make up the complete picture of what the health system in Catalonia should look like until 2015. The Plan was drawn up at a time when the environmental conditions were extremely particular, given the major economic crisis that began in 2007. This has meant that the system has been forced to address public health problems using a significant reduction in the economic resources available, while aiming to maintain the level of care provided, both quantitatively and qualitatively, and preserve the sustainability of the system whose defining traits are its universality, equity and the wide range of services on offer. The Health Plan focuses on three areas of action, 9 major courses of action and 32 strategic projects designed to respond to new social needs: addressing the most common health issues, comprehensive care for chronic patients and organizational modernization. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  9. [Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future].

    PubMed

    Brugulat, P; Séculi, E; Fusté, J; Juncà, S; Martínez, V; Medina, A; Mercader, M; Sánchez, E

    2003-01-01

    To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans. Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers. 78,8% (IC95%: 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed. The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies.

  10. Outcomes of annual wellness visits provided by pharmacists in an accountable care organization associated with a federally qualified health center.

    PubMed

    Alhossan, Abdulaziz; Kennedy, Amy; Leal, Sandra

    2016-02-15

    The clinical and financial outcomes of annual wellness visits (AWVs) conducted by clinical pharmacists working as part of an accountable care organization (ACO) in a federally qualified health center were evaluated. In this retrospective, single-center, chart review study, patients seen for AWVs at El Rio Health Center between October and December 2013 were eligible for study inclusion. Data collected from patient charts included patient demographics, preventive screenings ordered by clinical pharmacists during the AWV and completed within one month after the visit, other screenings completed by clinical pharmacists during the visit, medication changes by clinical pharmacists, and revenues collected from the AWV and preventive screenings. Descriptive statistics were calculated and variables compared; p values were calculated using single-sample Student's t tests. Three hundred patient records were reviewed. Clinical pharmacists completed 1608 interventions, with a mean of 5.4 interventions per patient. A total of 272 referrals were made, 120 (45%) of which were completed within one month of the visit. Of the 183 laboratory tests ordered for diabetes and lipid screening, 152 (83%) were completed within one month of the AWV (p < 0.001). Of the 370 vaccinations offered during the visits, 182 (49%) were administered (p < 0.001). Twenty-four medication and dosage changes were made by clinical pharmacists during AWVs, and the total revenue for the AWVs conducted by pharmacists and services completed during the visits exceeded $22,000. Recommendations made by pharmacists during AWVs in an ACO associated with a federally qualified health center had a high acceptance rate and generated substantial revenue. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  11. Consumer-directed health plans: are medical and health savings accounts viable options for financing American health care?

    PubMed

    Masri, Maysoun Demachkie; Oetjen, Reid M; Campbell, Claudia

    2010-01-01

    When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries.

  12. Urban planning and health equity.

    PubMed

    Northridge, Mary Evelyn; Freeman, Lance

    2011-06-01

    Although the fields of urban planning and public health share a common origin in the efforts of reformers to tame the ravages of early industrialization in the 19th century, the 2 disciplines parted ways in the early 20th century as planners increasingly focused on the built environment while public health professionals narrowed in on biomedical causes of disease and disability. Among the unfortunate results of this divergence was a tendency to discount the public health implications of planning decisions. Given increasingly complex urban environments and grave health disparities in cities worldwide, urban planners and public health professionals have once again become convinced of the need for inclusive approaches to improve population health and achieve health equity. To make substantive progress, intersectoral collaboration utilizing ecological and systems science perspectives will be crucial as the solutions lie well beyond the control of any single authority. Grounded in the social determinants of health, and with a renewed sense of interconnectedness, dedicated and talented people in government agencies and communities who recognize that our future depends on cultivating local change and evaluating the results can come to grips with the enormous challenge that lies ahead to create more equitable, sustainable, and healthier cities worldwide.

  13. Housing, health and master planning: rules of engagement.

    PubMed

    Harris, P; Haigh, F; Thornell, M; Molloy, L; Sainsbury, P

    2014-04-01

    Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted. Copyright © 2014 The Royal Society for Public Health. All rights reserved.

  14. 42 CFR 51c.105 - Accord with health planning.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Accord with health planning. 51c.105 Section 51c.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR COMMUNITY HEALTH SERVICES General Provisions § 51c.105 Accord with health planning. A grant may be made...

  15. 42 CFR 51c.105 - Accord with health planning.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Accord with health planning. 51c.105 Section 51c.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR COMMUNITY HEALTH SERVICES General Provisions § 51c.105 Accord with health planning. A grant may be made...

  16. 42 CFR 51c.105 - Accord with health planning.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Accord with health planning. 51c.105 Section 51c.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR COMMUNITY HEALTH SERVICES General Provisions § 51c.105 Accord with health planning. A grant may be made...

  17. 42 CFR 51c.105 - Accord with health planning.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Accord with health planning. 51c.105 Section 51c.105 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR COMMUNITY HEALTH SERVICES General Provisions § 51c.105 Accord with health planning. A grant may be made...

