Certified School Nurse Perspectives on State-Mandated Hearing Screens

ERIC Educational Resources Information Center

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

2016-01-01

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

Payer view of personalized medicine.

PubMed

Pezalla, Edmund J

2016-12-01

The process and methods used by payers when evaluating coverage of personalized medicine testing are described. Personalized medicine encompasses a number of diagnostic tools that measure drug metabolism, genetic risk for disease development, and tumor type or markers that can guide oncology treatments. However, whole genome testing, tumor marker testing, and testing for drug metabolism are additional costs to the healthcare system. In order to justify these costs, payers and health technology assessment bodies must evaluate the individual tests or groups of tests on their own merits. In order for a test to be covered by payers, test developers must demonstrate clinical utility as measured by improved outcomes or well-informed decision-making. In the United States, payers generally focus on clinical benefit to individual patients and benefits to the healthcare system. Clinical benefits include improved outcomes. Benefits to the healthcare system are generally considered to be cost offsets, which may be due to reductions in the use of unnecessary interventions or to more efficient use of resources. Provider organizations have been assuming more responsibility and liability for healthcare costs through various risk arrangements, including accountable care organizations and patient-centered medical homes. Diagnostic tests that increase efficiency, reduce unnecessary interventions, and improve outcomes will be chosen by specialists in provider organizations. For personalized medicine approaches to be adopted and covered by health plans, the methods must be shown to be analytically and clinically valid and provide clinical utility at a reasonable level of cost-effectiveness to payers. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Multiple payers, commonality and free-riding in health care: Medicare and private payers.

PubMed

Glazer, Jacob; McGuire, Thomas G

2002-11-01

Managed health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the total payments. While payers have different objectives and use different contracting practices, the plans and providers set some elements of the quality in common for all payers. In this paper, we study the interactions between a public payer, modeled on Medicare, which sets a price and takes any willing provider, a private payer, which limits providers and pays a price on the basis of quality, and a provider/plan, in the presence of shared elements of quality. The provider compromises in response to divergent incentives from payers. The private sector dilutes Medicare payment initiatives, and may, under some circumstances, repair Medicare payment policy mistakes. If Medicare behaves strategically in the presence of private payers, it can free-ride on the private payer and set its prices too low. Our paper has many testable implications, including a new hypothesis for why Medicare has failed to gain acceptance of health plans in the US.

Health Technology Assessment and Private Payers' Coverage of Personalized Medicine

PubMed Central

Trosman, Julia R.; Van Bebber, Stephanie L.; Phillips, Kathryn A.

2011-01-01

Purpose: Health technology assessment (HTA) plays an increasing role in translating emerging technologies into clinical practice and policy. Private payers are important users of HTA whose decisions impact adoption and use of new technologies. We examine the current use of HTA by private payers in coverage decisions for personalized medicine, a field that is increasingly impacting oncology practice. Study Design: Literature review and semistructured interviews. Methods: We reviewed seven HTA organizations used by private payers in decision making and explored how HTA is used by major US private payers (n = 11) for coverage of personalized medicine. Results: All payers used HTA in coverage decisions, but the number of HTA organizations used by an individual payer ranged from one (n = 1) to all seven (n = 1), with the majority of payers (n = 8) using three or more. Payers relied more extensively on HTAs for reviews of personalized medicine (64%) than for other technologies. Most payers (82%) equally valued expertise of reviewers and rigor of evaluation as HTA strengths, whereas genomic-specific methodology was less important. Key reported shortcomings were limited availability of reviews (73%) and limited inclusion of nonclinical factors (91%), such as cost-effectiveness or adoption of technology in clinical practice. Conclusion: Payers use a range of HTAs in their coverage decisions related to personalized medicine, but the current state of HTA to comprehensively guide those decisions is limited. HTA organizations should address current gaps to improve their relevance to payers and clinicians. Current HTA shortcomings may also inform the national HTA agenda. PMID:21886515

Myths and memes about single-payer health insurance in the United States: a rebuttal to conservative claims.

PubMed

Geyman, John P

2005-01-01

Recent years have seen the rapid growth of private think tanks within the neoconservative movement that conduct "policy research" biased to their own agenda. This article provides an evidence-based rebuttal to a 2002 report by one such think tank, the Dallas-based National Center for Policy Analysis (NCPA), which was intended to discredit 20 alleged myths about single-payer national health insurance as a policy option for the United States. Eleven "myths" are rebutted under eight categories: access, cost containment, quality, efficiency, single-payer as solution, control of drug prices, ability to compete abroad (the "business case"), and public support for a single-payer system. Six memes (self-replicating ideas that are promulgated without regard to their merits) are identified in the NCPA report. Myths and memes should have no place in the national debate now underway over the future of a failing health care system, and need to be recognized as such and countered by experience and unbiased evidence.

Effects of state contraceptive insurance mandates.

PubMed

Dills, Angela K; Grecu, Anca M

2017-02-01

Using U.S. Natality data for 1996 through 2009 and an event analysis specification, we investigate the dynamics of the effects of state insurance contraceptive mandates on births and measures of parental investment: prenatal visits, non-marital childbearing, and risky behaviors during pregnancy. We analyze outcomes separately by age, race, and ethnicity. Among young Hispanic women, we find a 4% decline in the birth rate. There is evidence of a decrease in births to single mothers, consistent with increased wantedness. We also find evidence of selection into motherhood, which could explain the lack of a significant effect on birth outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

Mandatory continuing education in physical therapy: survey of physical therapists in states with and states without a mandate.

PubMed

Landers, Merrill R; McWhorter, James W; Krum, Laura L; Glovinsky, David

2005-09-01

Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. A survey questionnaire was sent to 3,000 physical therapists in 7 states--1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists.

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

PubMed

Lahey, Joanna N

2012-01-01

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

Estimating inpatient hospital prices from state administrative data and hospital financial reports.

PubMed

Levit, Katharine R; Friedman, Bernard; Wong, Herbert S

2013-10-01

To develop a tool for estimating hospital-specific inpatient prices for major payers. AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers--an important asset as the payer mix changes with the implementation of the Affordable Care Act. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

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

ERIC Educational Resources Information Center

Lahey, Joanna N.

2012-01-01

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

Use of Diagnosis-Related Groups by Non-Medicare Payers

PubMed Central

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

1994-01-01

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

Physicians, payers, and power. The United States is witnessing a struggle for control of healthcare.

PubMed

Friedman, E

1995-01-01

From its earliest days, healthcare in the United States has been controlled by providers, that is, by physicians and by hospitals (which, in turn, were also usually controlled by physicians). But this situation is changing. In the 1920s and 1930s, providers created health insurance companies like Blue Cross and Blue Shield to help patients pay for healthcare--to pay, in other words, for those services offered by providers. After World War II, the Hill-Burton program covered the nation with new hospitals. In the 1960s, Medicare and Medicaid eased the healthcare burden of older Americans--and also recapitalized hospitals. Thus providers called the shots in the creation of both the delivery and the payment systems. But in the 1970s, payers began to become more powerful. Now, in the 1990s, they have joined employers in acting to contain rapidly escalating healthcare costs. But even those long disturbed by the arrogance of some healthcare providers are now asking themselves: Is this really what we wanted? Payers are governed by the market; they may well seek, not the best, but the cheapest healthcare available. This is not in the interest of either patients or physicians. A middle ground--a new power alignment--will have to be worked out by patients, physicians, payers, and government.

Payer and Pharmaceutical Manufacturer Considerations for Outcomes-Based Agreements in the United States.

PubMed

Brown, Joshua D; Sheer, Rich; Pasquale, Margaret; Sudharshan, Lavanya; Axelsen, Kirsten; Subedi, Prasun; Wiederkehr, Daniel; Brownfield, Fred; Kamal-Bahl, Sachin

2018-01-01

Considerable interest exists among health care payers and pharmaceutical manufacturers in designing outcomes-based agreements (OBAs) for medications for which evidence on real-world effectiveness is limited at product launch. To build hypothetical OBA models in which both payer and manufacturer can benefit. Models were developed for a hypothetical hypercholesterolemia OBA, in which the OBA was assumed to increase market access for a newly marketed medication. Fixed inputs were drug and outcome event costs from the literature over a 1-year OBA period. Model estimates were developed using a range of inputs for medication effectiveness, medical cost offsets, and the treated population size. Positive or negative feedback to the manufacturer was incorporated on the basis of expectations of drug performance through changes in the reimbursement level. Model simulations demonstrated that parameters had the greatest impact on payer cost and manufacturer reimbursement. Models suggested that changes in the size of the population treated and drug effectiveness had the largest influence on reimbursement and costs. Despite sharing risk for potential product underperformance, manufacturer reimbursement increased relative to having no OBA, if the OBA improved market access for the new product. Although reduction in medical costs did not fully offset the cost of the medication, the payer could still save on net costs per patient relative to having no OBA by tying reimbursement to drug effectiveness. Pharmaceutical manufacturers and health care payers have demonstrated interest in OBAs, and under a certain set of assumptions both may benefit. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cancer trial enrollment after state-mandated reimbursement.

PubMed

Gross, C P; Murthy, V; Li, Y; Kaluzny, A D; Krumholz, H M

2004-07-21

Recruitment of patients into cancer research studies is exceedingly difficult, particularly for early phase trials. Payer reimbursement policies are a frequently cited barrier. We examined whether state policies that ensure coverage of routine medical care costs for cancer trial participants are associated with an increase in clinical trial enrollment. We used logistic Poisson regressions to analyze enrollment in National Cancer Institute phase II and phase III Clinical Trials Cooperative Group trials and compared changes in trial enrollment rates between 1996 and 2001 of privately insured cancer patients who resided in the four states that enacted coverage policies in 1999 with enrollment rates in states without such policies. All statistical tests were two-sided. Trial enrollment rates increased in the coverage and noncoverage states by 24.9% (95% confidence interval [CI] = 22.8% to 27.0%) and 28.8% (95% CI = 27.7% to 29.8%) per year, respectively, from 1996 through 2001. After implementation of the coverage policies in 1999 in four states, there was a 21.7% (95% CI = 3.8% to 42.6%) annual increase in phase II trial enrollment in coverage states, compared with a 15.6% (95% CI = 8.8% to 21.8%) annual decrease in noncoverage states (P<.001). After accounting for secular trend, cancer type, and race in multivariable analyses, the odds ratio (OR) for a phase II trial participant residing in a coverage versus a noncoverage state after 1999 was 1.59 per year (95% CI = 1.22 to 2.07; P =.001). In a multivariable analysis of phase III trial participation, there was a decrease in the odds of residing in a coverage state after 1999 (OR = 0.90, 95% CI = 0.84 to 0.98; P =.011). State coverage policies were associated with a statistically significant increase in phase II cancer trial participation and did not increase phase III cancer trial enrollment.

Do States Have the Capacity to Meet the NCLB Mandates?

ERIC Educational Resources Information Center

Sunderman, Gail L.; Orfield, Gary

2007-01-01

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

Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009-2013 National Immunization Survey-Teen.

PubMed

Perkins, Rebecca B; Lin, Mengyun; Wallington, Sherrie F; Hanchate, Amresh D

2016-06-02

To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Using data from the National Immunization Survey-Teen from 2009-2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13-17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009-2013). Similar results were seen when comparing girls ages 13-14 to those ages 15-17, and after adjustment for known covariates of vaccination. States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates.

Comparison of Births by Provider, Place, and Payer in New Hampshire.

PubMed

Hamlin, Lynette

2017-05-01

This study examines maternity care in a rural state by birth attendant, place of birth, and payer of birth. It is a secondary analysis of birth certificate data in New Hampshire between the years 2005 and 2012. Results revealed that in New Hampshire, the majority of births occurred in the hospital setting (98.6%). Physicians attended 75.8% of births, certified nurse midwives attended 17%, and certified professional midwives attended 1%. Medicaid coverage was the payer source for 28% of all births, compared with 44.9% nationally. Women with a private payer source were more likely than women with Medicaid or other payer sources to have a cesarean section. The findings demonstrate quality of care outcomes among a range of clinicians and settings, providing a policy argument for expanding maternity care options.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement obligations of primary payers and... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from... reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to...

Variation in Private Payer Coverage of Rheumatoid Arthritis Drugs.

PubMed

Chambers, James D; Wilkinson, Colby L; Anderson, Jordan E; Chenoweth, Matthew D

2016-10-01

Payers in the United States issue coverage determinations to guide how their enrolled beneficiaries use prescription drugs. Because payers create their own coverage policies, how they cover drugs can vary, which in turn can affect access to care by beneficiaries. To examine how the largest private payers based on membership cover drugs indicated for rheumatoid arthritis and to determine what evidence the payers reported reviewing when formulating their coverage policies. Coverage policies issued by the 10 largest private payers that make their policies publicly available were identified for rheumatoid arthritis drugs. Each coverage determination was compared with the drug's corresponding FDA label and categorized according to the following: (a) consistent with the label, (b) more restrictive than the label, (c) less restrictive than the label, or (d) mixed (i.e., more restrictive than the label in one way but less restrictive in another). Each coverage determination was also compared with the American College of Rheumatology (ACR) 2012 treatment recommendations and categorized using the same relative restrictiveness criteria. The policies were then reviewed to identify the evidence that the payers reported reviewing. The identified evidence was divided into the following 6 categories: randomized controlled trials; other clinical studies (e.g., observational studies); health technology assessments; clinical reviews; cost-effectiveness analyses; and clinical guidelines. Sixty-nine percent of coverage determinations were more restrictive than the corresponding FDA label; 15% were consistent; 3% were less restrictive; and 13% were mixed. Thirty-four percent of coverage determinations were consistent with the ACR recommendations, 33% were more restrictive; 17% were less restrictive; and 17% were mixed. Payers most often reported reviewing randomized controlled trials for their coverage policies (an average of 2.3 per policy). The payers reported reviewing an average of

Impact of school-entry and education mandates by states on HPV vaccination coverage: Analysis of the 2009–2013 National Immunization Survey-Teen

PubMed Central

Perkins, Rebecca B.; Lin, Mengyun; Wallington, Sherrie F.; Hanchate, Amresh D.

2016-01-01

ABSTRACT Objective: To determine the effectiveness of existing school entry and education mandates on HPV vaccination coverage, we compared coverage among girls residing in states and jurisdictions with and without education and school-entry mandates. Virginia and the District of Columbia enacted school entry mandates, though both laws included liberal opt-out provisions. Ten additional states had mandates requiring distribution of education to parents or provision of education within school curricula. Methods: Using data from the National Immunization Survey-Teen from 2009–2013, we estimated multilevel logistic regression models to compare coverage with HPV vaccines for girls ages 13–17 residing in states and jurisdictions with and without school entry and education mandates, adjusting for demographic factors, healthcare access, and provider recommendation. Results: Girls residing in states and jurisdictions with HPV vaccine school entry mandates (DC and VA) and education mandates (LA, MI, CO, IN, IA, IL, NJ, NC, TX, and WA) did not have higher HPV vaccine series initiation or completion than those living in states without mandates for any year (2009–2013). Similar results were seen when comparing girls ages 13–14 to those ages 15–17, and after adjustment for known covariates of vaccination. Conclusions: States and jurisdictions with school-entry and education mandates do not currently have higher HPV vaccination coverage than states without such legislation. Liberal opt-out language in existing school entry mandates may weaken their impact. Policy-makers contemplating legislation to improve vaccination coverage should be aware of the limitations of existing mandates. PMID:27152418

State-Mandated (Mis)Information and Women's Endorsement of Common Abortion Myths.

PubMed

Berglas, Nancy F; Gould, Heather; Turok, David K; Sanders, Jessica N; Perrucci, Alissa C; Roberts, Sarah C M

The extent that state-mandated informed consent scripts affect women's knowledge about abortion is unknown. We examine women's endorsement of common abortion myths before and after receiving state-mandated information that included accurate and inaccurate statements about abortion. In Utah, women presenting for an abortion information visit completed baseline surveys (n = 494) and follow-up interviews 3 weeks later (n = 309). Women answered five items about abortion risks, indicating which of two statements was closer to the truth (as established by prior research) or responding "don't know." We developed a continuous myth endorsement scale (range, 0-1) and, using multivariable regression models, examined predictors of myth endorsement at baseline and change in myth endorsement from baseline to follow-up. At baseline, many women reported not knowing about abortion risks (range, 36%-70% across myths). Women who were younger, non-White, and had previously given birth but not had a prior abortion reported higher myth endorsement at baseline. Overall, myth endorsement decreased after the information visit (0.37-0.31; p < .001). However, endorsement of the myth that was included in the state script-describing inaccurate risks of depression and anxiety-increased at follow-up (0.47-0.52; p < .05). Lack of knowledge about the effects of abortion is common. Knowledge of information that was accurately presented or not referenced in state-mandated scripts increased. In contrast, inaccurate information was associated with decreases in women's knowledge about abortion, violating accepted principles of informed consent. State policies that require or result in the provision of inaccurate information should be reconsidered. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

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

2012-01-01

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

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

ERIC Educational Resources Information Center

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

2011-01-01

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

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.