  18. 20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

  19. 20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

  20. 20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

  1. 20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

  2. Tennessee health plan tobacco cessation coverage.

    PubMed

    Kolade, Folasade M

    2014-01-01

    To evaluate the smoking cessation coverage available from public and private Tennessee health plans. Cross-sectional study. The sampling frame for private plans was a register of licensed plans obtained from the Tennessee Commerce Department. Government websites and reports provided TennCare data. Data were abstracted from plan manuals and formularies for benefit year 2012. Classification of coverage included comprehensive-all seven recommended medications plus individual and group counseling; moderate-at least two forms of nicotine replacement therapy (NRT) plus bupropion and varenicline and one form of counseling; inadequate-at least one treatment, or none-no medications or counseling, or coverage only for pregnant women. Of nine private plans, one provided comprehensive coverage; two, moderate coverage; four, inadequate coverage, as did TennCare; and two plans provided no coverage. Over 362,800 smokers had inadequate access to cessation treatments under TennCare, while 119,094 smokers had inadequate or no cessation coverage under private plans. In 2012, Tennessee fell short of Healthy People goals for total managed care and comprehensive TennCare coverage of smoking cessation. If Tennessee mandates that all health plans provide full coverage, 481,900 smokers may immediately be in a better position to quit. © 2013 Wiley Periodicals, Inc.

  3. How to inject consumerism into your existing health plans.

    PubMed

    Havlin, Linda J; McAllister, Michael F; Slavney, David H

    2003-09-01

    Consumerism seeks to create a behavior change on the part of consumers so that they become accountable, knowledgeable and actively engaged in managing their health. It can be used in any existing health plan through targeted plan design changes and consumer education efforts. Employers have many options in addition to consumer-directed health plans (CDHPs).

  4. 42 CFR § 414.1440 - Qualifying APM participant determination: All-payer combination option.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1440 Qualifying APM participant determination: All-payer combination option. (a) Payments excluded...

  5. 42 CFR 440.350 - Employer-sponsored insurance health plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may provide...

  6. 42 CFR 440.350 - Employer-sponsored insurance health plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Employer-sponsored insurance health plans. 440.350 Section 440.350 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Benchmark-Equivalent Coverage § 440.350 Employer-sponsored insurance health plans. (a) A State may provide...

  7. How Do Private Health Plans Manage Specialty Behavioral Health Treatment Entry and Continuing Care?

    PubMed

    Quinn, Amity E; Reif, Sharon; Merrick, Elizabeth L; Horgan, Constance M; Garnick, Deborah W; Stewart, Maureen T

    2017-09-01

    This study examined private health plans' arrangements for accessing and continuing specialty behavioral health treatment in 2010 as federal health reforms were being implemented. These management practices have historically been stricter in behavioral health care than in general medical care; however, the Mental Health Parity and Addiction Equity Act of 2010 required parity in management policies. The data source was a nationally representative survey of private health plans' behavioral health treatment management approaches in 2010. Health plan executives were asked about activities for their plan's three products with highest enrollment (weighted N=8,427, 88% response rate). Prior authorization for outpatient behavioral health care was rarely required (4.7% of products), but 75% of products required authorization for ongoing care and over 90% required prior authorization for other levels of care. The most common medical necessity criteria were self-developed and American Society of Addiction Medicine criteria. Nearly all products had formal standards to limit waiting time for routine and urgent treatment, but almost 30% lacked such standards for detoxification services. A range of wait time-monitoring approaches was used. Health plans used a variety of methods to influence behavioral health treatment entry and continuing care. Few relied on prior authorization for outpatient care, but the use of other approaches to influence, manage, or facilitate access was common. Results provide a baseline for understanding the current management environment for specialty behavioral health care. Tracking health plans' approaches over time will be important to ensure that access to behavioral health care is not prohibitively restrictive.

  8. Health Plans' Early Response to Federal Parity Legislation for Mental Health and Addiction Services.

    PubMed

    Horgan, Constance M; Hodgkin, Dominic; Stewart, Maureen T; Quinn, Amity; Merrick, Elizabeth L; Reif, Sharon; Garnick, Deborah W; Creedon, Timothy B

    2016-02-01

    In 2008, the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed, prohibiting U.S. health plans from subjecting mental health and substance use disorder (behavioral health) coverage to more restrictive limitations than those applied to general medical care. This require d some health plans to make changes in coverage and management of services. The aim of this study was to examine private health plans' early responses to MHPAEA (after its 2010 implementation), in terms of both intended and unintended effects. Data were from a nationally representative survey of commercial health plans regarding the 2010 benefit year and the preparity 2009 benefit year (weighted N=8,431 products; 89% response rate). Annual limits specific to behavioral health care were virtually eliminated between 2009 and 2010. Prevalence of behavioral health coverage was unchanged, and copayments for both behavioral and general medical services increased slightly. Prior authorization requirements for specialty medical and behavioral health outpatient services continued to decline, and the proportion of products reporting strict continuing review requirements increased slightly. Contrary to expectations, plans did not make significant changes in contracting arrangements for behavioral health services, and 80% reported an increase in size of their behavioral health provider network. The law had the intended effect of eliminating quantitative limitations that applied only to behavioral health care without unintended consequences such as eliminating behavioral health coverage. Plan decisions may also reflect other factors, including anticipation of the 2010 regulations and a continuation of trends away from requiring prior authorization.

  9. Exploring selection and recruitment processes for newly qualified nurses: a sequential-explanatory mixed-method study.