Exploring Campus Response to State Mandated Change: A Case Study of the Implementation of Legislation Allowing Guns on Campus

ERIC Educational Resources Information Center

Grantham, Ashley Erin

2016-01-01

This case study examines the implementation of a state legislative mandate to allow guns on campus at a public higher education institution in the southeastern United States. This study explores the process that one campus underwent to implement an externally mandated change. Additionally, this study examined whether Newcombe and Conrad's (1981)…

“Prefacing the Script” as an Ethical Response to State-Mandated Abortion Counseling

PubMed Central

Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin

2016-01-01

BACKGROUND Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women’s Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman’s work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. METHODS We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. RESULTS Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. CONCLUSIONS Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient’s best interests. Our findings suggest that language constitutes a

A Comparative Analysis of Mandated Benefit Laws, 1949–2002

PubMed Central

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

2006-01-01

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

PAYER PERSPECTIVES ON FUTURE ACCEPTABILITY OF COMPARATIVE EFFECTIVENESS AND RELATIVE EFFECTIVENESS RESEARCH.

PubMed

Moloney, Rachael; Mohr, Penny; Hawe, Emma; Shah, Koonal; Garau, Martina; Towse, Adrian

2015-01-01

Our objective was to gather perspectives from payers on how comparative effectiveness research (CER) in the United States and relative effectiveness (RE) research in Europe will impact evidentiary standards for access decisions of new drugs by 2020. We conducted semi-structured interviews with fourteen senior officials representing public and private payers, health technology assessment groups, and pricing and reimbursement bodies in the United States and Europe. An online survey assessed current use of CER/RE evidence and potential trends that might influence its use for decision making by 2020. A semi-structured interview elicited payers' definitions of CER/RE and was structured around four hypothetical cases resembling drugs expected to be more common or poised to create policy challenges by 2020. Topics included acceptance of study designs and analytic methods associated with CER/RE. A systematic content review was done to extract relevant information. According to key informants, randomization will remain an essential component for assessing comparative or relative effectiveness. They anticipate greater use of policy levers such as conditional reimbursement or prior authorization to manage diffusion of new drugs. Case studies provided important insights into situations when certain types of CER evidence may be acceptable (e.g., observational data when differences between drugs are largely convenience). Industry perceptions that CER/RE will change payers' evidentiary requirements in the future are consistent with our findings. Growing investment in payers' own data and increased reliance on policy tools to control diffusion of new drugs may also influence the type of evidence industry will be required to produce by 2020.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion.

PubMed

Jones, Christine D; Scott, Serena J; Anoff, Debra L; Pierce, Read G; Glasheen, Jeffrey J

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for -0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. © The Author(s) 2015.

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

PubMed Central

Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

2015-01-01

Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001), uninsured encounters decreased (18.4% to 6.3%, P < 0.001), and private payer encounters also decreased (14.1% to 13.3%, P = .001). The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001). In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

Prescription Opioid Abuse: Challenges and Opportunities for Payers

PubMed Central

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

2013-01-01

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

The Association of State Legal Mandates for Data Submission of Central Line-associated Blood Stream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

PubMed Central

Zachariah, Philip; Reagan, Julie; Furuya, E. Yoko; Dick, Andrew; Liu, Hangsheng; Herzig, Carolyn T.A; Pogorzelska-Maziarz, Monika; Stone, Patricia W.; Saiman, Lisa

2014-01-01

Objective To determine the association between state legal mandates for data submission of central line-associated blood stream infections (CLABSIs) in neonatal intensive care units (NICUs) with process/outcome measures. Design Cross-sectional study. Participants National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance. Methods State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices i.e. compliance with checklist and bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate Standardized Infection Ratios (SIR). The association between mandates and process/outcome measures was assessed by multivariable logistic regression. Results Among 190 study NICUs, 107 (56.3%) NICUs were located in states with mandates, with mandates in place for 3 or more years for half. More NICUs in states with mandates reported ≥95% compliance to at least one CLABSI prevention practice (52.3% – 66.4%) than NICUs in states without mandates (28.9% – 48.2%). Mandates were predictors of ≥95% compliance with all practices (OR 2.8; 95% CI 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the <750gm birth-weight group (2.4 vs. 5.7 CLABSIs/1000 CL-days) but not in others. Mandates were not associated with SIR <1. Conclusions State mandates for NICU CLABSI data submission were significantly associated with ≥95% compliance with CLABSI prevention practices but not with lower CLABSI rates. PMID:25111921

The single-payer option: a reconsideration.

PubMed

Oliver, Adam

2009-08-01

This article discusses some of the merits and demerits of the single-payer model of health care financing, with particular reference to the English National Health Service (NHS). Specifically, it is argued that the main merits are that the model can directly provide universal health care coverage, thus eradicating or at least alleviating market failure and equity concerns, and that it can achieve this with relatively low total health care expenditure in general and -- as compared to the commercial multiple insurance model -- low administrative costs in particular. A perceived demerit of the single-payer model is that it can lead to excessive health care rationing, particularly in terms of waiting times, although it is argued here that long waits are probably caused by insufficient funding rather than by the single-payer model per se. Moreover, rationing of one form or another occurs in all health care systems, and single-payer models may be the best option if the aim is to incorporate structured rationing such that an entire population is subject to the same rules and is thus treated equitably. A further perceived disadvantage of the single-payer model is that it offers limited choice, which is necessarily true with respect to choice of insurer, but choice of provider can be, and increasingly is, a feature of centrally tax-financed health care systems. No model of health care funding is perfect; trade-offs are inevitable. Whether the merits of the single-payer model are judged to outweigh the demerits will typically vary both across countries at any point in time and within a country over time.

Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses

PubMed Central

Bitler, Marianne P.

2016-01-01

We examine the effects of state health insurance mandates requiring coverage of screening mammograms. We find evidence that mammography mandates significantly increased mammography screenings by 4.5–25 percent. Effects are larger for women with less than a high school degree in states that ban deductibles, a policy similar to a provision of federal health reform that eliminates cost-sharing for preventive care. We also find that mandates increased detection of early stage in-situ pre-cancers. Finally, we find a substantial proportion of the increased screenings were attributable to mandates that are not consistent with current recommendations of the American Cancer Society. PMID:29527253

Single payers, multiple systems: the scope and limits of subnational variation under a Federal health policy framework.

PubMed

Tuohy, Carolyn Hughes

2009-08-01

In political discourse, the term "single-payer system" originated in an attempt to stake out a middle ground between the public and private sectors in providing universal access to health care. In this view, a single-payer system is one in which health care is financed by government and delivered by privately owned and operated health care providers. The term appears to have been coined in U.S. policy debates to provide a rhetorical reference point for universal health insurance other than the "socialized medicine" of state-owned and -operated health care providers. This article, like others in this special issue, is meant to provide a more nuanced view of single-payer systems. In particular, it reviews experience in the prototypical single-payer system for physician and hospital services: the Canadian case. Given Canada's federal governance structure, this example also aptly illuminates the scope and limits of subnational variation within this single model of health care finance. And what it demonstrates in essence is that the very feature that defines the single-payer prototype -- the maintenance of independent providers remunerated by a single public payer in each province -- also leads to a set of profession-state bargains that define the limits of variation.

Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation

PubMed Central

Vella Bonanno, Patricia; Ermisch, Michael; Godman, Brian; Martin, Antony P.; Van Den Bergh, Jesper; Bezmelnitsyna, Liudmila; Bucsics, Anna; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Eriksson, Irene; Fürst, Jurij; Gad, Mohamed; Greičiūtė-Kuprijanov, Ieva; van der Graaff, Martin; Gulbinovic, Jolanta; Jones, Jan; Joppi, Roberta; Kalaba, Marija; Laius, Ott; Langner, Irene; Mardare, Ileana; Markovic-Pekovic, Vanda; Magnusson, Einar; Melien, Oyvind; Meshkov, Dmitry O.; Petrova, Guenka I.; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Schuurman, Ad; Ramos, Ricardo; Rodrigues, Jorge; Zara, Corinne; Zebedin-Brandl, Eva; Haycox, Alan

2017-01-01

Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The “introduction” of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers. PMID:28878667

Adaptive Pathways: Possible Next Steps for Payers in Preparation for Their Potential Implementation.

PubMed

Vella Bonanno, Patricia; Ermisch, Michael; Godman, Brian; Martin, Antony P; Van Den Bergh, Jesper; Bezmelnitsyna, Liudmila; Bucsics, Anna; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Eriksson, Irene; Fürst, Jurij; Gad, Mohamed; Greičiūtė-Kuprijanov, Ieva; van der Graaff, Martin; Gulbinovic, Jolanta; Jones, Jan; Joppi, Roberta; Kalaba, Marija; Laius, Ott; Langner, Irene; Mardare, Ileana; Markovic-Pekovic, Vanda; Magnusson, Einar; Melien, Oyvind; Meshkov, Dmitry O; Petrova, Guenka I; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Schuurman, Ad; Ramos, Ricardo; Rodrigues, Jorge; Zara, Corinne; Zebedin-Brandl, Eva; Haycox, Alan

2017-01-01

Medicines receiving a conditional marketing authorization through Medicines Adaptive Pathways to Patients (MAPPs) will be a challenge for payers. The "introduction" of MAPPs is already seen by the European Medicines Agency (EMA) as a fait accompli, with payers not consulted or involved. However, once medicines are approved through MAPPs, they will be evaluated for funding by payers through different activities. These include Health Technology Assessment (HTA) with often immature clinical data and high uncertainty, financial considerations, and negotiations through different types of agreements, which can require monitoring post launch. Payers have experience with new medicines approved through conditional approval, and the fact that MAPPs present additional challenges is a concern from their perspective. There may be some activities where payers can collaborate. The final decisions on whether to reimburse a new medicine via MAPPs will have more variation than for medicines licensed via conventional processes. This is due not only to increasing uncertainty associated with medicines authorized through MAPPs but also differences in legal frameworks between member states. Moreover, if the financial and side-effect burden from the period of conditional approval until granting full marketing authorization is shifted to the post-authorization phase, payers may have to bear such burdens. Collection of robust data during routine clinical use is challenging along with high prices for new medicines during data collection. This paper presents the concept of MAPPs and possible challenges. Concerns and potential ways forward are discussed and a number of recommendations are presented from the perspective of payers.

Impact of the New Jersey all-payer rate-setting system: an analysis of financial ratios.

PubMed

Rosko, M D

1989-01-01

Although prospective payment may contain costs, many analysts are concerned about the unintended consequences of rate regulation. This article presents the results of a case-study analysis of the New Jersey rate-setting programs during the period 1977-1985. Using measures of profitability, liquidity, and leverage, data for New Jersey, the Northeast, and the United States as a whole are used to contrast the impact of two forms of prospective payment. After attempting alternative cost-containment methods, the New Jersey Department of Health implemented an all-payer system in which prospective rates of compensation were established for DRGs. The new rate-setting system was designed to control costs, improve access to care, maintain quality of services, ensure financial viability of efficient providers, and limit the payment differentials associated with cost shifting. The results of this study have a number of implications for the evaluation of all-payer rate regulation. First, although the New Jersey all-payer system was more successful than the partial-payer program in restraining the rate of increase in cost per case, savings were achieved without adversely affecting the viability of regulated hospitals. Second, the large differentials among payers that were associated with the partial-payer program were reduced dramatically by the all-payer program. Third, using the financial position of inner-city hospitals relative to suburban hospitals as a measure of equity, the all-payer system appeared to be a fairer method of regulating rates.

Payer Perspectives on Patient-Reported Outcomes in Health Care Decision Making: Oncology Examples.

PubMed

Brogan, Andrew P; DeMuro, Carla; Barrett, Amy M; D'Alessio, Denise; Bal, Vasudha; Hogue, Susan L

2017-02-01

Health authorities and payers increasingly recognize the importance of patient perspectives and patient-reported outcomes (PROs) in health care decision making. However, given the broad variety of PRO endpoints included in clinical programs and variations in the timing of PRO data collection and country-specific needs, the role of PRO data in reimbursement decisions requires characterization. To (a) determine the effect of PRO data on market access and reimbursement decisions for oncology products in multiple markets and (b) assess the effect of PRO data collected after clinical progression on payer decision making. A 3-part assessment (targeted literature review, qualitative one-on-one interviews, and online survey) was undertaken. Published literature was identified through searches in PubMed/MEDLINE and Embase. In addition, a targeted search was conducted of health technology assessment (HTA) agency websites in the United States, the United Kingdom, France, and Germany. Qualitative one-on-one interviews were conducted with 16 payers from the RTI Health Solutions global advisory panel in 14 markets (Australia, Brazil, France, Germany, Italy, South Korea, Netherlands, Poland, Spain, Sweden, Taiwan, Turkey, the United Kingdom, and the United States [n = 3]). Of the 200 payers and payer advisors from the global advisory panel invited to participate in the online survey, 20 respondents (China, France, Germany, Spain [n = 2], Taiwan, the United Kingdom, and the United States [n = 13]) completed the survey, and 6 respondents (Australia, South Korea, and the United States [n = 4]) partially completed the survey. Reviews of the literature and publicly available HTAs and reimbursement decisions suggested that HTA bodies and payers have varying experience with and confidence in PRO data. Payers participating in the survey indicated that PRO data may be especially influential in oncology compared with other therapeutic areas. Payers surveyed offered little differentiation

A Local School District Implements a State Mandated Instructional Program on AIDS Prevention.

ERIC Educational Resources Information Center

Hall, Janie L.

Implementation of an Acquired Immune Deficiency Syndrome (AIDS) education program in Oklahoma is briefly outlined in the areas of the state mandate, local implementation, teacher training, parent meetings, and short and long courses. A study of the level of student knowledge about AIDS before and after instruction is described. Subjects were 7,145…

Insurance mandates, embryo transfer, outcomes--the link is tenuous.

PubMed

Banks, Nicole K; Norian, John M; Bundorf, M Kate; Henne, Melinda B

2010-12-01

To examine the relationship between state insurance mandate status and the number of embryos transferred in assisted reproductive technology cycles, we conducted a retrospective analysis of clinics reporting to the publicly available national Society for Assisted Reproductive Technology registry. We found that clinics in states with comprehensive mandates transferred between 0.210 and 0.288 fewer embryos per cycle depending upon patient age, and were more likely to transfer fewer embryos than recommended for older women; however, the relationship between state mandate status and clinic birth and multiple birth rates varied by age group. Published by Elsevier Inc.

32 CFR 220.6 - Certain payers excluded.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 2 2012-07-01 2012-07-01 false Certain payers excluded. 220.6 Section 220.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

32 CFR 220.6 - Certain payers excluded.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Certain payers excluded. 220.6 Section 220.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

32 CFR 220.6 - Certain payers excluded.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Certain payers excluded. 220.6 Section 220.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

32 CFR 220.6 - Certain payers excluded.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Certain payers excluded. 220.6 Section 220.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

32 CFR 220.6 - Certain payers excluded.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 2 2013-07-01 2013-07-01 false Certain payers excluded. 220.6 Section 220.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

32 CFR 728.35 - Coordination of benefits-third party payers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Retired Members and... care incurred by the United States on behalf of retirees and dependents. Naval hospital collection... to third-party payers for the cost of such care. Admission office personnel must obtain insurance...

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

PubMed

Howrigon, Ron

2016-01-01

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

With Our Feet on the Ground (and in the Classroom): Towards Making State-Mandated Assessment Meaningful

ERIC Educational Resources Information Center

Carlile, Susan

2006-01-01

This study considered the problem of ineffective fieldwork experiences in the English Single Subject Credential Program at California State University, Long Beach prior to student teaching by combining structured fieldwork into a newly established state-mandated assessment, Teaching Performance Assessment Task 1 (TPA 1). This combination of a…

The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

PubMed

Carr, Jillian B; Packham, Analisa

2017-04-01

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Two Case Studies of Beginning Teachers in State-Mandated Induction Programs: The Influence of Institutional Factors.

ERIC Educational Resources Information Center

Paulissen, Margaret O.; And Others

The Teacher Induction Study investigated 2 state-mandated beginning teacher programs and examined the translation of state policy by 4 school districts, 13 individual schools, and 32 classrooms. From the case histories of 16 teams, 2 case histories were selected for further study. One case illustrated how institutional factors influenced team…

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

ERIC Educational Resources Information Center

Miller, William M.

2013-01-01

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

Innovative payer engagement strategies: will the convergence lead to better value creation in personalized medicine?

PubMed

Akhmetov, Ildar; Bubnov, Rostyslav V

2017-12-01

As reimbursement authorities are gaining greater power to influence the prescription behavior of physicians, it remains critical for life science companies focusing on personalized medicine to develop "tailor-made" payer engagement strategies to secure reimbursement and assure timely patient access to their innovative products. Depending on the types of such engagement, pharmaceutical and diagnostic companies may benefit by obtaining access to medical and pharmacy claims data, getting invaluable upfront inputs on evidence requirements and clinical trial design, and strengthening trust by payers, therefore avoiding uncertainties with regards to pricing, reimbursement, and research and development reinvestment. This article aims to study the evolving trend of partnering among two interdependent, yet confronting, stakeholder groups-payers and producers-as well as to identify the most promising payer engagement strategies based on cocreation of value introduced by life science companies in the past few years. We analyzed the recent case studies from both therapeutic and diagnostic realms considered as the "best practices" in payer engagement. The last 5 years were a breakout period for deals between life science companies and reimbursement authorities in the area of personalized medicine with a number of felicitous collaborative practices established already, and many more yet to emerge. We suggest that there are many ways for producers and payers to collaborate throughout the product life cycle-from data exchange and scientific counseling to research collaboration aimed at reducing healthcare costs, addressing adherence issues, and diminishing risks associated with future launches. The presented case studies provide clear insights on how successful personalized medicine companies customize their state-of-the-art payer engagement strategies to ensure closer proximity with payers and establish longer-term trust-based relationships.

Changes in state prescription contraceptive mandates for insurers: the effect on women's contraceptive use.

PubMed

Atkins, Danielle N; Bradford, W David

2014-03-01

Access to effective contraceptives is critical to reducing levels of unintended childbearing in the United States. Since 1998, more than half the states have passed legislation requiring insurers that cover prescription drugs to cover prescription contraceptives approved by the Food and Drug Administration. An assessment of the impact of these laws on women's contraceptive use is needed to determine whether such policies are effective. Information was collected on state contraceptive coverage policies, and contraceptive use data among women at risk of unintended pregnancy were drawn from Behavioral Risk Factor Surveillance System surveys conducted between 1998 and 2010. Logit regression analysis was used to calculate the marginal effects of state contraceptive coverage laws on insured and uninsured women's use of prescription methods. Insured women who lived in a state with a contraceptive coverage law were 5% more likely than their counterparts in states without such laws to use an effective method (i.e., a prescription method, condoms or sterilization). Among women who used such methods, those in contraceptive coverage states were 5% more likely than women in other states to use any prescription method, and 4% more likely to use the pill. No associations were found between contraceptive mandates and method use by uninsured women. Among both users and nonusers, contraceptive coverage was associated with a 5% increase in pill use. Contraceptive coverage mandates appear to play a role in increasing the use of prescription contraceptives among insured women, and hence may help to reduce the numbers of unintended pregnancies. Copyright © 2014 by the Guttmacher Institute.

State-mandated accountability as a constraint on teaching and learning science

NASA Astrophysics Data System (ADS)

Wood, Terry

The purpose of this study is to examine the effect of state-mandated policy, emphasizing control through performance-based instruction and student test scores as the basis for determining school accreditation, on the teaching and learning of science. The intended consequence of instigating the rational theory of management by one state is to improve their current level of student literacy. However, some contend that the implementation of the policy has results that are not intended. The identification of the tension between the intended and unintended results of centralized policy making is the basis for examining a specific case in which the rational model is implemented. One hundred and sixty-five seventh-grade science students and four teachers are participants in the study. Qualitative analysis is the research methodology used as a means to provide detailed information about the contextual nature of the classroom processes. The intention is to identify and describe features of the behavior setting that influence the behavior of the teachers and their students. Three assertions generated during the field work were: Teachers redefine the goals of science instruction as the acquisition of facts and isolated skills, teachers alter their usual instructional behavior to implement uniform instructional procedures, and the teacher/student classroom interaction constrains students' opportunities to learn science. The implications of the study indicate that the state-mandated policy has results that are in opposition to the intended results. Instead of improving the practices of teachers, the implementation of the policy constrains and routinizes the teachers' behavior, causing them to violate their own standards of good teaching. They feel pressured to get through the materials so students will score well on tests. The classroom interaction is structured in such a way as to inhibit students from asking questions of their own. As a result, students' opportunity to

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

PubMed

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

2015-07-01

New York State law mandates specific intimate partner violence (IPV) documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n = 191), more often when injury occurred (p < .01) and the defendant had prior court contact (p < .05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation. © The Author(s) 2015.

Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers.

PubMed

MacLeod, Tatjana E; Harris, Anthony H; Mahal, Ajay

2016-06-01

The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs. The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions. A thorough review of the empirical, peer-reviewed English literature was conducted. Information sources were PubMed, EMBASE, MEDLINE, Web of Science, Business Source Complete, and EconLit. Eligible studies (1) assessed the cancer drug funding preferences of patients, the general public or payers, (2) had pre-defined measures of funding preference, and (3) had outcomes with attributes or measures of 'value'. The quality of included studies was evaluated using a health technology assessment-based assessment tool, followed by extraction of general study characteristics and funding preferences, which were categorized using an established WHO-based framework. Twenty-five preference studies were retrieved (11 quantitative, seven qualitative, seven mixed-methods). Most studies were published from 2005 onward, with the oldest dating back to 1997. Two studies evaluated both patient and public perspectives, giving 27 total funding perspectives (41 % payer, 33 % public, 26 % patients). Of 41 identified funding criteria, payers consider the most (35), the general public considers fewer (23), and patients consider the fewest (12). We identify four unique patient criteria: financial protection, access to medical information, autonomy in treatment decision making, and the 'value of hope'. Sixteen countries/jurisdictions were represented. Our results suggest that (1) payers prioritize efficiency (health gains per dollar), while citizens (patients and the general public) prioritize

Challenges of coverage policy development for next-generation tumor sequencing panels: experts and payers weigh in.

PubMed

Trosman, Julia R; Weldon, Christine B; Kelley, R Kate; Phillips, Kathryn A

2015-03-01

Next-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers. We conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings. All interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies. Payers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement. Copyright © 2015 by the National Comprehensive Cancer Network.

Challenges of Coverage Policy Development for Next-Generation Tumor Sequencing Panels: Experts and Payers Weigh In

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Kate Kelley, R.; Phillips, Kathryn A.

2015-01-01

Background Next-generation tumor sequencing (NGTS) panels, which include multiple established and novel targets across cancers, are emerging in oncology practice, but lack formal positive coverage by US payers. Lack of coverage may impact access and adoption. This study identified challenges of NGTS coverage by private payers. Methods We conducted semi-structured interviews with 14 NGTS experts on potential NGTS benefits, and with 10 major payers, representing more than 125,000,000 enrollees, on NGTS coverage considerations. We used the framework approach of qualitative research for study design and thematic analyses and simple frequencies to further describe findings. Results All interviewed payers see potential NGTS benefits, but all noted challenges to formal coverage: 80% state that inherent features of NGTS do not fit the medical necessity definition required for coverage, 70% view NGTS as a bundle of targets versus comprehensive tumor characterization and may evaluate each target individually, and 70% express skepticism regarding new evidence methods proposed for NGTS. Fifty percent of payers expressed sufficient concerns about NGTS adoption and implementation that will preclude their ability to issue positive coverage policies. Conclusions Payers perceive that NGTS holds significant promise but, in its current form, poses disruptive challenges to coverage policy frameworks. Proactive multidisciplinary efforts to define the direction for NGTS development, evidence generation, and incorporation into coverage policy are necessary to realize its promise and provide patient access. This study contributes to current literature, as possibly the first study to directly interview US payers on NGTS coverage and reimbursement. PMID:25736008

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

NASA Astrophysics Data System (ADS)

Lim, Shinling

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

Parent opinion of sexuality education in a state with mandated abstinence education: does policy match parental preference?

PubMed

Ito, Kristin E; Gizlice, Ziya; Owen-O'Dowd, Judy; Foust, Evelyn; Leone, Peter A; Miller, William C

2006-11-01

Despite public debate about the content of sexuality education in schools, state and federal policy has increasingly financed and legislated abstinence-only education over the past decade. Although public schools strive to meet the needs of parents who, as taxpayers, fund the educational system, little is known about parental desires regarding sexuality education in states with mandated abstinence education. The objective of this study was to assess parental opinion about sexuality education in public schools in North Carolina, a state with mandated abstinence education. Computer-assisted, anonymous, cross-sectional telephone surveys were conducted among 1306 parents of North Carolina public school students in grades K-12. Parental support for sexuality education in public schools and 20 sexuality education topics was measured. We defined comprehensive sexuality education as education that includes a discussion of how to use and talk about contraception with partners. Parents in North Carolina overwhelmingly support sexuality education in public schools (91%). Of these respondents, the majority (89%) support comprehensive sexuality education. Less than a quarter of parents oppose teaching any specific topic, including those typically viewed as more controversial, such as discussions about sexual orientation, oral sex, and anal sex. Parents' level of education was inversely related to support for specific sexuality education topics and comprehensive education, although these differences were small in magnitude. More than 90% of respondents felt that parents and public health professionals should determine sexuality education content and opposed the involvement of politicians. Current state-mandated abstinence sexuality education does not match parental preference for comprehensive sexuality education in North Carolina public schools.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Benefits and Beneficiary Protections § 422...; (2) Identify the amounts payable by those payers; and (3) Coordinate its benefits to Medicare enrollees with the benefits of the primary payers, including reporting, on an ongoing basis, information...

Billing third party payers for pharmaceutical care services.

PubMed

Poirier, S; Buffington, D E; Memoli, G A

1999-01-01

To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

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

PubMed

McCauley, Janet L

2015-01-01

Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

National cost of trauma care by payer status.

PubMed

Velopulos, Catherine G; Enwerem, Ngozi Y; Obirieze, Augustine; Hui, Xuan; Hashmi, Zain G; Scott, Valerie K; Cornwell, Edward E; Schneider, Eric B; Haider, Adil H

2013-09-01

Several studies have described the burden of trauma care, but few have explored the economic burden of trauma inpatient costs from a payer's perspective or highlighted the differences in the average costs per person by payer status. The present study provides a conservative inpatient national trauma cost estimate and describes the variation in average inpatient trauma cost by payer status. A retrospective analysis of patients who had received trauma care at hospitals in the Nationwide Inpatient Sample from 2005-2010 was conducted. Our sample patients were selected using the appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification" codes to identify admissions due to traumatic injury. The data were weighted to provide national population estimates, and all cost and charges were converted to 2010 US dollar equivalents. Generalized linear models were used to describe the costs by payer status, adjusting for patient characteristics, such as age, gender, and race, and hospital characteristics, such as location, teaching status, and patient case mix. A total of 2,542,551 patients were eligible for the present study, with the payer status as follows: 672,960 patients (26.47%) with private insurance, 1,244,817 (48.96%) with Medicare, 262,256 (10.31%) with Medicaid, 195,056 (7.67%) with self-pay, 18,506 (0.73%) with no charge, and 150,956 (5.94%) with other types of insurance. The estimated yearly trauma inpatient cost burden was highest for Medicare at $17,551,393,082 (46.79%), followed by private insurance ($10,772,025,421 [28.72%]), Medicaid ($3,711,686,012 [9.89%], self-pay ($2,831,438,460 [7.55%]), and other payer types ($2,370,187,494 [6.32%]. The estimated yearly trauma inpatient cost burden was $274,598,190 (0.73%) for patients who were not charged for their inpatient trauma treatment. Our adjusted national inpatient trauma yearly costs were estimated at $37,511,328,659 US dollars. Privately insured patients had a significantly

Spillover effects of state mandated benefit laws: the case of outpatient breast cancer surgery.

PubMed

Bian, John; Lipscomb, Joseph; Mello, Michelle M

This paper examines the "spillover effects" of state laws that mandate inpatient coverage for breast cancer surgery. It looks at outpatient utilization of two types of breast cancer surgery among Medicare fee-for-service patients, who are exempt from state regulation. Using data from the Surveillance, Epidemiology and End Results cancer registries and Medicare claims, we performed difference-in-differences analyses of patients in nine states from 1993 to 2002. The analyses show that state laws had a significant impact on only the likelihood of outpatient mastectomy, which was reduced by five percentage points. Such a spillover effect may diminish the expected impact of federal coverage laws for inpatient breast cancer surgery, which have been proposed to achieve similar ends.

Fla. Budget Threatens Online Ed. Mandate

ERIC Educational Resources Information Center

Manzo, Kathleen Kennedy

2009-01-01

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

42 CFR § 414.1420 - Other payer advanced APMs.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1420 Other payer... payment by the APM Entity to the payer. (2) Medicaid Medical Home Model financial risk standard. For an... APM benchmark, except for episode payment models, for which it is defined as the episode target price...

Predictors of Payer Mix and Financial Performance Among Safety Net Hospitals Prior to the Affordable Care Act.

PubMed

Sommers, Benjamin D; Stone, Juliana; Kane, Nancy

2016-01-01

The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. We analyzed the 2010 financial statements of 98 large, urban safety net hospital systems in 34 states, supplemented with data on population demographics, hospital features, and state policies. We used multivariate regression to identify independent predictors of three outcomes: 1) Medicaid-reliant payer mix (hospitals for which at least 25% of hospital days are paid for by Medicaid); 2) safety net revenue-to-cost ratio (Medicaid and Medicare Disproportionate Share Hospital payments and local government transfers, divided by charity care costs and Medicaid payment shortfall); and 3) operating margin. Medicaid-reliant payer mix was positively associated with more inclusive state Medicaid eligibility criteria and more minority patients. More inclusive Medicaid eligibility and higher Medicaid reimbursement rates positively predicted safety net revenue-to-cost ratio. University governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs. Institutional and state policies may outweigh patient demographics in the financial health of safety net hospitals. © The Author(s) 2015.

10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

Code of Federal Regulations, 2013 CFR

2013-01-01

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

10 CFR 490.201 - Alternative fueled vehicle acquisition mandate schedule.

Code of Federal Regulations, 2014 CFR

2014-01-01

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

Treatment of Depression in Voluntary Versus Mandated Physicians.

PubMed

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

2015-12-01

Few if any publications discuss the effectiveness of voluntary versus mandated treatment for impaired physicians. This retrospective case-control study compared the recovery rates of physicians whose treatment was mandated or coerced by either licensure boards or employers (mandated physicians) with the rates for physicians admitted voluntarily (voluntary physicians) to the Menninger Clinic's Professionals in Crisis program from 2009 through 2012. Beck Depression Inventory (BDI)-II scores served as the primary outcome measure. At the time of admission, voluntary physicians were more depressed, but the improvement rates in the voluntary and mandated groups did not differ significantly. In addition, the two groups differed neither in rates of return to the healthy range of BDI-II scores, nor in whether BDI-II scores had decreased by at least two standard deviations by the time of discharge. These findings suggest that state physician health programs can continue to mandate physicians into treatment despite concerns that mandatory treatment may be less efficacious than voluntary treatment. © 2015 American Academy of Psychiatry and the Law.

Organizational Responses to External Demands: Strategies Employed by Superintendents in Developing and Implementing State Mandated Improvement Plans.

ERIC Educational Resources Information Center

Wills, Frances G.

Strategies utilized by district superintendents to implement school improvement plans in response to state-mandated change are examined in this report. Methodology involved document analysis of written plans and interviews with 30 Maine superintendents and assistant superintendents who were identified as successful developers of school improvement…

Training and Mandated Reporters' Confidence Levels: A Correlational Study

ERIC Educational Resources Information Center

Eichelberger, Cathy S.

2011-01-01

Child maltreatment is a costly social issue, both financially and in terms of children's well-being. All 50 states and many countries have enacted mandatory reporting laws, but not all of them require mandated reporter training. A multitude of studies have shown that many mandated reporters do not report all of the cases of suspected child abuse…

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

ERIC Educational Resources Information Center

Duggan, Mark; Hayford, Tamara

2013-01-01

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

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

ERIC Educational Resources Information Center

Suchman, Sara P.

2012-01-01

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

Variation in provider vaccine purchase prices and payer reimbursement.

PubMed

Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

2009-12-01

The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

Variation in provider vaccine purchase prices and payer reimbursement.

PubMed

Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

2008-12-01

The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

Assisted reproductive technology use, embryo transfer practices, and birth outcomes after infertility insurance mandates: New Jersey and Connecticut.

PubMed

Crawford, Sara; Boulet, Sheree L; Jamieson, Denise J; Stone, Carol; Mullen, Jewel; Kissin, Dmitry M

2016-02-01

To explore whether recently enacted infertility mandates including coverage for assisted reproductive technology (ART) treatment in New Jersey (2001) and Connecticut (2005) increased ART use, improved embryo transfer practices, and decreased multiple birth rates. Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, embryo transfer practices and birth outcomes, and compared changes in practices and outcomes during a 2-year period before and after passing the mandate between mandate and non-mandate states. Not applicable. Cycles of ART performed in the United States between 1996 and 2013. Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005). Number of ART cycles performed, number of embryos transferred, multiple live birth rates. Both New Jersey and Connecticut experienced an increase in ART use greater than the non-mandate states. The mean number of embryos transferred decreased significantly in New Jersey and Connecticut; however, the magnitudes were not significantly different from non-mandate states. There was no significant change in ART birth outcomes in either mandate state except for an increase in live births in Connecticut; the magnitude was not different from non-mandate states. The infertility insurance mandates passed in New Jersey and Connecticut were associated with increased ART treatment use but not a decrease in the number of embryos transferred or the rate of multiples; however, applicability of the mandates was limited. Published by Elsevier Inc.