    PubMed

    Newton, Paul; Chandler, Val; Morris-Thomson, Trish; Sayer, Jane; Burke, Linda

    2015-01-01

    To map current selection and recruitment processes for newly qualified nurses and to explore the advantages and limitations of current selection and recruitment processes. The need to improve current selection and recruitment practices for newly qualified nurses is highlighted in health policy internationally. A cross-sectional, sequential-explanatory mixed-method design with 4 components: (1) Literature review of selection and recruitment of newly qualified nurses; and (2) Literature review of a public sector professions' selection and recruitment processes; (3) Survey mapping existing selection and recruitment processes for newly qualified nurses; and (4) Qualitative study about recruiters' selection and recruitment processes. Literature searches on the selection and recruitment of newly qualified candidates in teaching and nursing (2005-2013) were conducted. Cross-sectional, mixed-method data were collected from thirty-one (n = 31) individuals in health providers in London who had responsibility for the selection and recruitment of newly qualified nurses using a survey instrument. Of these providers who took part, six (n = 6) purposively selected to be interviewed qualitatively. Issues of supply and demand in the workforce, rather than selection and recruitment tools, predominated in the literature reviews. Examples of tools to measure values, attitudes and skills were found in the nursing literature. The mapping exercise found that providers used many selection and recruitment tools, some providers combined tools to streamline process and assure quality of candidates. Most providers had processes which addressed the issue of quality in the selection and recruitment of newly qualified nurses. The 'assessment centre model', which providers were adopting, allowed for multiple levels of assessment and streamlined recruitment. There is a need to validate the efficacy of the selection tools. © 2014 John Wiley & Sons Ltd.

  10. Disaster mental health preparedness plan in Indonesia.

    PubMed

    Setiawan, G Pandu; Viora, Eka

    2006-12-01

    The tsunami brought into focus many issues related to mental health and psychosocial distress. A prompt response to the disaster relies on existing disaster management plans so that appropriate interventions can be put in place in order to meet the needs of the affected populations. The response must involve both physical and psychological aspects of care. The Indonesian experience was unique in a number of ways and it allowed us to explore the lessons in order to develop strategies to maximize the resources in order to ensure that the whole affected population was cared for. Massive destruction of the physical structures and the work force made the task particularly difficult. Existing policies did not include psychosocial efforts in the plan. However, mental health and psychosocial relief efforts are now being integrated into the disaster preparedness plan of Indonesia. To further implement the plan, a strong community mental health system is being developed. This system will be able to deliver mental health and psychosocial interventions on a routine basis and could be scaled up in times of disasters.

  11. Health plan decision making with new medicare information materials.

    PubMed Central

    McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

    2001-01-01

    OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to

  12. Health plan decision making with new medicare information materials.

    PubMed

    McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

    2001-07-01

    To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or

  13. Amendments to Summary Plan Description regulations. Pension and Welfare Benefits Administration, Labor. Final rule.

    PubMed

    2000-11-21

    This document contains a final rule amending the regulations governing the content of the Summary Plan Description (SPD) required to be furnished to employee benefit plan participants and beneficiaries under the Employee Retirement Income Security Act of 1974, as amended (ERISA). These amendments implement information disclosure recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, as set forth in their November 20, 1997, report, "Consumer Bill of Rights and Responsibilities." Specifically, the amendments clarify benefit, medical provider, and other information required to be disclosed in, or as part of, the SPD of a group health plan and repeal the limited exemption with respect to SPDs of welfare plans providing benefits through qualified health maintenance organizations (HMOs). In addition, this document contains several amendments updating and clarifying provisions relating to the content of SPDs that affect both pension and welfare benefit plans. This document also adopts in final form certain regulations that were effective on an interim basis implementing amendments to ERISA enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This final rule will affect employee pension and welfare benefit plans, including group health plans, as well as administrators, fiduciaries, participants and beneficiaries of such plans.

  14. When patients govern: federal grant funding and uncompensated care at federally qualified health centers.

    PubMed

    Wright, Brad; Ricketts, Thomas C

    2013-05-01

    To determine if the proportion of consumers on federally qualified health center (FQHC) governing boards is associated with their use of federal grant funds to provide uncompensated care. Using FQHC data from the Uniform Data System, county-level data from the Area Resource File and governing board data from FQHC grant applications, the uncompensated care an FQHC provides relative to the amount of its federal funding is modeled as a function of board and executive committee composition using fixed-effects regression with FQHC and county-level controls. Consumer governance does not predict how much uncompensated care an FQHC provides relative to the size of its federal grant. Rather, the proportion of an FQHC's patient-mix that is uninsured drives uncompensated care provision. Aside from a small executive committee effect, consumer governance does not influence FQHCs' provision of uncompensated care. More work is needed to understand the role of consumer governance.

  15. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  16. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  17. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  18. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  19. 30 CFR 75.155 - Qualified hoisting engineer; qualifications.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-hoisting engineer; or (2) If a State has no program for qualifying persons as electric-hoisting engineers... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Qualified hoisting engineer; qualifications. 75... Persons § 75.155 Qualified hoisting engineer; qualifications. (a)(1) A person is a qualified hoisting...

  20. Dyadic planning of health-behavior change after prostatectomy: a randomized-controlled planning intervention.

    PubMed

    Burkert, Silke; Scholz, Urte; Gralla, Oliver; Roigas, Jan; Knoll, Nina

    2011-09-01

    In this study, we investigated the role of dyadic planning for health-behavior change. Dyadic planning refers to planning health-behavior change together with a partner. We assumed that dyadic planning would affect the implementation of regular pelvic-floor exercise (PFE), with other indicators of social exchange and self-regulation strategies serving as mediators. In a randomized-controlled trial at a German University Medical Center, 112 prostatectomy-patients with partners were randomly assigned to a dyadic PFE-planning condition or one of three active control conditions. Questionnaire data were assessed at multiple time points within six months post-surgery, measuring self-reported dyadic PFE-planning and pelvic-floor exercise as primary outcomes and social exchange (support, control) and a self-regulation strategy (action control) as mediating mechanisms. There were no specific intervention effects with regard to dyadic PFE-planning or pelvic-floor exercise, as two active control groups also showed increases in either of these variables. However, results suggested that patients instructed to plan dyadically still benefited from self-reported dyadic PFE-planning regarding pelvic-floor exercise. Cross-sectionally, received negative control from partners was negatively related with PFE only in control groups and individual action control mediated between self-reported dyadic PFE-planning and PFE for participants instructed to plan PFE dyadically. Longitudinally, action control mediated between self-reported dyadic PFE-planning and pelvic-floor exercise for all groups. Findings provide support for further investigation of dyadic planning in health-behavior change with short-term mediating effects of behavior-specific social exchange and long-term mediating effects of better self-regulation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. 45 CFR 162.506 - Standard unique health plan identifier.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Standard unique health plan identifier. 162.506 Section 162.506 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health Plans § 162...

  2. 45 CFR 162.506 - Standard unique health plan identifier.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Standard unique health plan identifier. 162.506 Section 162.506 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health Plans § 162...

  3. Characteristics of health plans that treat psychiatric patients.

    PubMed

    Zarin, D A; West, J C; Pincus, H A; Tanielian, T L

    1999-01-01

    Nationally representative data regarding the organizational, financial, and procedural features of health plans in which psychiatric patients receive treatment indicate that fewer privately insured, Medicaid, and Medicare managed care enrollees receive care from a psychiatrist than is true for "nonmanaged" enrollees. Financial considerations were reported to adversely affect treatment for one-third of all patients. Although utilization management techniques and financial/resource constraints commonly applied to patients in both managed and nonmanaged plans, performance-based incentives were rare in nonmanaged plans. The traditional health plan categories provide limited information to identify salient plan characteristics and guide policy decisions regarding the provision of care.

  4. 'Practising under your own Pin'- a description of the transition experiences of newly qualified midwives.

    PubMed

    Avis, Mark; Mallik, Maggie; Fraser, Diane M

    2013-11-01

    Transition experiences of newly qualified midwives were examined in depth during the third phase of a UK evaluation study of midwifery education. The fitness to practise and the retention of newly qualified nursing and midwifery graduates are pressing concerns for health care managers. The advantages of preceptorship are reported in the literature but the content and timing of schemes remain unclear. A semi-structured diary was kept for up to 6 months by 35 newly qualified midwives in 18 work sites covering all countries in the UK. The preceptor and supervisor of midwives for each newly qualified midwife completed short questionnaires about their preceptee's performance, and a further sub-sample of newly qualified midwives and preceptors participated in a semi-structured interview. Data were analysed to elicit aspects of newly qualified midwives transition experiences. Findings confirm that structured preceptorship schemes are not widely available. Newly qualified midwives primarily obtained transition support from members of the midwifery team. Although perceived as competent, there is no demarcation point in becoming confident to practise as a registered practitioner. Implications for managers include the importance of a supportive culture within clinical teams for successful transition and the introduction of structured preceptorship schemes facilitated by appropriate rotation patterns. © 2012 John Wiley & Sons Ltd.

  5. Geographic variation in premiums in health insurance marketplaces.

    PubMed

    Barker, Abigail R; McBride, Timothy D; Kemper, Leah M; Mueller, Keith

    2014-08-01

    This policy brief analyzes the 2014 premiums associated with qualified health plans (QHPs) made available through new health insurance marketplaces (HIMs), an implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. We report differences in premiums by insurance rating areas while controlling for other important factors such as the actuarial value of the plan (metal level), cost-of-living differences, and state-level decisions over type of rating area. While market equilibrium, based on experience and understanding of the characteristics of the new market, should not be expected this soon, preliminary results give policymakers key issues to monitor.

  6. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  7. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  8. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  9. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  10. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  11. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  12. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  13. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  14. 45 CFR 1151.12 - Qualified handicapped person.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Qualified handicapped person. 1151.12 Section 1151... AND THE HUMANITIES NATIONAL ENDOWMENT FOR THE ARTS NONDISCRIMINATION ON THE BASIS OF HANDICAP Standards for Determining Who Are Handicapped Persons § 1151.12 Qualified handicapped person. Qualified...

  15. 28 CFR 41.32 - Qualified handicapped person.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Qualified handicapped person. 41.32..., NONDISCRIMINATION ON THE BASIS OF HANDICAP IN FEDERALLY ASSISTED PROGRAMS Standards for Determining Who Are Handicapped Persons § 41.32 Qualified handicapped person. Qualified handicapped person means: (a) With respect...

  16. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network.

    PubMed

    Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R

    2009-07-20

    The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health

  17. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network

    PubMed Central

    Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, VR

    2009-01-01

    The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health

  18. Reproductive health/family planning and the health of infants, girls and women.

    PubMed

    Sadik, N

    1997-01-01

    The 1994 International Conference on Population and Development developed international consensus amongst health providers, policy makers, and group representing the whole of civil society regarding the concept of reproductive health and its definition. In line with this definition, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. Reproductive health care saves lives and prevents significant levels of morbidity through family planning programmes, antenatal, delivery and post-natal services, prevention and management programmes for reproductive tract infections (including sexually transmitted diseases and HIV/AIDS), prevention of abortion and management of its complications, cancers of the reproductive system, and harmful practices that impact on reproductive function. Reproductive health care needs are evident at all stages of the life cycle and account for a greater proportion of disability adjusted life years (DALYS) in girls and women than in boys and men. Reproductive health protects infant health by enabling birth spacing and birth limitation to be practiced through family planning. The prevention and early detection of reproductive tract infections, including sexually transmitted diseases and HIV, through the integration of preventive measures in family planning service delivery not only improves the quality of care provided but is also directly responsible for improvement in survival and health of infants. Addressing harmful practices such as son preference, sex selection, sexual violence and female genital mutilation complements the positive impact of planned and spaced children through family planning services on infant mortality and the reproductive health of young girls and women. They are also in addition to prenatal, delivery and postnatal services, positive determinants of low maternal mortality and

  19. Consumer experiences in a consumer-driven health plan.

    PubMed

    Christianson, Jon B; Parente, Stephen T; Feldman, Roger

    2004-08-01

    To assess the experience of enrollees in a consumer-driven health plan (CDHP). Survey of University of Minnesota employees regarding their 2002 health benefits. Comparison of regression-adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10-point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.