Print News Coverage of School-Based Human Papillomavirus Vaccine Mandates

ERIC Educational Resources Information Center

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

2014-01-01

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

Charges for maternity services: associations with provider type and payer source in a university teaching hospital.

PubMed

Carr, C A

2000-01-01

Considerable evidence exists that payer status influences the type and cost of services provided. If payer status influences care, consumers may receive differential care secondary to presence and type of payer. This study examines the effect of payer status on certified nurse-midwives (CNMs) and obstetricians (OBs), correcting for methodologic problems that have been noted in previous studies. Participants were 715 low-risk pregnant women seen in the CNM or OB practice in a university hospital service. All billed charges from the initial prenatal visit through two months postpartum were compared by payer. Charges by provider were also examined to determine the presence of differential payer effect. Unexpectedly, charges by payer did not show significant variance, nor did payer differently affect providers. Charges by provider type varied significantly, with CNMs having lower mean charges than OBs. Differences in practice by payer source were not found for either provider group. This may reflect a lack of financial incentives to alter practice based on the payer, the homogeneity of the participants, or the large number of payers. The findings indicate that provider decision-making styles are likely due to non-payer factors in a system that lacks clear incentives to alter care patterns.

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

PubMed

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

2016-09-01

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

Multiple Perspectives on the State-Mandated Implementation of a High-Stakes Performance Assessment for Preservice English Teacher Candidates

ERIC Educational Resources Information Center

Chandler-Olcott, Kelly; Fleming, Sarah

2017-01-01

Drawing on situated learning and communities of practice, this teacher-research study examined multiple stakeholders' perspectives about the purpose, design, and inaugural implementation of the edTPA, a teacher performance assessment mandated for state certification. Participants included teacher candidates, mentor teachers, a field placement…

An (un)clear conscience clause: the causes and consequences of statutory ambiguity in state contraceptive mandates.

PubMed

VanSickle-Ward, Rachel; Hollis-Brusky, Amanda

2013-08-01

Since 1996, twenty-eight states have adopted legislation mandating insurance coverage of prescription contraceptives for women. Most of these policies include language that allows providers to opt out of the requirement because of religious or moral beliefs-conscience clause exemptions. There is striking variation in how these exemptions are defined. This article investigates the sources and consequences of ambiguous versus precise statutory language in conscience clauses. We find that some forms of political and institutional fragmentation (party polarization and gubernatorial appointment power) are correlated with the degree of policy specificity in state contraceptive mandates. This finding reinforces previous law and policy scholarship that has shown that greater fragmentation promotes ambiguous statutory language because broad wording acts as a vehicle for compromise when actors disagree. Interestingly, it is the more precisely worded statutes that have prompted court battles. We explain this with reference to the asymmetry of incentives and mobilizing costs between those disadvantaged by broad (primarily female employees) versus precisely worded statutes (primarily Catholic organizations). Our findings suggest that the impact of statutory ambiguity on court intervention is heavily contextualized by the resources and organization of affected stakeholders.

The Effect of Florida Medicaid's State-Mandated Formulary Provision on Prescription Drug Use and Health Plan Costs in a Medicaid Managed Care Plan.

PubMed

Munshi, Kiraat D; Mager, Douglas; Ward, Krista M; Mischel, Brian; Henderson, Rochelle R

2018-02-01

Formulary or preferred drug list (PDL) management is an effective strategy to ensure clinically efficient prescription drug management by managed care organizations (MCOs). Medicaid MCOs participating in Florida's Medicaid program were required to use a state-mandated PDL between May and August 2014. To examine differences in prescription drug use and plan costs between a single Florida Medicaid managed care (MMC) health plan that implemented a state-mandated PDL policy on July 1, 2014, and a comparable MMC health plan in another state without a state-mandated PDL, controlling for sociodemographic confounders. A retrospective analysis with a pre-post design was conducted using deidentified administrative claims data from a large pharmacy benefit manager. The prepolicy evaluation period was January 1 through June 30, 2014, and the postpolicy period was January 1 through June 30, 2015. Continuously eligible Florida MMC plan members were matched on sociodemographic and health characteristics to their counterparts enrolled in a comparable MMC health plan in another state without a state-mandated formulary. Outcomes were drug use, measured as the number of 30-day adjusted nonspecialty drug prescriptions per member per period, and total drug plan costs per member per period for all drugs, with separate measures for generic and brand drugs. Bivariate comparisons were conducted using t-tests. Employing a difference-in-differences (DID) analytic approach, multivariate negative binomial regression and generalized estimating equation models were used to analyze prescription drug use and costs. The final analytical sample consisted of 18,372 enrollees, evenly divided between the 2 groups. In the postpolicy evaluation period, overall and generic use declined, while brand use increased for members in the Florida health plan. Drug costs, especially for brands, significantly increased for Florida health plan members. No significant changes were observed over the same time period

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

PubMed

Walker, R Dale; Bigelow, Douglas A

2011-01-01

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

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

PubMed

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

2016-01-01

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

Mandated Preparation Program Redesign: Kentucky Case

ERIC Educational Resources Information Center

Browne-Ferrigno, Tricia

2013-01-01

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

"Managed competition" for Ireland? The single versus multiple payer debate.

PubMed

Mikkers, Misja; Ryan, Padhraig

2014-09-26

A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems. Although Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland's sparse hospital distribution. This may increase the market power of hospitals and weaken insurers' ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals' quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of

10 CFR 490.202 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Acquisitions satisfying the mandate. 490.202 Section 490.202 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory... previously under control of the State or State agency; (b) The purchase or lease of an after-market converted...

Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers.

PubMed

Baker, Christine L; Ferrufino, Cheryl P; Bruno, Marianna; Kowal, Stacey

2017-01-01

Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. A closed cohort budget impact model was developed in Microsoft Excel ® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact

Primary payer status is significantly associated with postoperative mortality, morbidity, and hospital resource utilization in pediatric surgical patients within the United States.

PubMed

Stone, Matthew L; LaPar, Damien J; Mulloy, Daniel P; Rasmussen, Sara K; Kane, Bartholomew J; McGahren, Eugene D; Rodgers, Bradley M

2013-01-01

Current healthcare reform efforts have highlighted the potential impact of insurance status on patient outcomes. The influence of primary payer status (PPS) within the pediatric surgical patient population remains unknown. The purpose of this study was to examine risk-adjusted associations between PPS and postoperative mortality, morbidity, and resource utilization in pediatric surgical patients within the United States. A weighted total of 153,333 pediatric surgical patients were evaluated using the national Kids' Inpatient Database (2003 and 2006): appendectomy, intussusception, decortication, pyloromyotomy, congenital diaphragmatic hernia repair, and colonic resection for Hirschsprung's disease. Patients were stratified according to PPS: Medicare (n=180), Medicaid (n=51,862), uninsured (n=12,539), and private insurance (n=88,753). Multivariable hierarchical regression modeling was utilized to evaluate risk-adjusted associations between PPS and outcomes. Overall median patient age was 12 years, operations were primarily non-elective (92.4%), and appendectomies accounted for the highest proportion of cases (81.3%). After adjustment for patient, hospital, and operation-related factors, PPS was independently associated with in-hospital death (p<0.0001) and postoperative complications (p<0.02), with increased risk for Medicaid and uninsured populations. Moreover, Medicaid PPS was also associated with greater adjusted lengths of stay and total hospital charges (p<0.0001). Importantly, these results were dependent on operation type. Primary payer status is associated with risk-adjusted postoperative mortality, morbidity, and resource utilization among pediatric surgical patients. Uninsured patients are at increased risk for postoperative mortality while Medicaid patients accrue greater morbidity, hospital lengths of stay, and total charges. These results highlight a complex interaction between socioeconomic and patient-related factors, and primary payer status should

Hospital compliance with a state unfunded mandate: the case of California's Earthquake Safety Law.

PubMed

McCue, Michael J; Thompson, Jon M

2012-01-01

Abstract In recent years, community hospitals have experienced heightened regulation with many unfunded mandates. The authors assessed the market, organizational, operational, and financial characteristics of general acute care hospitals in California that have a main acute care hospital building that is noncompliant with state requirements and at risk of major structural collapse from earthquakes. Using California hospital data from 2007 to 2009, and employing logistic regression analysis, the authors found that hospitals having buildings that are at the highest risk of collapse are located in larger population markets, possess smaller market share, have a higher percentage of Medicaid patients, and have less liquidity.

Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

PubMed

Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

2017-01-01

Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality

Print News Coverage of School-Based HPV Vaccine Mandate

PubMed Central

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

2015-01-01

BACKGROUND In 2007, legislation was proposed in 24 states and the District of Columbia for school-based HPV vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. METHODS We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005-2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. RESULTS Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. CONCLUSIONS If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages, and promote informed decision-making by parents and students. PMID:25099421

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

ERIC Educational Resources Information Center

Paterson, Andrea

1986-01-01

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

California's Proposition 186: lessons from a single-payer health care reform ballot initiative campaign.

PubMed

Farey, K; Lingappa, V R

1996-01-01

Proposition 186 was an initiative on the November 1994 California ballot which proposed to establish a state single-payer health care program. Although Prop 186 was overwhelmingly defeated in the November 1994 election (73% No, 27% Yes), it accomplished many things. Model legislation was developed showing the feasibility of a specific single-payer program for California. It was placed on the ballot by an unprecedented volunteer signature-gathering effort and was the largest grassroots political campaign fund-raising effort in California history. A novel strategy for the discussion of complex issues through 1500 house parties was launched. Prop 186 was defeated by an insurance industry-led coalition with an anti-government message. Lessons for future efforts include increasing the size and duration of the grassroots organizing and educational effort, and decreasing reliance on conventional political campaign tactics and the mainstream media.

EXAMINING EVIDENCE IN U.S. PAYER COVERAGE POLICIES FOR MULTI-GENE PANELS AND SEQUENCING TESTS.

PubMed

Chambers, James D; Saret, Cayla J; Anderson, Jordan E; Deverka, Patricia A; Douglas, Michael P; Phillips, Kathryn A

2017-01-01

The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions. We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study. Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73-100 percent), clinical studies in 69 percent (50-87 percent), technology assessments 47 percent (33-86 percent), systematic reviews or meta-analyses 31 percent (7-71 percent), and CEAs 5 percent (0-7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types. Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions.

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

ERIC Educational Resources Information Center

Leblanc, Michael; Dufore, Emily; McDougal, James

2012-01-01

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

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

PubMed

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

2015-01-01

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

The effect of state dependent mandate laws on the labor supply decisions of young adults.

PubMed

Depew, Briggs

2015-01-01

Prior to the Affordable Care Act, the majority of states in the U.S. had already implemented state laws that extended the age that young adults could enroll as dependents on their parent's employer-based health insurance plans. Because of the fundamental link between health insurance and employment in the U.S., such policies may effect the labor supply decisions of young adults. Although the interaction between labor supply and health insurance has been extensively studied for other subpopulations, little is known about the role of health insurance in the labor supply decisions of young adults. I use the variation from the implementation and changes in state policies that expanded dependent health insurance coverage to examine how young adults adjusted their labor supply when they were able to be covered as a dependent on their parent's plan. I find that these state mandates led to a decrease in labor supply on the intensive margin. Copyright © 2014 Elsevier B.V. All rights reserved.

Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations.

PubMed

Lee, Cecilia; Robinson, Joan L

2016-06-01

The efficacy of immunization mandates for childcare or school entry is a long-standing controversy. The United States (US) adopted school entry immunization mandates in the 1800s, while most countries still do not have mandates. The objective of this systematic review was to analyze the evidence that immunization uptake increases with mandates. A search was conducted for studies that compared immunization uptake in a population prior to and after mandates, or in similar populations with one group having and the other not having mandates. Data were extracted and synthesized qualitatively due to the heterogeneity of study design. Eleven before-and-after studies and ten studies comparing uptake in similar populations with and without mandates were included. Studies were from the US (n = 18), France (n = 1) and Canada (n = 2). Eleven of the 21 studies looked at middle school mandates. All but two studies showed at least a trend towards increased uptake with mandates. Higher uptake was associated with a more long-standing mandate. Immunization mandates have generally led to increased short-term and long-term uptake in the group to whom the mandate applies. Many studies have centered around middle school mandates in the US and there is a paucity of studies of childcare mandates or of studies of mandates in other countries or in settings with relatively high baseline immunization uptake. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

EXAMINING EVIDENCE IN U.S. PAYER COVERAGE POLICIES FOR MULTI-GENE PANELS AND SEQUENCING TESTS

PubMed Central

Chambers, James D.; Saret, Cayla J.; Anderson, Jordan E.; Deverka, Patricia A.; Douglas, Michael P.; Phillips, Kathryn A.

2017-01-01

Objectives The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions. Methods We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study. Results Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73–100 percent), clinical studies in 69 percent (50–87 percent), technology assessments 47 percent (33–86 percent), systematic reviews or meta-analyses 31 percent (7–71 percent), and CEAs 5 percent (0–7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types. Conclusions Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions. PMID:29065945

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

ERIC Educational Resources Information Center

Greytak, Emily A.

2009-01-01

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

UnitedHealthcare experience illustrates how payers can enable patient engagement.

PubMed

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

2013-08-01

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

Developing evidence that is fit for purpose: a framework for payer and research dialogue.

PubMed

Sabharwal, Rajeev K; Graff, Jennifer S; Holve, Erin; Dubois, Robert W

2015-09-01

Matching the supply and demand of evidence requires an understanding of when more evidence is needed, as well as the type of evidence that will meet this need. This article describes efforts to develop and refine a decision-making framework that considers payers' perspectives on the utility of evidence generated by different types of research methods, including real-world evidence. Conceptual framework development with subsequent testing during a roundtable dialogue. The framework development process included a literature scan to identify existing frameworks and relevant articles on payer decision making. The framework was refined during a stand-alone roundtable in December 2013 hosted by the research team, which included representatives from public and private payers, pharmacy benefit management, the life sciences industry, and researchers. The roundtable discussion also included an application of the framework to 3 case studies. Application of the framework to the clinical scenarios and the resulting discussion provided key insights into when new evidence is needed to inform payer decision making and what questions should be addressed. Payers are not necessarily seeking more evidence about treatment efficacy; rather, they are seeking more evidence for relevant end points that illustrate the differences between treatment alternatives that can justify the resources required to change practice. In addition, payers are interested in obtaining new evidence that goes beyond efficacy, with an emphasis on effectiveness, longer-term safety, and delivery system impact. We believe that our decision-making framework is a useful tool to increase dialogue between evidence generators and payers, while also allowing for greater efficiency in the research process.

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

PubMed

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

2011-11-01

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

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

NASA Astrophysics Data System (ADS)

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

2011-12-01

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

Print news coverage of school-based human papillomavirus vaccine mandates.

PubMed

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

2014-02-01

In 2007, legislation was proposed in 24 states and the District of Columbia for school-based human papillomavirus (HPV) vaccine mandates, and mandates were enacted in Texas, Virginia, and the District of Columbia. Media coverage of these events was extensive, and media messages both reflected and contributed to controversy surrounding these legislative activities. Messages communicated through the media are an important influence on adolescent and parent understanding of school-based vaccine mandates. We conducted structured text analysis of newspaper coverage, including quantitative analysis of 169 articles published in mandate jurisdictions from 2005 to 2009, and qualitative analysis of 63 articles from 2007. Our structured analysis identified topics, key stakeholders and sources, tone, and the presence of conflict. Qualitative thematic analysis identified key messages and issues. Media coverage was often incomplete, providing little context about cervical cancer or screening. Skepticism and autonomy concerns were common. Messages reflected conflict and distrust of government activities, which could negatively impact this and other youth-focused public health initiatives. If school health professionals are aware of the potential issues raised in media coverage of school-based health mandates, they will be more able to convey appropriate health education messages and promote informed decision-making by parents and students. © 2014, American School Health Association.

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network.

PubMed

Smith, Marie; Cannon-Breland, Michelle L; Spiggle, Susan

2014-01-01

Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient

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

PubMed

Lynch, John

2004-01-01

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

State Policies Influence Medicare Telemedicine Utilization.

PubMed

Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem

2016-01-01

Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs

Provider-Payer Partnerships as an Engine for Continuous Quality Improvement.

PubMed

Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay

2018-06-01

The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

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

ERIC Educational Resources Information Center

McEvoy, Cathleen K.

2013-01-01

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

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

PubMed Central

Zagadailov, Erin; Fine, Michael; Shields, Alan

2013-01-01

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

Diagnosis and Treatment of Diminished Ovarian Reserve in ART Cycles of Women Up to Age 40 Years: The Role of Insurance Mandates

PubMed Central

Butts, Samantha F.; Ratcliffe, Sarah; Dokras, Anuja; Seifer, David B.