  20. Provider Communication and Role Modeling Related to Patients' Perceptions and Use of a Federally Qualified Health Center-based Farmers' Market

    PubMed Central

    Friedman, Daniela B.; Freedman, Darcy A.; Choi, Seul Ki; Anadu, Edith C.; Brandt, Heather M.; Carvalho, Natalia; Hurley, Thomas G.; Young, Vicki M.; Hebert, James R.

    2013-01-01

    Farmers’ markets have the potential to improve the health of underserved communities, shape people’s perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers’ market located at a federally qualified health center (FQHC). Although provider communication about diet decreased over time, communication strategies included: providing patients with “prescriptions” and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed the market had potential to improve the health of FHQC staff and patients. Provider modeling of healthy behaviors may influence patients’ food-related perceptions and dietary behaviors. PMID:23986503

  1. A research education program model to prepare a highly qualified workforce in biomedical and health-related research and increase diversity.

    PubMed

    Crockett, Elahé T

    2014-09-24

    The National Institutes of Health has recognized a compelling need to train highly qualified individuals and promote diversity in the biomedical/clinical sciences research workforce. In response, we have developed a research-training program known as REPID (Research Education Program to Increase Diversity among Health Researchers) to prepare students/learners to pursue research careers in these fields and address the lack of diversity and health disparities. By inclusion of students/learners from minority and diverse backgrounds, the REPID program aims to provide a research training and enrichment experience through team mentoring to inspire students/learners to pursue research careers in biomedical and health-related fields. Students/learners are recruited from the University campus from a diverse population of undergraduates, graduates, health professionals, and lifelong learners. Our recruits first enroll into an innovative on-line introductory course in Basics and Methods in Biomedical Research that uses a laboratory Tool-Kit (a lab in a box called the My Dr. ET Lab Tool-Kit) to receive the standard basics of research education, e.g., research skills, and lab techniques. The students/learners will also learn about the responsible conduct of research, research concept/design, data recording/analysis, and scientific writing/presentation. The course is followed by a 12-week hands-on research experience during the summer. The students/learners also attend workshops and seminars/conferences. The students/learners receive scholarship to cover stipends, research related expenses, and to attend a scientific conference. The scholarship allows the students/learners to gain knowledge and seize opportunities in biomedical and health-related careers. This is an ongoing program, and during the first three years of the program, fifty-one (51) students/learners have been recruited. Thirty-six (36) have completed their research training, and eighty percent (80%) of them have

  2. 76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

  3. 76 FR 17653 - Public Meeting of the Consumer Operated and Oriented Plan (CO-OP) Advisory Board, April 15, 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    ...] Public Meeting of the Consumer Operated and Oriented Plan (CO-OP) Advisory Board, April 15, 2011 AGENCY... of the Department of Health and Human Services' through CCIIO strategy to foster the creation of... Oversight (CCIIO) on the Department's strategy to foster the creation of qualified consumer-operated...

  4. 10 CFR 436.32 - Qualified contractors lists.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Qualified contractors lists. 436.32 Section 436.32 Energy... Procedures for Energy Savings Performance Contracting § 436.32 Qualified contractors lists. (a) DOE shall... energy savings performance contracts. (c) DOE may remove a firm from DOE's list of qualified contractors...

  5. 12 CFR 583.17 - Qualified thrift lender.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Qualified thrift lender. 583.17 Section 583.17 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY DEFINITIONS FOR REGULATIONS AFFECTING SAVINGS AND LOAN HOLDING COMPANIES § 583.17 Qualified thrift lender. The term qualified thrift...

  6. 5 CFR 2634.403 - Qualified blind trusts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Qualified blind trusts. 2634.403 Section... Qualified blind trusts. (a) Definition. A qualified blind trust is a trust in which the filer, his spouse... instrument which establishes a blind trust must adhere substantively to model drafts circulated by the Office...

  7. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 17 2012-04-01 2012-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a qualifying...

  8. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 17 2013-04-01 2013-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a qualifying...

  9. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 17 2011-04-01 2011-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a qualifying...

  10. 26 CFR 54.4980B-4 - Qualifying events.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 17 2014-04-01 2014-04-01 false Qualifying events. 54.4980B-4 Section 54.4980B... EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4980B-4 Qualifying events. The determination of what constitutes a qualifying event is addressed in the following questions and answers: Q-1: What is a qualifying...

  11. [What do company health insurance plans provide?

    PubMed

    Hamiki, R

    2016-12-15

    Company health insurance plans are a voluntary employer benefit and an increasingly important part of company pension and benefits systems. They enable employers to invest in the health of their employees. They are also a useful modular complement to both statutory and private health insurance. Company health insurance plans allow employers to attract first-rate staff and to retain them for the long term. Employees, in turn, are provided with a variety of attractive additional benefits, for instance treatment by chief physicians, single or double-room hospital accommodation, additional aids and remedies, and a variety of screenings and medical check ups. It is expected that, in the next few years, company health insurance will become very widespread.