2012-01-01

Summary Objective To explore correlates of diminished ovarian reserve (DOR) and predictors of ART treatment outcome in DOR cycles using the SART-CORS database. We hypothesized that state insurance coverage for ART is associated with the prevalence of DOR diagnosis in ART cycles and with treatment outcomes in DOR cycles. Design Cross sectional study using ART cycles between 2004–2007. Setting United States ART registry data. Patients 182,779 fresh, non-donor, initial ART cycles in women up to age 40. Interventions None. Main Outcome Measures Prevalence of DOR and elevated FSH, odds ratio of DOR and elevated FSH in ART mandated vs. non-mandated states, live birth rates. Results Compared to cycles performed in states with mandated ART coverage, cycles in states with no ART mandate were more likely to have DOR (AOR 1.43 95% CI 1.37–1.5, p<0.0001) or elevated FSH (AOR 1.69 95% CI 1.56–1.85, p<0.0001) as the sole reason for treatment. A relationship between lack of mandated ART coverage and increased live birth rates in some, but not all DOR cycles. Conclusions A significant association was observed between lack of mandated insurance for ART and the proportion of cycles treating DOR or elevated FSH. The presence or absence of state mandated ART coverage could impact access to care and the mix of patients that pursue and initiate ART cycles. Additional studies are needed that consider the coalescence of insurance mandates, patient and provider factors, and state level variables on the odds of specific infertility diagnoses and treatment prognosis. PMID:23102859

Insurance-mandated preoperative diet and outcomes after bariatric surgery.

PubMed

Keith, Charles J; Goss, Lauren E; Blackledge, Camille D; Stahl, Richard D; Grams, Jayleen

2018-05-01

Despite a lack of demonstrated patient benefit, many insurance providers mandate a physician-supervised diet before financial coverage for bariatric surgery. To compare weight loss between patients with versus without insurance mandating a preoperative diet. University hospital, United States. Retrospective study of all patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy over a 5-year period, stratified based on whether an insurance-mandated physician-supervised diet was required. Weight loss outcomes at 6, 12, and 24 months postoperation were compared. Linear mixed-models and backward-stepwise selection were used. P<0.05 was considered significant. Of 284 patients, 225 (79%) were required and 59 (21%) were not required to complete a preoperative diet by their insurance provider. Patients without the requirement had a shorter time to operation from initial consultation (P = .04), were older (P<.01), and were more likely to have government-sponsored insurance (P<.01). There was no difference in preoperative weight or body mass index or co-morbidities. In unadjusted models, percent excess weight loss was superior in the group without an insurance-mandated diet at 12 (P = .050) and 24 (P = .045) months. In adjusted analyses, this group also had greater percent excess weight loss at 6 (P<.001), 12 (P<.001), and 24 (P<.001) months; percent total weight loss at 24 months (P = .004); and change in body mass index at 6 (P = .032) and 24 (P = .007) months. There was no difference in length of stay or complication rates. Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss. Published by Elsevier Inc.

How to Successfully Survive a Mandated Project

ERIC Educational Resources Information Center

Ellern, Jill

2011-01-01

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

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

ERIC Educational Resources Information Center

Johnson, Carla C.; Fargo, Jamison D.

2014-01-01

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

Child Abuse and Mandated Reporting

ERIC Educational Resources Information Center

Woika, Shirley; Bowersox, Carissa

2013-01-01

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

State-Mandated Student Assessment Programs: An Examination of the Issues. Proceedings of a Teleconference (October 3, 1985) and a Conference of National and State Educators (Stillwater, Oklahoma, October 4, 1985).

ERIC Educational Resources Information Center

Perry, Katye M., Ed.; And Others

These combined proceedings summarize presentations of two conference programs designed to address state-mandated student achievement issues. Dr. Terrel Bell delivered the keynote speech at a teleconference focusing on a broad perspective of competency testing. He discussed testing problems, as well as positive aspects such as comparison, diagnosis…

Mandated Reporting Thresholds for Community Professionals

ERIC Educational Resources Information Center

Crowell, Kathryn; Levi, Benjamin H.

2012-01-01

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

Mandated Psychotherapy with the Impaired Physician

PubMed Central

2008-01-01

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

10 CFR 490.302 - Vehicle acquisition mandate schedule.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490.302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a...

10 CFR 490.305 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Acquisitions satisfying the mandate. 490.305 Section 490.305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The...

10 CFR 490.302 - Vehicle acquisition mandate schedule.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490.302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a...

10 CFR 490.305 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Acquisitions satisfying the mandate. 490.305 Section 490.305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The...

10 CFR 490.305 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Acquisitions satisfying the mandate. 490.305 Section 490.305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The...

10 CFR 490.305 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Acquisitions satisfying the mandate. 490.305 Section 490.305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.305 Acquisitions satisfying the mandate. The...

10 CFR 490.302 - Vehicle acquisition mandate schedule.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490.302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a...

10 CFR 490.302 - Vehicle acquisition mandate schedule.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490.302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a...

10 CFR 490.302 - Vehicle acquisition mandate schedule.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Vehicle acquisition mandate schedule. 490.302 Section 490.302 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel Provider Vehicle Acquisition Mandate § 490.302 Vehicle acquisition mandate schedule. (a...

Modified mandated choice for organ procurement

PubMed Central

Chouhan, P; Draper, H

2003-01-01

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

Financing care for the uninsured: the dilemma vexes New Jersey hospitals and payers.

PubMed

Wells, E V

1996-05-01

New Jersey's diverse constituencies and special interest groups don't usually agree on a public policy issue. However, almost everyone in the public policy arena agrees that hospitals should treat people who show up in emergency departments with problems requiring medical attention. For over a decade, Garden State policymakers, payers, and providers have faced the dilemma of excess demand on hospitals that treat the uninsured. This demand has risen due to increasing health care costs, development of costly technology, state deregulation of hospital payments, and employers' reluctance to insure workers and their families coupled with a mobile workforce holding part-time and seasonal jobs. The fiscal solvency of inner-city hospitals is threatened yet the problem continues to elude resolution.

Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Adult Intensive Care Unit Patients Following State-Mandated Active Surveillance.

PubMed

Lin, Michael Y; Hayden, Mary K; Lyles, Rosie D; Lolans, Karen; Fogg, Louis F; Kallen, Alexander J; Weber, Stephen G; Weinstein, Robert A; Trick, William E

2018-05-02

In 2007, Illinois became the first state in the United States to mandate active surveillance of methicillin-resistant Staphylococcus aureus (MRSA). The Illinois law applies to intensive care unit (ICU) patients; contact precautions are required for patients found to be MRSA colonized. However, the effectiveness of a legislated "search and isolate" approach to reduce MRSA burden among critically ill patients is uncertain. We evaluated whether the prevalence of MRSA colonization declined in the 5 years after the start of mandatory active surveillance. All hospitals with an ICU having ≥10 beds in Chicago, Illinois, were eligible to participate in single-day serial point prevalence surveys. We assessed MRSA colonization among adult ICU patients present at time of survey using nasal and inguinal swab cultures. The primary outcome was region-wide MRSA colonization prevalence over time. All 25 eligible hospitals (51 ICUs) participated in serial point prevalence surveys over 8 survey periods (2008-2013). A total of 3909 adult ICU patients participated in the point prevalence surveys, with 432 (11.1%) found to be colonized with MRSA (95% confidence interval [CI], 10.1%-12.0%). The MRSA colonization prevalence among patients was unchanged during the study period; year-over-year relative risk for MRSA colonization was 0.97 (95% CI, .89-1.05; P = .48). MRSA colonization prevalence among critically ill adult patients did not decline during the time period following legislatively mandated MRSA active surveillance. Our findings highlight the limits of legislated MRSA active surveillance as a strategy to reduce MRSA colonization burden among ICU patients.

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

PubMed Central

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

2012-01-01

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

Association between payer mix and costs, revenues and profitability: a cross-sectional study of Lebanese hospitals.

PubMed

Saleh, S; Ammar, W; Natafgi, N; Mourad, Y; Dimassi, H; Harb, H

2015-09-08

This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources (61.1%), out-of-pocket (18.4%) and private insurance (18.2%). Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of out of- pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability.

Can Payers Use Prices to Improve Quality? Evidence from English Hospitals.

PubMed

Allen, Thomas; Fichera, Eleonora; Sutton, Matt

2016-01-01

In most activity-based financing systems, payers set prices reactively based on historical averages of hospital reported costs. If hospitals respond to prices, payers might set prices proactively to affect the volume of particular treatments or clinical practice. We evaluate the effects of a unique initiative in England in which the price offered to hospitals for discharging patients on the same day as a particular procedure was increased by 24%, while the price for inpatient treatment remained unchanged. Using national hospital records for 205,784 patients admitted for the incentivised procedure and 838,369 patients admitted for a range of non-incentivised procedures between 1 December 2007 and 31 March 2011, we consider whether this price change had the intended effect and/or produced unintended effects. We find that the price change led to an almost six percentage point increase in the daycase rate and an 11 percentage point increase in the planned daycase rate. Patients benefited from a lower proportion of procedures reverted to open surgery during a planned laparoscopic procedure and from a reduction in long stays. There was no evidence that readmission and death rates were affected. The results suggest that payers can set prices proactively to incentivise hospitals to improve quality. Copyright © 2014 John Wiley & Sons, Ltd.

… what do payers really want to see?

PubMed

Silverman, Ed

2007-04-01

Last fall's launch of a lower-priced monoclonal antibody to treat colorectal cancer raised the question: Has the biotech industry opened a price war? Not necessarily. Even if it were so, payers would view it with skepticism - despite all the talk about the cost of biologic drugs. So when a lower-cost product hits the market, if price isn't persuasive enough…

Benchmarking Insulin Treatment Persistence Among Patients with Type 2 Diabetes Across Different U.S. Payer Segments.

PubMed

Wei, Wenhui; Jiang, Jenny; Lou, Youbei; Ganguli, Sohini; Matusik, Mark S

2017-03-01

Treatment persistence with basal insulins is crucial to achieving sustained glycemic control, which is associated with a reduced risk of microvascular disease and other complications of type 2 diabetes (T2D). However, studies suggest that persistence with basal insulin treatment is often poor. To measure and benchmark real-world basal insulin treatment persistence among patients with T2D across different payer segments in the United States. This was a retrospective observational study of data from a national pharmacy database (Walgreen Co., Deerfield, IL). The analysis included patients with T2D aged ≥ 18 years who filled ≥ 1 prescription for basal insulins between January 2013 and June 2013 (the index prescription) and who had also filled prescriptions for ≥ 1 oral antidiabetes drug in the database. Patients with claims for premixed insulin were excluded. Treatment persistence was defined as remaining on the study medication(s) during the 1-year follow-up period. Patients were stratified according to treatment history (existing basal insulin users vs. new insulin users), payer segments (commercially insured, Medicare, Medicaid, or cash-pay), type of basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin [NPH]), and device for insulin administration (pen or vial/syringe). A total of 274,102 patients were included in this analysis, 82% of whom were existing insulin users. In terms of payer segments, 45.3% of patients were commercially insured, 47.8% had Medicare, 5.9% had Medicaid, and 1.1% were cash-pay. At the 1-year follow-up, basal insulin treatment persistence rate was 66.8% overall, 61.7% for new users, and 67.9% for existing users. In general, for both existing and new basal insulin users, higher persistence rate and duration were associated with Medicare versus cash-pay patients, use of insulin pens versus vial/syringe, and use of insulin glargine versus NPH. This large-scale study provides a benchmark of basal insulin

Certification of Public Librarians in the United States. A Detailed Summary of Legally Mandated and Voluntary Certification Plans for Public Librarians Based on Information Supplied by the Various Certificating State Agencies or Other Appropriate Sources. 3rd Edition.

ERIC Educational Resources Information Center

Coe, Mary J., Ed.

This report contains summaries of legally mandated and voluntary certification plans for public librarians in the United States based on information supplied by the various certifying state agencies or other appropriate sources in April 1979. Each plan is identified by the descriptive terms "mandatory" (certification required by law--23 states),…

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

PubMed Central

Kapinos, Kandice A.

2015-01-01

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

External Mandates and Instructional Leadership: School Leaders as Mediating Agents

ERIC Educational Resources Information Center

Louis, Karen Seashore; Robinson, Viviane M.

2012-01-01

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

Prospective political analysis for policy design: enhancing the political viability of single-payer health reform in Vermont.

PubMed

Blanchet, Nathan J; Fox, Ashley M

2013-06-01

In 2011 the state of Vermont adopted legislation that aims to create the nation's first state-level single-payer health care system, a system that would go well beyond national reform efforts. To conduct a prospective, institutional stakeholder analysis to guide development of a politically viable, universal health care reform proposal, as commissioned by Vermont's legislature in July 2010. A total of 64 semi-structured stakeholder interviews with nearly 120 individuals, representing 60 different groups/institutions, were conducted between July and December 2010. Interviews probed stakeholders regarding five major design components: financing options, decoupling insurance from employment, organization/governance, comprehensiveness of benefits, and payment reform. There was a range of opposition and support across stakeholder groups and components, and more remarkably a diversity of views within groups often believed to be unwavering supporters or detractors of comprehensive health reform. Given the balance of conflicting views, relative power, and acceptable trade-offs, the research team proposed a single-payer health care system financed through payroll taxes, decoupled from employment, with a generous benefit package, governed by a public-private intermediary. Prospective political analysis can assist in choosing among a range of technically sound policy options to create a more politically viable health reform package. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?

PubMed

Gao, Yubo; Johnston, Richard C; Karam, Matthew

2010-01-01

The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis. The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794). Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

17 CFR 232.101 - Mandated electronic submissions and exceptions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.101 Mandated electronic submissions and exceptions. (a) Mandated electronic submissions. (1) The...

17 CFR 232.101 - Mandated electronic submissions and exceptions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Mandated electronic... COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.101 Mandated electronic submissions and exceptions. (a) Mandated electronic submissions. (1) The...

PREEMPTIVE PHARMACOGENETIC TESTING: EXPLORING THE KNOWLEDGE AND PERSPECTIVES OF UNITED STATES PAYERS

PubMed Central

Keeling, Nicholas J.; Rosenthal, Meagen M.; West-Strum, Donna; Patel, Amit; Haidar, Cyrine E.; Hoffman, James M.

2017-01-01

PURPOSE Preemptive pharmacogenetic testing aims to optimize medication use by having genetic information at the point of prescribing. Payers’ decisions influence implementation of this technology. We investigated U.S. payers’ knowledge, awareness, and perspectives on preemptive pharmacogenetic testing. METHODS A qualitative study was conducted using semi-structured interviews. Participants were screened for eligibility through an online survey. A blended inductive and deductive approach was used to analyze the transcripts. Two authors conducted an iterative reading process to code and categorize the data. RESULTS Medical or pharmacy directors from 14 payer organizations covering 122 million U.S. lives were interviewed. Three concept domains and ten dimensions were developed. Key findings include: clinical utility concerns and limited exposure to preemptive germline testing, continued preference for outcomes from randomized controlled trials, interest in guideline development, importance of demonstrating an impact on clinical decision making, concerns of downstream costs and benefit predictability, and the impact of public stakeholders such as the FDA and CMS. CONCLUSION Both barriers and potential facilitators exist to developing cohesive reimbursement policy for pharmacogenetics, and there are unique challenges for the preemptive testing model. Prospective outcome studies, more precisely defining target populations, and predictive economic models are important considerations for future research. PMID:29261180

The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age.

PubMed

Villelli, Nicolas W; Yan, Hong; Zou, Jian; Barbaro, Nicholas M

2017-12-01

OBJECTIVE Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors' prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers' compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and "other" categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65-84 years old, with a decrease in surgeries for those 18-44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly

Effects of a Legislated Mandate: "The Comprehensive School Improvement Process and Middle-Level Gifted and Talented Programming"

ERIC Educational Resources Information Center

Schneider, Jean Suchsland

2006-01-01

This descriptive study investigated two areas: (a) perceived changes in gifted and talented (G/T) programming in Iowa from the time a state mandate was implemented to the time of the study, and (b) perceived effects of the mandate on G/T programming in Iowa. Perceptions of middle-level teachers of gifted and talented students (n = 111) were…

Making the case: the impetus for federally mandating insurance companies to cover colorectal cancer screening.

PubMed

Toomey, April; Menon, Usha

2010-01-01

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths per year in the U.S. The 5-year survival rate of CRC detected early is 90%, but only 39% of CRC is detected in this stage. CRC screening is effective in reducing mortality from this disease, but national screening rates are alarmingly low. Mandated CRC screening insurance coverage significantly increases screening rates. However, mandated coverage varies greatly by state. Bill H.R. 1330, which would federally mandate insurance companies to cover CRC screening for people 50 and older, is currently under consideration by the House of Representatives. Reasons to support this bill and rebuttals to arguments made against H.R. 1330 are discussed.

Effects of Mandating Benefits Packages. Background Paper No. 32.

ERIC Educational Resources Information Center

Mitchell, Olivia S.

This study of the potential labor market consequences of government mandating of employee benefits suggests that mandating benefits will increase benefit coverage and generosity for insurance coverage will not be helped; even when mandating benefits does improve benefit provision, there will be other offsetting effects, including wage and other…

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

PubMed

Mookencherry, Shefali

2012-01-01

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

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

ERIC Educational Resources Information Center

Neumann, Jacob

2013-01-01

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

Relative efficacy of drugs: an emerging issue between regulatory agencies and third-party payers.

PubMed

Eichler, Hans-Georg; Bloechl-Daum, Brigitte; Abadie, Eric; Barnett, David; König, Franz; Pearson, Steven

2010-04-01

Drug regulatory agencies have traditionally assessed the quality, safety and efficacy of drugs, and the current paradigm dictates that a new drug should be licensed when the benefits outweigh the risks. By contrast, third-party payers base their reimbursement decisions predominantly on the health benefits of the drug relative to existing treatment options (termed relative efficacy; RE). Over the past decade, the role of payers has become more prominent, and time-to-market no longer means time-to-licensing but time-to-reimbursement. Companies now have to satisfy the sometimes divergent needs of both regulators and payers, and to address RE during the pre-marketing stages. This article describes the current political background to the RE debate and presents the scientific and methodological challenges as they relate to RE assessment. In addition, we explain the impact of RE on drug development, and speculate on future developments and actions that are likely to be required from key players.

Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Critically Ill Children in a State With Mandated Active Surveillance.

PubMed

Lyles, Rosie D; Trick, William E; Hayden, Mary K; Lolans, Karen; Fogg, Louis; Logan, Latania K; Shulman, Stanford T; Weinstein, Robert A; Lin, Michael Y

2016-12-01

In theory, active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) reduces MRSA spread by identifying all MRSA-colonized patients and placing them under contact precautions. In October 2007, Illinois mandated active MRSA surveillance in all intensive care units, including neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). We evaluated MRSA trends in a large metropolitan region in the wake of this law. Chicago hospitals with a NICU or PICU were recruited for 8 single-day point prevalence surveys that occurred twice-yearly between June 2008 and July 2011 and then yearly in 2012 to 2013. Samples from all patients were cultured for MRSA (nose and umbilicus for neonates, nose and groin for pediatric patients). Hospital-reported admission MRSA-screening results also were obtained. Point prevalence cultures were screened for MRSA by using broth enrichment, chromogenic agar, and standard confirmatory methods. All eligible hospitals (N = 10) participated (10 NICUs, 6 PICUs). Hospital-reported adherence to state-mandated MRSA screening at admission was high (95% for NICUs, 94% for PICUs). From serial point prevalence surveys, overall MRSA prevalences in the NICUs and PICUs were 4.2% (89 of 2101) and 5.7% (36 of 632), respectively. MRSA colonization prevalences were unchanged in the NICUs (year-over-year risk ratio [RR], 0.93 [95% confidence interval (CI), 0.78-1.12]; P = .45) and trended toward an increase in the PICUs (RR, 1.25 [95% CI, 0.72-2.12]; P = .053). We estimated that 81% and 40% of MRSA-positive patients in the NICUs and PICUs, respectively, had newly acquired MRSA. In a region with mandated active MRSA surveillance, we found ongoing unchanged rates of MRSA colonization and acquisition among NICU and PICU patients. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Payers' Perspectives: Health Economics Outcomes in Managed Care

PubMed Central

Bankhead, Charles

2015-01-01

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

Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs.

PubMed

Halpern, Neil A; Pastores, Stephen M

2010-01-01

To analyze the evolving role, patterns of use, and costs of critical care medicine in the United States from 2000 to 2005. Retrospective study of data from the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, Maryland). Nonfederal, acute care hospitals with critical care medicine beds in the United States. None. None. We analyzed hospital and critical care medicine beds, bed types, days, occupancy rates, payer mix (Medicare and Medicaid), and costs. Critical care medicine costs were compared with national cost indexes. Between 2000 and 2005, the total number of U.S. hospitals with critical care medicine beds decreased by 12.2% (from 3,586 to 3,150). Although the number of hospital beds decreased by 4.2% (from 655,785 to 628,409), both hospital days and occupancy rates increased by 5.1% (from 145.1 to 152.5 million) and 13.7% (from 59% to 67%), respectively. Critical care medicine beds increased by 6.5% (from 88,252 to 93,955), days by 10.6% (from 21.0 to 23.2 million), and occupancy rates by 4.5% (from 65% to 68%). The majority (90%) of critical care medicine beds were classified as intensive care, premature/neonatal, and coronary care unit beds. The percentage of critical care medicine days used by Medicare decreased by 3.8% (from 37.9% to 36.5%) compared with an increase of 15.5% (from 14.5% to 16.8%) by Medicaid. From 2000 to 2005, critical care medicine costs per day increased by 30.4% (from $2698 to $3518). Although annual critical care medicine costs increased by 44.2% (from $56.6 to $81.7 billion), the proportion of hospital costs and national health expenditures allocated to critical care medicine decreased by 1.6% and 1.8%, respectively. However, the proportion of the gross domestic product used by critical care medicine increased by 13.7%. In 2005, critical care medicine costs represented 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of the gross domestic product. Critical care

Linking Job-Embedded Professional Development and Mandated Teacher Evaluation: Teacher as Learner

ERIC Educational Resources Information Center

Derrington, Mary Lynne; Kirk, Julia

2017-01-01

This study explores the link between individualized, job-embedded professional development and teacher evaluation. Moreover, the study explores and describes job-embedded strategies that principals used to facilitate teacher development while working within a state-mandated evaluation system. The theoretical frame utilized four elements of…

32 CFR 220.2 - Statutory obligation of third party payer to pay.

Code of Federal Regulations, 2012 CFR

2012-07-01

... DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE... healthcare services provided in or through any facility of the Uniformed Services to a covered beneficiary...

32 CFR 220.2 - Statutory obligation of third party payer to pay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE... healthcare services provided in or through any facility of the Uniformed Services to a covered beneficiary...

32 CFR 220.2 - Statutory obligation of third party payer to pay.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE... healthcare services provided in or through any facility of the Uniformed Services to a covered beneficiary...

32 CFR 220.2 - Statutory obligation of third party payer to pay.

Code of Federal Regulations, 2014 CFR

2014-07-01

... DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE... healthcare services provided in or through any facility of the Uniformed Services to a covered beneficiary...

32 CFR 220.2 - Statutory obligation of third party payer to pay.

Code of Federal Regulations, 2013 CFR

2013-07-01

... DEFENSE (CONTINUED) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE... healthcare services provided in or through any facility of the Uniformed Services to a covered beneficiary...

Utilizing Online Education in Florida to Meet Mandated Class Size Limitations

ERIC Educational Resources Information Center

Mattox, Kari Ann

2012-01-01

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

Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data.

PubMed

Freedman, Seth; Nikpay, Sayeh; Carroll, Aaron; Simon, Kosali

2017-01-01

The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges. To provide new estimates of the effect of the ACA on discharges for specific conditions. We compared outcomes between states that did and did not expand Medicaid using state-level all-capture discharge data from 2009-2014 for 42 states from the Healthcare Costs and Utilization Project's FastStats database; for a subset of states we used data through 2015. We stratified the analysis by baseline uninsured rates and used difference-in-differences and synthetic control methods to select comparison states with similar baseline characteristics that did not expand Medicaid. Our main outcomes were total and condition-specific hospital discharges per 1,000 population and the share of total discharges by payer. Conditions reported separately in FastStats included maternal, surgical, mental health, injury, and diabetes. The share of uninsured discharges fell in Medicaid expansion states with below (-4.39 percentage points (p.p.), -6.04 --2.73) or above (-7.66 p.p., -9.07 --6.24) median baseline uninsured rates. The share of Medicaid discharges increased in both small (6.42 p.p. 4.22-6.62) and large (10.5 p.p., 8.48-12.5) expansion states. Total and most condition-specific discharges per 1,000 residents did not change in Medicaid expansion states with high or low baseline uninsured rates relative to non-expansion states (0.418, p = 0.225), with one exception: diabetes. Discharges for that condition per 1,000 fell in states with high baseline uninsured rates relative to non-expansion states (-0.038 95% p = 0.027). Early changes in payer mix identified in the first two quarters of 2014 continued through the Medicaid expansion's first year and are

Specialty pharmacy cost management strategies of private health care payers.

PubMed

Stern, Debbie; Reissman, Debi

2006-01-01

The rate of increase in spending on specialty pharmaceuticals is outpacing by far the rate of increase in spending for other drugs. To explore the strategies payers are using in response to challenges related to coverage, cost, clinical management, and access of specialty pharmaceuticals and to describe the potential implications for key stakeholders, including patients, physicians, and health care purchasers. Sources of information were identified in the course of providing consulting services in the subject area of specialty pharmaceuticals to health plans, pharmacy benefit managers, employers, and pharmaceutical manufacturers. Specialty pharmaceuticals represent the fastest growing segment of drug spending due to new product approvals, high unit costs, and increasing use. Health care payers are faced with significant challenges related to coverage, cost, clinical management, and access. A variety of short- and long-term strategies have been employed to address these challenges. Current management techniques for specialty pharmaceuticals often represent a stop-gap approach for controlling rising drug costs. Optimum cost and care management methods will evolve as further research identifies the true clinical and economic value of various specialty pharmaceuticals.

Factors Influencing Compliance with Legislative Mandates within Information Technology Departments

ERIC Educational Resources Information Center

Gioia, Paul J.

2014-01-01

Since 2001, information technology (IT) leadership has had to contend with a host of new federal and local regulatory mandates. The purpose of this quantitative study was to identify and assess the possible inefficiencies associated with efforts to comply with recent legislative IT mandates and to model the impact of these mandates on the…

Communication of potential benefits and harm to patients and payers in psychiatry: a review and commentary.

PubMed

Wu, Renrong; Kemp, David E; Sajatovic, Martha; Zhao, Jingping; Calabrese, Joseph R; Gao, Keming

2011-12-01

Communicating potential benefits and harm to patients and payers is essential for high-quality care. However, there are no published guidelines or consensuses on how to communicate potential benefits and harm to patients and payers. The goal of this review was to identify key elements for communication between clinicians, patients, and payers to achieve maximal benefits and minimal risk. Literature published from January 1980 to July 2011 and cited on MEDLINE was searched using the terms communication, benefit, harm, effectiveness, cost, cost-effectiveness, psychiatry, bipolar disorder, schizophrenia, and major depressive disorder. Elements related to communicating benefits and/or harm to patients and payers were identified, with only key elements discussed in detail here. Evidence-based medicine, number needed to treat to benefit (NNTB) or harm (NNTH), and the likelihood of being helped or harmed (LHH) have been advocated as the basis for communication in all specialties of medicine. Phase-dependent communication of benefits and harm is novel, especially in patients with different phases of illness, such as bipolar disorder. Duration-dependent (short-term versus long-term) communication is essential for all psychiatric disorders to reduce the burden of relapse and adverse events with long-term treatment. For drugs with multiple therapeutic indications, a disease-dependent approach is crucial to maximize benefits and minimize harm. The exclusion of comorbid psychiatric disorders in pivotal efficacy trials affects their generalizability. Communicating cost (direct versus indirect) is an essential component in reducing health care expenditures. The results of available cost-effectiveness analyses of psychiatric pharmacotherapy have been inconsistent and/or contradictory. Evidence-based communication of potential benefits and harm to patients and payers, using NNTB, NNTH, and LHH, should be the key principle that guides decision making. Phase-, duration-, and disease

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

PubMed

Zavadsky, Matt

2015-07-01

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

Ethanol mandate thrown out by appeals court

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

Begley, R.

1995-05-10

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

Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services.

PubMed

Trapskin, Kari; Johnson, Curtis; Cory, Patrick; Sorum, Sarah; Decker, Chris

2009-01-01

To describe the Wisconsin Pharmacy Quality Collaborative (WPQC), a quality-based network of pharmacies and payers with the common goals of improving medication use and safety, reducing health care costs for payers and patients, and increasing professional recognition and compensation for pharmacist-provided services. Wisconsin between 2006 and 2009. Community (independent, chain, and health-system) pharmacies and private and public health care payers/purchasers with support from the McKesson Corporation. This initiative aligns incentives for pharmacies and payers through implementation of 12 quality-based pharmacy requirements as conditions of pharmacy participation in a practice-advancement pilot. Payers compensate network pharmacies that meet the quality-based requirements for two levels of pharmacy professional services (level 1, intervention-based services; level 2, comprehensive medication review and assessment services). The pilot project is designed to measure the following outcomes: medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction. The Pharmacy Society of Wisconsin created the WPQC network, which consists of 53 pharmacies, 106 trained pharmacists, 45 student pharmacists, 6 pharmacy technicians, and 2 initial payers. A quality assurance process is followed approximately quarterly to audit the 12 network quality requirements. An evaluation of this collaboration is being conducted. This program demonstrates that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services, and professional service compensation for pharmacists. This combination of a quality-based credentialing process with a professional services reimbursement schedule is unique and has the promise to

Trial of the University Assistance Program for Alcohol Use Among Mandated Students*

PubMed Central

Amaro, Hortensia; Ahl, Marilyn; Matsumoto, Atsushi; Prado, Guillermo; Mulé, Christina; Kemmemer, Amaura; Larimer, Mary E.; Masi, Dale; Mantella, Philomena

2009-01-01

Objective: The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Method: Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Results: Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. Conclusions: The University Assistance Program may have a possible advantage over services as usual for mandated students. PMID:19538912

Trial of the university assistance program for alcohol use among mandated students.

PubMed

Amaro, Hortensia; Ahl, Marilyn; Matsumoto, Atsushi; Prado, Guillermo; Mulé, Christina; Kemmemer, Amaura; Larimer, Mary E; Masi, Dale; Mantella, Philomena

2009-07-01

The aim of this study was to investigate the effectiveness of a brief intervention for mandated students in the context of the University Assistance Program, a Student Assistance Program developed and modeled after workplace Employee Assistance Programs. Participants were 265 (196 males and 69 females) judicially mandated college students enrolled in a large, urban university in the northeast United States. All participants were sanctioned by the university's judicial office for an alcohol- or drug-related violation. Participants were randomized to one of two intervention conditions (the University Assistance Program or services as usual) and were assessed at baseline and 3 and 6 months after intervention. Growth curve analyses showed that, relative to services as usual, the University Assistance Program was more efficacious in reducing past-90-day weekday alcohol consumption and the number of alcohol-related consequences while increasing past-90-day use of protective behaviors and coping skills. No significant differences in growth trajectories were found between the two intervention conditions on past-90-day blood alcohol concentration, total alcohol consumption, or weekend consumption. The University Assistance Program may have a possible advantage over services as usual for mandated students.

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

PubMed

Weiss, Robert

2016-12-01

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

Biosimilars: How Can Payers Get Long-Term Savings?

PubMed

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

2016-06-01

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

The Collaborative Payer Provider Model Enhances Primary Care, Producing Triple Aim Plus One Outcomes: A Cohort Study.

PubMed

Doerr, Thomas; Olsen, Lisa; Zimmerman, Deborah

2017-08-27

Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. From 2010 through 2014, a Medicare Advantage plan prospectively deployed the CPPM, averaging 30,561 members with costs that were 73.6% of fee-for-service (FFS) Medicare ( p < 0.001). The health plan was not part of an integrated delivery system. After allocating $80 per member per month (PMPM) for primary care costs, the health plan had medical cost ratios averaging 75.1% before surplus distribution. Member benefits were the best in the market. The health plan was rated 4.5 Stars by the Centers for Medicare and Medicaid Services for years 1-4, and 5 Stars in study year 5 for quality, patient experience, access to care, and care process metrics. Primary care and specialist satisfaction were significantly better than national benchmarks. Savings resulted from shifts in spending from inpatient to outpatient settings, and from specialists to primary care physicians when appropriate. The CPPM is a scalable model that enables a win-win-win system for patients, providers, and payers.

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

ERIC Educational Resources Information Center

Wilt, Barbara C.

2016-01-01

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

Lessons from a New Continuing Education Mandate: The Experience of NASW-NYC

ERIC Educational Resources Information Center

Schachter, Robert

2016-01-01

The New York City Chapter of the National Association of Social Workers (NASW-NYC), one of the largest in the country, launched a continuing education initiative in 2015 in response to passage of a new statute mandating that all MSW-level state licensed social workers begin accumulating approved hours of continuing education as a requirement for…

Managing Mandated Educational Change

ERIC Educational Resources Information Center

Clement, Jennifer

2014-01-01

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

Pricing and reimbursement experiences and insights in the European Union and the United States: Lessons learned to approach adaptive payer pathways.