  12. Organisational travel plans for improving health.

    PubMed

    Hosking, Jamie; Macmillan, Alexandra; Connor, Jennie; Bullen, Chris; Ameratunga, Shanthi

    2010-03-17

    Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single-occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base. To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode. We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2-RIPE (to July 2008), C2-SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status. We included randomised controlled trials and controlled before-after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included. Two authors independently assessed eligibility, assessed trial

  13. Does Your Health Plan Measure Up? How Can You Tell?

    ERIC Educational Resources Information Center

    Edwards, Tom

    1999-01-01

    Describes the process behind health-plan selection for school district employees and offers suggestions on how managers might enhance their current healthcare plan purchasing process. Areas of health-plan review and critique are listed as are tips for measuring plan performance and advice on acquiring backup data on plan quality. (GR)

  14. 76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-26

    ... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

  15. 75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

  16. Engagement of health plans and employers in addressing racial and ethnic disparities in health care.

    PubMed

    Rosenthal, Meredith B; Landon, Bruce E; Normand, Sharon-Lise T; Ahmad, Thaniyyah S; Epstein, Arnold M

    2009-04-01

    Disparities in access to and quality of health care along racial and ethnic lines are an important national problem. Health care purchasers and payers have a potentially important role to play in alleviating this problem. Using national surveys of 609 employers and 252 health plans with HMO products in 41 U.S. markets, we examined awareness of racial and ethnic disparities in health care access and quality, perceptions of employer and health plan role in addressing disparities, and reported efforts to measure and reduce disparities. Our findings suggest that most health plans and many employers are aware of the existence of substantial disparities and that health plans, but not employers, have taken steps to examine and influence patterns of care by race and ethnicity among their members.

  17. Environmental Health Planning Guide. Revised 1968.

    ERIC Educational Resources Information Center

    Public Health Service (DHEW), Rockville, MD.

    This guide to environmental health planning outlines the process and procedures of bringing together certain fundamental data pertaining to various physical aspects of the environment, including data collection, evaluation, usage, and implementation. The components of such planning programs are listed along with study preparation information.…

  18. 26 CFR 1.46-3 - Qualified investment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified investment. 1.46-3 Section 1.46-3... Computing Credit for Investment in Certain Depreciable Property § 1.46-3 Qualified investment. (a) In general. (1) With respect to any taxable year, the qualified investment of the taxpayer is the aggregate...

  19. 26 CFR 25.2702-3 - Qualified interests.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Qualified interests. 25.2702-3 Section 25.2702-3... GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Special Valuation Rules § 25.2702-3 Qualified interests. (a) In general. This section provides rules for determining if an interest is a qualified annuity...

  20. 26 CFR 1.414(r)-1 - Requirements applicable to qualified separate lines of business.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT..., Stock Bonus Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating...

  1. 26 CFR 1.414(r)-1 - Requirements applicable to qualified separate lines of business.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT..., Stock Bonus Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating...

  2. 26 CFR 1.414(r)-1 - Requirements applicable to qualified separate lines of business.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT..., Stock Bonus Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating...

  3. 26 CFR 1.414(r)-1 - Requirements applicable to qualified separate lines of business.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... lines of business. 1.414(r)-1 Section 1.414(r)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT..., Stock Bonus Plans, Etc. § 1.414(r)-1 Requirements applicable to qualified separate lines of business. (a) In general. Section 414(r) prescribes the conditions under which an employer is treated as operating...

  4. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program. Final rule.

    PubMed

    2016-12-22

    This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics.

  5. 75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

  6. Family Health and Family Planning.

    ERIC Educational Resources Information Center

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    This document is made up of a selection of some of the papers distributed to participants in courses on "Family Health and Family Planning" which have been organized each year since 1973 by the International Children's Center and the World Health Organization Regional Office for Europe. Six courses, held between 1973 and 1978, brought together a…

  7. State planning of mental health services.

    PubMed

    Sauber, S R

    1976-03-01

    Planning is the vital process that links needs to solutions. The interorganizational field of human services constitutes a "turbulent environment," a condition of rapid change, and there needs to be greater receptivity toward comprehensive planning on the part of state departments of mental health. Increased overlap with various welfare and educational service, advances in scientific knowledge, and shifts in general attitudes and social philosophy lead to demands for new and different types of service and require changes in approach and method. Generalized findings of a study of 14 state departments of mental health are presented.

  8. 42 CFR § 414.1430 - Qualifying APM participant determination: QP and partial QP thresholds.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1430 Qualifying APM participant determination: QP and partial QP thresholds. (a...

  9. The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality

    PubMed Central

    Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G

    2010-01-01

    Objective To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. PMID:20403064

  10. Building and measuring infrastructure and capacity for community health assessment and health improvement planning in Florida.

    PubMed

    Abarca, Christine; Grigg, C Meade; Steele, Jo Ann; Osgood, Laurie; Keating, Heidi

    2009-01-01

    COMPASS (Comprehensive Assessment, Strategic Success) is the Florida Department of Health's community health assessment and health improvement planning initiative. Since 2002, COMPASS built state and county health department infrastructure to support a comprehensive, systematic, and integrated approach to community health assessment and planning. To assess the capacity of Florida's 67 county health departments (CHDs) to conduct community health assessment and planning and to identify training and technical assistance needs, COMPASS surveyed the CHDs using a Web-based instrument annually from 2004 through 2008. Response rate to the survey was 100 percent annually. In 2007, 96 percent of CHDs reported conducting assessment and planning within the past 3 years; 74 percent used the MAPP (Mobilizing for Action through Planning and Partnerships) framework. Progress was greater for the organizational and assessment phases of the MAPP-based work; only 10 CHDs had identified strategic priorities in 2007, and even fewer had implemented strategies for improving health. In 2007, the most frequently requested types of training were measuring success, developing goals and action plans, and using qualitative data; technical assistance was most frequently requested for program evaluation and writing community health status reports. Florida's CHDs have increased their capacity to conduct community health assessment and planning. Questions remain about sustaining these gains with limited resources.