PubMed

Faulkner, S D; Lee, M; Qin, D; Morrell, L; Xoxi, E; Sammarco, A; Cammarata, S; Russo, P; Pani, L; Barker, R

2016-12-01

Earlier patient access to beneficial therapeutics that addresses unmet need is one of the main requirements of innovation in global healthcare systems already burdened by unsustainable budgets. "Adaptive pathways" encompass earlier cross-stakeholder engagement, regulatory tools, and iterative evidence generation through the life cycle of the medicinal product. A key enabler of earlier patient access is through more flexible and adaptive payer approaches to pricing and reimbursement that reflect the emerging evidence generated. © 2016 American Society for Clinical Pharmacology and Therapeutics.

Legal Briefing: Mandated Reporters and Compulsory Reporting Duties.

PubMed

Pope, Thaddeus Mason

2016-01-01

This issue's "Legal Briefing" column, one product of a Greenwall Foundation grant, reviews recent developments concerning compulsory reporting duties. Most licensed clinicians in the United States are "mandated reporters." When these clinicians discover certain threats to the safety of patients or the public, they are legally required to report that information to specified government officials. Over the past year, several states have legislatively expanded the scope of these reporting duties. In other states, new court cases illustrate the vigorous enforcement of already existing duties. I have organized all these legal developments into the following eight categories: 1. Overview of Mandatory Reporting Duties 2. Controversy over the Benefits of Mandatory Reporting 3. New and Expanded Duties to Report 4. Criminal Penalties for Failing to Report 5. Civil Liability for Failing to Report 6. Disciplinary Penalties for Failing to Report 7. Legal Immunity for Good-Faith Reporting 8. Protection against Employers' Retaliation. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Public Support for Mandated Nicotine Reduction in Cigarettes

PubMed Central

Abrams, David B.; Niaura, Raymond S.; Richardson, Amanda; Vallone, Donna M.

2013-01-01

Objectives. We assessed public support for a potential Food and Drug Administration (FDA)–mandated reduction in cigarette nicotine content. Methods. We used nationally representative data from a June 2010 cross-sectional survey of US adults (n = 2649) to obtain weighted point estimates and correlates of support for mandated nicotine reduction. We also assessed the potential role of political ideology in support of FDA regulation of nicotine. Results. Nearly 50% of the public supported mandated cigarette nicotine reduction, with another 28% having no strong opinion concerning this potential FDA regulation. Support for nicotine reduction was highest among Hispanics, African Americans, and those with less than a high school education. Among smokers, the odds of supporting FDA nicotine regulation were 2.77 times higher among smokers who intended to quit in the next 6 months than among those with no plans to quit. Conclusions. Mandating nicotine reduction in cigarettes to nonaddictive levels may reduce youth initiation and facilitate adult cessation. The reasons behind nicotine regulation need to be communicated to the public to preempt tobacco industry efforts to impede such a regulation. PMID:23327262

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

NASA Astrophysics Data System (ADS)

Jeffery, Samuel Shird

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

Delphi-Discrepancy Evaluation: A Model for the Quality Control of Federal, State, and Locally Mandated Programs.

ERIC Educational Resources Information Center

Sirois, Herman A.; Iwanick, Edward F.

Legally mandated educational programs often lack specificity and guidelines for such programs are often vague and subject to considerable variability in interpretation. This situation presents perennial problems for evaluators. Few evaluation models have the flexibility for dealing with this ambiguity and variability while at the same time…

Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

PubMed Central

2013-01-01

Background More effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level. Methods The Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage. Discussion Although addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer’s role—has not received a lot of attention in research on EBP adoption. This

Contract law: relationship between dermatologists and third-party payers.

PubMed

Askanas, A V

1993-04-01

The relationship between third-party payers and dermatologists is generally governed by a written contract. That relationship can be more beneficial to the dermatologist, and chances of liability may be decreased, both for breach of contract and for malpractice, if the dermatologist pays close attention to the language in the contract. All contracts are generally negotiable; detrimental language in the contract often may be removed or changed. This article presents information to help prepare dermatologists to review and negotiate contracts.

Vestibular evoked myogenic potential testing: Payment policy review for clinicians and payers.

PubMed

Fife, Terry D; Satya-Murti, Saty; Burkard, Robert F; Carey, John P

2018-04-01

A recent American Academy of Neurology Evidence-Based Practice Guideline on vestibular myogenic evoked potential (VEMP) testing has described superior canal dehiscence syndrome (SCDS) and evaluated the merits of VEMP in its diagnosis. SCDS is an uncommon but now well-recognized cause of dizziness and auditory symptoms. This article familiarizes health care providers with this syndrome and the utility and shortcomings of VEMP as a diagnostic test and also explores payment policies for VEMP. In carefully selected patients with documented history compatible with the SCDS, both high-resolution temporal bone CT scan and VEMP are valuable aids for diagnosis. Payers might be unfamiliar with both this syndrome and VEMP testing. It is important to raise awareness of VEMP and its possible indications and the rationale for coverage of VEMP testing. Payers may not be readily receptive to VEMP coverage if this test is used in an undifferentiated manner for all common vestibular and auditory symptoms.

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act.

PubMed

Frean, Molly; Gruber, Jonathan; Sommers, Benjamin D

2017-05-01

Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

Social learning in a policy-mandated collaboration: Community wildfire protection planning in the eastern United States

Treesearch

Rachel F. Brummel; Kristen C. Nelson; Pamela J. Jakes; Daniel R. Williams

2010-01-01

Policies such as the US Healthy Forests Restoration Act (HFRA) mandate collaboration in planning to create benefits such as social learning and shared understanding among partners. However, some question the ability of top-down policy to foster successful local collaboration. Through in-depth interviews and document analysis, this paper investigates social learning and...

What do providers, payers and patients need from comparative effectiveness research on diagnostics? The case of HER2/Neu testing in breast cancer.

PubMed

Trosman, Julia R; Weldon, Christine B; Schink, Julian C; Gradishar, William J; Benson, Al B

2013-07-01

Comparing effectiveness of diagnostic tests is one of the highest priorities for comparative effectiveness research (CER) set by the Institute of Medicine. Our study aims to identify what information providers, payers and patients need from CER on diagnostics, and what challenges they encounter implementing comparative information on diagnostic alternatives in practice and policy. Using qualitative research methods and the example of two alternative protocols for HER2 testing in breast cancer, we conducted interviews with 45 stakeholders: providers (n = 25) from four academic and eight nonacademic institutions, executives (n = 13) from five major US private payers and representatives (n = 7) from two breast cancer patient advocacies. The need for additional scientific evidence to determine the preferred HER2 protocol was more common for advocates than payers (100 vs 54%; p = 0.0515) and significantly more common for advocates than providers (100 vs 40%; p = 0.0077). The availability of information allowing assessment of the implementation impact from alternative diagnostic protocols on provider institutions may mitigate the need for additional scientific evidence for some providers and payers (24 and 46%, respectively). The cost-effectiveness of alternative protocols from the societal perspective is important to payers and advocates (69 and 71%, respectively) but not to providers (0%; p = 0.0001 and p = 0.0001). The lack of reporting laboratory practices is a more common implementation challenge for payers and advocates (77 and 86%, respectively) than for providers (32%). The absence of any mechanism for patient involvement was recognized as a challenge by payers and advocates (69 and 100%, respectively) but not by providers (0%; p = 0.0001 and p = 0.0001). Comparative implementation research is needed to inform the stakeholders considering diagnostic alternatives. Transparency of laboratory practices is an important factor in enabling implementation of CER on

Actuarial analysis of private payer administrative claims data for women with endometriosis.

PubMed

Mirkin, David; Murphy-Barron, Carrieann; Iwasaki, Kosuke

2007-04-01

Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce. The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed. This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share. The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire

Stepped Care: A Promising Treatment Strategy for Mandated Students

ERIC Educational Resources Information Center

Borsari, Brian; Tevyaw, Tracy O'Leary

2005-01-01

Over the past decade, there has been a steady increase in the number of mandated students who have been referred to campus alcohol programs for violating campus alcohol policies. However, the severity of alcohol use and problems varies widely in mandated students, indicating that a "one size fits all" delivery of treatment may be inappropriate.…

Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways.

PubMed

Ermisch, Michael; Bucsics, Anna; Vella Bonanno, Patricia; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Fürst, Jurij; Garuolienė, Kristina; van der Graaff, Martin; Gulbinovič, Jolanta; Haycox, Alan; Jones, Jan; Joppi, Roberta; Laius, Ott; Langner, Irene; Martin, Antony P; Markovic-Pekovic, Vanda; McCullagh, Laura; Magnusson, Einar; Nilsen, Ellen; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Sauermann, Robert; Schuurman, Ad; Ramos, Ricardo; Vlahovic-Palcevski, Vera; Zara, Corinne; Godman, Brian

2016-01-01

Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward.

National Health Insurance by Regulation: Mandated Employee Benefits,

DTIC Science & Technology

1980-04-01

A0AO95 050 RANW CORP SANTA MONICA CA F/0 S/I1 NATIONAL HEALTH INSURANCE BY REKULATION: MANDATED EMPLOYEE NE-TC(U) APR 80 C E PI4ELPS LICLASSIFIED...31 ! 9 : I NATIONAL HEALTH INSURANCE BY REGULATION: MANDATED EMPLOYEE BENEFITS 1 I. INTRODUCTION Social issues have often been solved...offer a variety of insurance packages to employees , iThis paper was presented at the Conference on "National Health Insurance: Ihat Now, What Later, What

The demand for health insurance coverage for tobacco dependence treatments: support for a benefit mandate and willingness to pay.

PubMed

Halpin, Helen Ann; McMenamin, Sara B; Shade, Starley B

2007-12-01

One solution for reducing tobacco use is to expand health insurance coverage for tobacco dependence treatments (TDTs), but the public demand for a coverage mandate is unknown. This study finds that demand for coverage of TDTs among a random sample of adult Californians with employer-sponsored health insurance is strong, with 62% indicating that health insurers should be required to offer coverage as part of their standard plans and a majority (56%) indicating a willingness to pay $3 more for their annual health insurance premium to finance cessation coverage. Compared to never smokers, current and former smokers are no more likely to support a benefit mandate to require coverage of cessation treatments, but the adjusted odds are approximately three times greater that current and former smokers are willing to pay $3 more toward their annual premium to finance cessation coverage. Liberals had higher adjusted odds of supporting a benefit mandate and of being willing to pay a higher premium compared to conservatives. Non-whites had higher adjusted odds of supporting a mandate compared to whites, with no differences by race/ethnicity in willingness to pay a higher premium. There were no differences in preferences for a benefit mandate or willingness to pay a higher premium as a function of age, gender or income. These findings have important policy implications for a state health insurance mandate to cover tobacco dependence treatments.

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...

Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

PubMed

Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

2018-05-03

Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018

Discounts and rebates granted to public payers for medicines in European countries

PubMed Central

Vogler, Sabine; Zimmermann, Nina; Habl, Claudia; Piessnegger, Jutta; Bucsics, Anna

2012-01-01

Objective: The objective of this study was to provide an overview about the existence and types of discounts and rebates granted to public payers by the pharmaceutical industry in European countries. Methods: Data were collected via a questionnaire in spring 2011. Officials from public authorities for pharmaceutical pricing and reimbursement represented in the PPRI (Pharmaceutical Pricing and Reimbursement Information) network provided the information and reviewed the compilation. Results: Information is available from 31 European countries. Discounts and rebates granted to public payers by pharmaceutical industry were reported for 25 European countries. Such discounts exist both in the in- and out-patient sectors in 21 countries and in the in-patient sector only in four countries. Six countries reported not having any regulations or agreements regarding the discounts and rebates granted by industry. The most common discounts and rebates are price reductions and refunds linked to sales volume but types such as in-kind support, price-volume and risk-sharing agreements are also in place. A mix of various types of discounts and rebates is common. Many of these arrangements are confidential. Differences regarding types, the organizational and legal framework, validity and frequency of updates and the amount of the discounts and rebates granted exist among the surveyed countries. Conclusions: In Europe, discounts and rebates on medicines granted by pharmaceutical industry to public payers are common tools to contain public pharmaceutical expenditure. They appear to be used as a complimentary measure when price regulation does not achieve the desired results and in the few European countries with no or limited price regulation. The confidential character of many of these arrangements impedes transparency and may lead to a distortion of medicines prices. An analysis of the impact on these measures is recommended. PMID:23093898

Compared to Canadians, U.S. physicians spend nearly four times as much money interacting with payers.

PubMed

Zimmerman, Christina

2011-11-01

(1) In Canadian office practices, physi­cians spent 2.2 hours per week interacting with payers, nurses spent 2.5 hours, and clerical staff spent 15.9 hours. In U.S. practices, physicians spent 3.4 hours per week interacting with payers, nurses spent 20.6 hours, and clerical staff spent 53.1 hours. (2) Canadian physician practices spent $22,205 per physician per year on interactions with health plans. U.S. physician practices spent $82,975 per physician per year. (3) U.S. physician practices spend $60,770 per physician per year more (approximately four times as much) than their Canadian counterparts.

Economic Evaluation of PCSK9 Inhibitors in Reducing Cardiovascular Risk from Health System and Private Payer Perspectives.

PubMed

Arrieta, Alejandro; Page, Timothy F; Veledar, Emir; Nasir, Khurram

2017-01-01

The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9) inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy). From health system perspective, incremental cost per quality adjusted life years (QALYs) gained are presented. From a private payer perspective, return-on-investment and net present values over patient lifespan are presented. At the current annual cost of $14,000 to $15,000, PCSK9 inhibitors are not cost-effective at an incremental cost of about $350,000 per QALY. Moreover, for every dollar invested in PCSK9 inhibitors, the private payer loses $1.98. Our study suggests that the annual treatment price should be set at $4,250 at a societal willingness-to-pay of $100,000 per QALY. However, we estimate the breakeven price for private payer is only $600 per annual treatment. At current prices, our study suggests that PCSK9 inhibitors do not add value to the U.S. health system and their provision is not profitable for private payers. To be the breakthrough drug in the fight against cardiovascular disease, the current price of PCSK9 inhibitors must be reduced by more than 70%.

The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

PubMed

Rocco, Philip; Kelly, Andrew S; Béland, Daniel; Kinane, Michael

2017-02-01

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

Payers' Views of the Changes Arising through the Possible Adoption of Adaptive Pathways

PubMed Central

Ermisch, Michael; Bucsics, Anna; Vella Bonanno, Patricia; Arickx, Francis; Bybau, Alexander; Bochenek, Tomasz; van de Casteele, Marc; Diogene, Eduardo; Fürst, Jurij; Garuolienė, Kristina; van der Graaff, Martin; Gulbinovič, Jolanta; Haycox, Alan; Jones, Jan; Joppi, Roberta; Laius, Ott; Langner, Irene; Martin, Antony P.; Markovic-Pekovic, Vanda; McCullagh, Laura; Magnusson, Einar; Nilsen, Ellen; Selke, Gisbert; Sermet, Catherine; Simoens, Steven; Sauermann, Robert; Schuurman, Ad; Ramos, Ricardo; Vlahovic-Palcevski, Vera; Zara, Corinne; Godman, Brian

2016-01-01

Payers are a major stakeholder in any considerations and initiatives concerning adaptive licensing of new medicinal products, also referred to as Medicines Adaptive Pathways to patients (MAPPs). Firstly, the scope and necessity of MAPPs need further scrutiny, especially with regard to the definition of unmet need. Conditional approval pathways already exist for new medicines for seriously debilitating or life-threatening diseases and only a limited number of new medicines are innovative. Secondly, MAPPs will result in new medicines on the market with limited evidence about their effectiveness and safety. Additional data are to be collected after approval. Consequently, adaptive pathways may increase the risk of exposing patients to ineffective or unsafe medicines. We have already seen medicines approved conventionally that subsequently proved ineffective or unsafe amongst a wider, more co-morbid population as well as medicines that could have been considered for approval under MAPPs but subsequently proved ineffective or unsafe in Phase III trials and were never licensed. Thirdly, MAPPs also put high demands on payers. Routine collection of patient level data is difficult with high transaction costs. It is not clear who will fund these. Other challenges for payers include shifts in the risk governance framework, implications for evaluation and HTA, increased complexity of setting prices, difficulty with ensuring equity in the allocation of resources, definition of responsibility and liability and implementation of stratified use. Exit strategies also need to be agreed in advance, including price reductions, rebates, or reimbursement withdrawals when price premiums are not justified. These issues and concerns will be discussed in detail including potential ways forward. PMID:27733828

Mandate-Based Health Reform and the Labor Market: Evidence from the Massachusetts Reform*

PubMed Central

Kolstad, Jonathan T.; Kowalski, Amanda E.

2016-01-01

We model the labor market impact of the key provisions of the national and Massachusetts “mandate-based” health reforms: individual mandates, employer mandates, and subsidies. We characterize the compensating differential for employer-sponsored health insurance (ESHI) and the welfare impact of reform in terms of “sufficient statistics.” We compare welfare under mandate-based reform to welfare in a counterfactual world where individuals do not value ESHI. Relying on the Massachusetts reform, we find that jobs with ESHI pay $2,812 less annually, somewhat less than the cost of ESHI to employers. Accordingly, the deadweight loss of mandate-based health reform was approximately 8 percent of its potential size. PMID:27037897

Proposed Strategic Mandates for Ontario Universities: An Organizational Theory Perspective

ERIC Educational Resources Information Center

Buzzelli, Michael; Allison, Derek J.