  11. 76 FR 60788 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent... marketplaces for individuals and small employers to directly compare available private health insurance options... January 1, 2014, would help enhance competition in the health insurance market, improve choice of...

  12. Prepared for commissioning? A qualitative study into the views of recently qualified GPs.

    PubMed

    Sabey, Abby; Hardy, Holly

    2013-09-01

    Expectations of the latest manifestation of GPled commissioning, in delivering cost-savings and improved services, are considerable. However, previous models suggest clinical engagement and other factors may hinder its success. It is timely to explore the views of the newest generation of GPs about involvement in commissioning, to inform plans for preparing the future workforce. To explore the views of recently qualified GPs about their future role in commissioning health services. A qualitative study with GPs qualifying with Severn Deanery between 2007 and 2010. Semi-structured interviews with 18 GPs between November 2011 and April 2012. These GPs lack understanding of roles and skills required for commissioning. Readiness is related to experience as a GP and of how services are financed and run, making timeliness for becoming involved important. Not all GPs feel motivated for commissioning and readiness is further hindered by feelings of conflict and uncertainty about how commissioning will work. There is optimism around working differently and better representing patients, but caution around risks and for some, cynicism about motives, will need addressing. While there is some optimism among these GPs about representing patients, leading reform and working differently with colleagues, there are concerns. GPs need to better understand the processes involved, experience and skills needed, and roles they can take. They can be helped through education and mentoring by established GPs to be ready for a role in commissioning.

  13. Responsive Consumerism: Empowerment in Markets for Health Plans

    PubMed Central

    Elbel, Brian; Schlesinger, Mark

    2009-01-01

    Context: American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans. Methods: Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of “empowered” consumers compared with those who are “less empowered.” Findings: The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. “Empowered” consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this. Conclusions: While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers’ responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form. PMID:19751285

  14. Responsive consumerism: empowerment in markets for health plans.

    PubMed

    Elbel, Brian; Schlesinger, Mark

    2009-09-01

    American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans. Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered." The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this. While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.

  15. 9 CFR 11.21 - Inspection procedures for designated qualified persons (DQP's).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Inspection procedures for designated qualified persons (DQP's). 11.21 Section 11.21 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE HORSE PROTECTION REGULATIONS § 11.21 Inspection...

  16. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE... qualified State-legislated sorghum promotion, research, and education commission or organization, approved... education commission or organization, qualified sorghum producer organization means any qualified...

  17. Strategic Planning in Population Health and Public Health Practice: A Call to Action for Higher Education

    PubMed Central

    PHELPS, CHARLES; RAPPUOLI, RINO; LEVIN, SCOTT; SHORTLIFFE, EDWARD; COLWELL, RITA

    2016-01-01

    Policy Points: Scarce resources, especially in population health and public health practice, underlie the importance of strategic planning.Public health agencies’ current planning and priority setting efforts are often narrow, at times opaque, and focused on single metrics such as cost‐effectiveness.As demonstrated by SMART Vaccines, a decision support software system developed by the Institute of Medicine and the National Academy of Engineering, new approaches to strategic planning allow the formal incorporation of multiple stakeholder views and multicriteria decision making that surpass even those sophisticated cost‐effectiveness analyses widely recommended and used for public health planning.Institutions of higher education can and should respond by building on modern strategic planning tools as they teach their students how to improve population health and public health practice. Context Strategic planning in population health and public health practice often uses single indicators of success or, when using multiple indicators, provides no mechanism for coherently combining the assessments. Cost‐effectiveness analysis, the most complex strategic planning tool commonly applied in public health, uses only a single metric to evaluate programmatic choices, even though other factors often influence actual decisions. Methods Our work employed a multicriteria systems analysis approach—specifically, multiattribute utility theory—to assist in strategic planning and priority setting in a particular area of health care (vaccines), thereby moving beyond the traditional cost‐effectiveness analysis approach. Findings (1) Multicriteria systems analysis provides more flexibility, transparency, and clarity in decision support for public health issues compared with cost‐effectiveness analysis. (2) More sophisticated systems‐level analyses will become increasingly important to public health as disease burdens increase and the resources to deal with them become

  18. Strategic Planning in Population Health and Public Health Practice: A Call to Action for Higher Education.

    PubMed

    Phelps, Charles; Madhavan, Guruprasad; Rappuoli, Rino; Levin, Scott; Shortliffe, Edward; Colwell, Rita

    2016-03-01

    Scarce resources, especially in population health and public health practice, underlie the importance of strategic planning. Public health agencies' current planning and priority setting efforts are often narrow, at times opaque, and focused on single metrics such as cost-effectiveness. As demonstrated by SMART Vaccines, a decision support software system developed by the Institute of Medicine and the National Academy of Engineering, new approaches to strategic planning allow the formal incorporation of multiple stakeholder views and multicriteria decision making that surpass even those sophisticated cost-effectiveness analyses widely recommended and used for public health planning. Institutions of higher education can and should respond by building on modern strategic planning tools as they teach their students how to improve population health and public health practice. Strategic planning in population health and public health practice often uses single indicators of success or, when using multiple indicators, provides no mechanism for coherently combining the assessments. Cost-effectiveness analysis, the most complex strategic planning tool commonly applied in public health, uses only a single metric to evaluate programmatic choices, even though other factors often influence actual decisions. Our work employed a multicriteria systems analysis approach--specifically, multiattribute utility theory--to assist in strategic planning and priority setting in a particular area of health care (vaccines), thereby moving beyond the traditional cost-effectiveness analysis approach. (1) Multicriteria systems analysis provides more flexibility, transparency, and clarity in decision support for public health issues compared with cost-effectiveness analysis. (2) More sophisticated systems-level analyses will become increasingly important to public health as disease burdens increase and the resources to deal with them become scarcer. The teaching of strategic planning in public

  19. 45 CFR 162.925 - Additional requirements for health plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Section 162.925 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND... data elements not needed or used by the health plan (for example, coordination of benefits information... coordination of benefits data it needs to forward the standard transaction to the other health plan (or other...

  20. 45 CFR 162.925 - Additional requirements for health plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 162.925 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND... data elements not needed or used by the health plan (for example, coordination of benefits information... coordination of benefits data it needs to forward the standard transaction to the other health plan (or other...

  1. The Hemophilia Games: An Experiment in Health Education Planning.

    ERIC Educational Resources Information Center

    National Heart and Lung Inst. (DHEW/PHS), Bethesda, MD.

    The Hemophilia Health Education Planning Project was designed to (1) create a set of tools useful in hemophilia planning and education, and (2) create a planning model for other diseases with similar factors. The project used the game-simulations technique which was felt to be particularly applicable to hemophilia health problems, since as a…

  2. Financial performance of health plans in Medicaid managed care.

    PubMed

    McCue, Mike

    2012-01-01

    This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization.

  3. 33 CFR 154.1026 - Qualified individual and alternate qualified individual.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... alternate must: (1) Be located in the United States; (2) Speak fluent English; (3) Be familiar with the... facility may designate an organization to fulfill the role of the qualified individual and the alternate...

  4. Planning for Students with Complex Health Care Needs.

    ERIC Educational Resources Information Center

    Lowman, Dianne Koontz

    1997-01-01

    This article discusses the efforts of Virginia school divisions as they prepared for and received students with complex health care needs. Findings from four studies that interviewed early childhood special education teachers and occupational therapies are described. The need for team planning and the development of a Health Services Plan is…

  5. Federal employees health benefits program: discontinuance of health plan in an emergency. Final regulation.

    PubMed

    2007-01-17

    The Office of Personnel Management (OPM) is issuing a final rule to amend the Federal Employees Health Benefits (FEHB) regulations regarding discontinuance of a health plan to include situations in which a health plan becomes incapacitated, either temporarily or permanently, as the result of a disaster.

  6. Principles of health infrastructure planning in less developed countries.

    PubMed

    Unger, J P; Criel, B

    1995-01-01

    This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited.

  7. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... qualified State-legislated sorghum promotion, research, and education commission or organization, approved... education commission or organization, qualified sorghum producer organization means any qualified organization that has the primary purpose of representing sorghum producers, has sorghum producers as members...

  8. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... qualified State-legislated sorghum promotion, research, and education commission or organization, approved... education commission or organization, qualified sorghum producer organization means any qualified organization that has the primary purpose of representing sorghum producers, has sorghum producers as members...

  9. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... qualified State-legislated sorghum promotion, research, and education commission or organization, approved... education commission or organization, qualified sorghum producer organization means any qualified organization that has the primary purpose of representing sorghum producers, has sorghum producers as members...

  10. 7 CFR 1221.24 - Qualified sorghum producer organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... qualified State-legislated sorghum promotion, research, and education commission or organization, approved... education commission or organization, qualified sorghum producer organization means any qualified organization that has the primary purpose of representing sorghum producers, has sorghum producers as members...

  11. 75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... group health plans and health insurance coverage in the group and individual markets under provisions of...

  12. 42 CFR 417.151 - Applicability.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PREPAYMENT PLANS Inclusion of Qualified Health Maintenance Organizations in Employee Health Benefits Plans... least one qualified HMO a written request for inclusion and that request met the timing, content, and...

  13. 42 CFR 417.151 - Applicability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PREPAYMENT PLANS Inclusion of Qualified Health Maintenance Organizations in Employee Health Benefits Plans... least one qualified HMO a written request for inclusion and that request met the timing, content, and...

  14. 42 CFR 417.151 - Applicability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PREPAYMENT PLANS Inclusion of Qualified Health Maintenance Organizations in Employee Health Benefits Plans... least one qualified HMO a written request for inclusion and that request met the timing, content, and...

  15. 42 CFR 417.151 - Applicability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PLANS Inclusion of Qualified Health Maintenance Organizations in Employee Health Benefits Plans § 417... qualified HMO a written request for inclusion and that request met the timing, content, and procedural...

  16. 42 CFR 417.151 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PLANS Inclusion of Qualified Health Maintenance Organizations in Employee Health Benefits Plans § 417... qualified HMO a written request for inclusion and that request met the timing, content, and procedural...

  17. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Other Provisions § 1400.12 Qualified researchers. The Administrator is authorized to provide OCA information, including facility identification, to qualified researchers pursuant to a system developed and...

  18. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Other Provisions § 1400.12 Qualified researchers. The Administrator is authorized to provide OCA information, including facility identification, to qualified researchers pursuant to a system developed and...

  19. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Other Provisions § 1400.12 Qualified researchers. The Administrator is authorized to provide OCA information, including facility identification, to qualified researchers pursuant to a system developed and...

  20. 40 CFR 1400.12 - Qualified researchers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Other Provisions § 1400.12 Qualified researchers. The Administrator is authorized to provide OCA information, including facility identification, to qualified researchers pursuant to a system developed and...

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