2017-01-01

This paper presents an empirical analysis of the Ontario-led strategic mandate agreement (SMA) planning exercise. Focusing on the self-generated strategic mandates of five universities (McMaster, Ottawa, Queen's, Toronto, and Western), we asked how universities responded to this exercise of strategic visioning? The answer to this question is…

Perils of Current Testing Mandates

ERIC Educational Resources Information Center

Petress, Ken

2006-01-01

Mandated testing is not working as advertised. Too much classroom time and energy is being spent on tests that do little to measure or instill in our students the skills and knowledge needed for their later life. Corruption and political manipulation of the testing process and test results further add to questions about the use of such testing.…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-11

... [CMS-6061-ANPRM] RIN 0938-AR88 Medicare Program; Medicare Secondary Payer and Certain Civil Money... practices for which civil money penalties (CMPs) may or may not be imposed for failure to comply with...-3951. I. Background A. Imposition of Civil Money Penalties (CMPs) In 1981, the Congress added section...

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

PubMed

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

2016-08-01

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

Impact of Virginia's School-Entry Vaccine Mandate on Human Papillomavirus Vaccination Among 13-17-Year-Old Females.

PubMed

Pierre-Victor, Dudith; Page, Timothy F; Trepka, Mary Jo; Stephens, Dionne P; Li, Tan; Madhivanan, Purnima

2017-03-01

The link between human papillomavirus (HPV) and anogenital cancers is well established in the literature. Many states have passed laws requiring funding for HPV education or vaccination. Mandatory HPV vaccination policies have been considered and passed in several states; yet their effectiveness has not been evaluated. This study sought to assess the impact of Virginia's HPV vaccine mandate for school-entry on HPV vaccine uptake among females aged 13-17 years. Data from the National Immunization Survey-Teen for the 2008-2012 period were used, and 3,203 adolescent females were included in the analysis. We performed difference-in-differences estimation and logistic regression with a policy and period interaction term. Virginia was considered the treatment state, and South Carolina and Tennessee were the comparison states to account for nonpolicy factors that may have affected vaccination rates during the time period considered in the analysis. There was no evidence of an effect of Virginia's HPV vaccine mandate for school-entry on vaccination rates or on physician vaccination recommendation using either the difference-by-differences analysis or the policy and period interaction term in the logistic regression. Physician recommendation was the factor most strongly associated with vaccination in the Virginia-South Carolina analysis (adjusted odds ratio [aOR] = 9.33; 95% confidence interval [CI]: 6.11-14.3) and in the Virginia-Tennessee analysis (aOR = 9.33; 95% CI: 6.11-14.3). Study findings suggest that Virginia's HPV vaccine mandate for school-entry did not lead to a significant increase in HPV vaccination among adolescent females or physician recommendations. However, physician recommendation was the factor most strongly associated with vaccination.

Outcome and cost of trauma among the elderly: a real-life model of a single-payer reimbursement system.

PubMed

Young, J S; Cephas, G A; Blow, O

1998-10-01

As our population ages, the number of elderly trauma patients (age > or = 65 years) increases. Studies have demonstrated increased mortality and cost for a given injury severity in the elderly compared with younger patients. The financial viability of trauma centers in the United States has been an area of concern for many years. As reimbursement diminishes for privately insured patients, the ability to finance the care of the indigent is jeopardized. Medicare, the single-payer insurance plan for the elderly, reimburses at a lower rate than standard private insurance carriers. We examined the differences in outcome and cost between the elderly and younger patients and the financial burden imposed by care for elderly trauma. Our hypothesis was that elderly trauma patients would have poorer outcomes, higher cost, and generate greater financial losses than younger patients. All patients admitted to the University of Virginia Trauma Service from July 1, 1994, to July 1, 1997 were included. Trauma registry and patients records were examined. Patients with incomplete financial data (cost, reimbursement, and payer source) were excluded. Patients were grouped by age (18-64 and > or =65 years), Injury Severity Score, and payer source. One thousand one hundred twenty-seven patients met the entry criteria. One hundred forty patients had incomplete financial or patient data and were excluded. Nine hundred eighty-seven patients were included in the study, of which 159 were elderly and 828 were 18 to 64 years of age. Injury Severity Scores were significantly higher in the elderly group. Only 2% of elderly patients were uninsured (76% were insured by Medicare), whereas 25% of younger patients were uninsured. Medicare reimbursement rates actually exceeded those of all other carriers (114% of costs). Elderly patients had a higher mortality rate, but the z score did not reach significance. The W score, however, indicated that there were more unexpected, negative outcomes among

An economic model: value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections.

PubMed

Singh, Ashima; Bartsch, Sarah M; Muder, Robert R; Lee, Bruce Y

2014-08-01

While the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined. Using TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%-20%), the cost of triclosan-coated sutures (range, $5-$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%-50%) to highlight the range of costs associated with using such sutures. Triclosan-coated sutures saved $4,109-$13,975 (hospital perspective), $4,133-$14,297 (third-party payer perspective), and $40,127-$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%). Our results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.

Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

PubMed Central

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

2014-01-01

Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

PubMed

Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

2007-01-15

Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

The Effect of Formulary Restrictions on Patient and Payer Outcomes: A Systematic Literature Review.

PubMed

Park, Yujin; Raza, Syed; George, Aneesh; Agrawal, Rumjhum; Ko, John

2017-08-01

Formulary restrictions are implemented to reduce pharmacy costs and ensure appropriate use of pharmaceutical products. As adoption of formulary restrictions increases with rising pharmacy costs, there is a need to better understand the potential effect of formulary restrictions on patient and payer outcomes. To conduct a systematic literature review that assesses the effect of formulary restrictions on the following outcomes: medication adherence, clinical outcomes, treatment satisfaction, drug utilization, health care resource utilization, and economic outcomes. Studies published in 2005 or later were identified from the MEDLINE, Embase, and Cochrane databases and the National Health Service Economic Evaluation Database, using 2 sets of search terms. A total of 17 formulary restriction terms (e.g., step therapy [ST] and prior authorization [PA]) and 55 outcome terms were included, resulting in 935 unique search term combinations. Two reviewers independently conducted analyses of the titles, abstracts, and full-text articles. The search was limited to English-language articles that evaluated the effect of ST and/or PA placed by U.S. third-party payers on the following outcomes: patient outcomes (medication adherence, clinical outcomes, and treatment satisfaction) and payer outcomes (drug utilization, health care resource utilization, and economic outcomes). Of 2,321 reviewed articles, 59 articles met the study inclusion criteria. The included studies assessed the effect of ST (n = 18), PA (n = 35), or both (n = 6) on medication adherence (n = 14), clinical outcomes (n = 12), treatment satisfaction (n = 2), drug utilization (n = 39), health care resource utilization (n = 18), and economic outcomes (n = 42). The 59 articles measured 164 outcomes across the patient, health care resource utilization, and economic outcome categories of interest. Of the total number of outcomes, 50.6% (n = 83) were negative in direction or were unfavorable, whereas 40.2% (n = 66) were

Implementing a Statewide Mandated Career Pathways/Programs of Study School Reform Model: Select Findings from a Multisite Case Study

ERIC Educational Resources Information Center

Withington, Cairen; Hammond, Cathy; Mobley, Catherine; Stipanovic, Natalie; Sharp, Julia L.; Stringfield, Sam; Drew, Sam F., Jr.

2012-01-01

"A Longitudinal Study of the South Carolina Personal Pathways to Success Initiative" (see Hammond, Drew, et al., 2011) follows the implementation of a statewide mandated career-focused school reform policy in one U.S. state. The research focuses on eight diverse high schools in the state, personnel at those schools, and approximately…

Summer Versus School-Year Alcohol Use Among Mandated College Students.

PubMed

Miller, Mary Beth; Merrill, Jennifer E; Yurasek, Ali M; Mastroleo, Nadine R; Borsari, Brian

2016-01-01

Longitudinal research examining college students' alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students' alcohol use and related consequences over the summer. Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer. Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants' tendency to live at home. Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations.

The need for and cost of mandating private insurance coverage of contraception.

PubMed

Gold, R B

1998-08-01

A public policy debate in the US is considering whether it is in the public interest to mandate that private, employment-related health insurance plans cover contraception. Industry representatives oppose mandates as unnecessary and costly, but women's health advocates point out that mandates were necessary to remove other health insurance disadvantages to women. For example, the Pregnancy Discrimination Act of 1978 was necessary to mandate coverage for maternity care. US women rely on contraception to avoid pregnancy for approximately 20 years during their reproductive lives, but health insurance policies vary widely in the amount of contraceptive coverage provided. Some fail to cover contraception but cover sterilization and abortion. Coverage is important because women cite cost as a consideration when choosing a method, and some of the more effective methods are more costly. Estimates show that the cost of covering the full range of approved reversible contraception would be a minimal $21.40/employee/year, of which employers would pay $17.12, a 0.6% increase in costs. The cost of plans that already cover some reversible methods would increase even less. Public opinion overwhelmingly favors mandated contraception coverage, even if employee costs were to increase. Congress is considering legislation to mandate coverage in private, employment-related plans, and the industry has indicated that it will not fight the legislation.

Health Reform and the Constitutionality of the Individual Mandate

PubMed Central

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

2012-01-01

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

Heterogeneity and the Effect of Mental Health Parity Mandates on the Labor Market*

PubMed Central

Andersen, Martin

2015-01-01

Health insurance benefit mandates are believed to have adverse effects on the labor market, but efforts to document such effects for mental health parity mandates have had limited success. I show that one reason for this failure is that the association between parity mandates and labor market outcomes vary with mental distress. Accounting for this heterogeneity, I find adverse labor market effects for non-distressed individuals, but favorable effects for moderately distressed individuals and individuals with a moderately distressed family member. On net, I conclude that the mandates are welfare increasing for moderately distressed workers and their families, but may be welfare decreasing for non-distressed individuals. PMID:26210944

The Dragon in School Backyards: The Influence of Mandated Testing on School Contexts and Educators' Narrative Knowing

ERIC Educational Resources Information Center

Craig, Cheryl J.

2004-01-01

Researched in the narrative inquiry tradition, this article examines the influence of state-mandated accountability testing on Eagle High School's dramatically shifting context and the embodied knowledge held and expressed by principal, Henry Richards, and the Eagle teachers. Through carefully unpacking Richards's dragon in school backyards…

Stress, Burnout and Reform Mandated Accountability.

ERIC Educational Resources Information Center

Lutz, Frank W.; Maddirala, James

A mail questionnaire study involving 3,000 Texas educators was undertaken to describe the effects of certain Texas education reform policies as they relate to teacher burnout. Focus was on determining how the production of teacher-required paperwork and mandated student achievement testing influence teacher burnout. An initial mailing resulted in…

Postintroduction Study of Cost Effectiveness of Pneumococcal Vaccine PCV10 from Public Sector Payer's Perspective in the State of Santa Catarina, Brazil.

PubMed

Kupek, Emil; Viertel, Ilse

2018-05-14

To evaluate cost effectiveness of 10-valent pneumococcal conjugate vaccine in the routine immunization program for children younger than 5 years in Brazil by a postintroduction study. Ecological study of prevaccine (2006-2009) versus postvaccine (2011-2014) period related the changes in mortality rate and hospitalization rate to direct cost of pneumonia treatment from the payer's perspective to estimate the cost effectiveness regarding lives saved, life-years gained, and disability-adjusted life-year for children younger than 5 years in the southern Brazilian state of Santa Catarina. All-cause pneumonia (ICD-10 J12-J18) deaths, hospital admissions, and associated costs were retrieved from the Brazilian Ministry of Health official Web site. Life expectancy at birth, population, ambulatory costs, cost savings, and plausible range of these parameters were used from published sources. Computer simulations with sensitivity analysis were performed to obtain the cost-effectiveness estimates. About 27 lives were saved and 2573 hospitalizations averted by the 10-valent pneumococcal conjugate vaccine vaccination in the 2011 to 2014 period at the cost of US $24,348 per life-year gained and US $27,748 per disability-adjusted life-year. The latter cost is 81% of Brazilian gross domestic product per capita over the same period. The vaccine was very cost-effective according to the World Health Organization criterion. Copyright © 2018. Published by Elsevier Inc.

Heterogeneity and the effect of mental health parity mandates on the labor market.

PubMed

Andersen, Martin

2015-09-01

Health insurance benefit mandates are believed to have adverse effects on the labor market, but efforts to document such effects for mental health parity mandates have had limited success. I show that one reason for this failure is that the association between parity mandates and labor market outcomes vary with mental distress. Accounting for this heterogeneity, I find adverse labor market effects for non-distressed individuals, but favorable effects for moderately distressed individuals and individuals with a moderately distressed family member. On net, I conclude that the mandates are welfare increasing for moderately distressed workers and their families, but may be welfare decreasing for non-distressed individuals. Copyright © 2015 Elsevier B.V. All rights reserved.

Summer Versus School-Year Alcohol Use Among Mandated College Students

PubMed Central

Miller, Mary Beth; Merrill, Jennifer E.; Yurasek, Ali M.; Mastroleo, Nadine R.; Borsari, Brian

2016-01-01

Objective: Longitudinal research examining college students’ alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students’ alcohol use and related consequences over the summer. Method: Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer. Results: Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants’ tendency to live at home. Conclusions: Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations. PMID:26751354

Mandated Supervision: An Intervention for Disciplined Professionals

ERIC Educational Resources Information Center

Cobia, Debra C.; Pipes, Randolph B.

2002-01-01

Mandated supervision with disciplined mental health professionals is defined and discussed. In the absence of empirical support for supervision in this context, sources of theoretical support are provided. Risks, benefits, and implications for practice for supervisors are also discussed.

17 CFR 232.100 - Persons and entities subject to mandated electronic filing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to mandated electronic filing. 232.100 Section 232.100 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.100 Persons and entities subject to mandated electronic filing. The following...

17 CFR 232.100 - Persons and entities subject to mandated electronic filing.

Code of Federal Regulations, 2012 CFR

2012-04-01

... to mandated electronic filing. 232.100 Section 232.100 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.100 Persons and entities subject to mandated electronic filing. The following...

17 CFR 232.100 - Persons and entities subject to mandated electronic filing.

Code of Federal Regulations, 2013 CFR

2013-04-01

... to mandated electronic filing. 232.100 Section 232.100 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.100 Persons and entities subject to mandated electronic filing. The following...

17 CFR 232.100 - Persons and entities subject to mandated electronic filing.

Code of Federal Regulations, 2014 CFR

2014-04-01

... to mandated electronic filing. 232.100 Section 232.100 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.100 Persons and entities subject to mandated electronic filing. The following...

17 CFR 232.100 - Persons and entities subject to mandated electronic filing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to mandated electronic filing. 232.100 Section 232.100 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Electronic Filing Requirements § 232.100 Persons and entities subject to mandated electronic filing. The following...

Accreditation of ambulatory facilities.

PubMed

Urman, Richard D; Philip, Beverly K

2014-06-01

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

Performance-Based Risk-Sharing Arrangements: U.S. Payer Experience.

PubMed

Goble, Joseph A; Ung, Brian; van Boemmel-Wegmann, Sascha; Navarro, Robert P; Parece, Andrew

2017-10-01

As a result of global concern about rising drug costs, many U.S. payers and European agencies such as the National Health Service have partnered with pharmaceutical companies in performance-based risk-sharing arrangements (PBRSAs) by which manufacturers share financial risk with health care purchasing entities and authorities. However, PBRSAs present many administrative and legal challenges that have minimized successful contract experiences in the United States. To (a) identify drug and disease characteristics and contract components that contribute to successful PBRSA experiences and the primary barriers to PBRSA execution and (b) explore solutions to facilitate contract negotiation and execution. A 37-item, web-based survey instrument (Qualtrics), approximately 20 minutes in duration, was open during July and August 2016. The survey was emailed to 90 pharmacy and medical directors of various health care organizations. Statistical analysis included the Kruskal-Wallis test and chi-square tests to examine differences among payer responses. Survey responses were anonymized and data were aggregated. Twenty-seven individuals completed the survey (30% completion rate). The majority of respondents worked for regional health plans (52%, n = 14), covering at least 1 million lives (63%, n = 17), with at least 7 years of managed care experience (81%, n = 22). A total of 51 PBRSAs were active among respondents at the time of the survey. Easily obtainable and evaluable drug data and medical data were the most important drug and disease attributes for successful PBRSAs, respectively. Pharmacy claims and patient demographic data were assessed as "very easy and inexpensive" to collect. Type and amount of manufacturer payment for drug outcome performance failure, endpoint measurement, and necessary clinical data for drug performance measurement were all critical factors for successful PBRSAs. Standardized contract templates and transparent contract financial risk evaluation and

Cost-effectiveness analysis of allopurinol versus febuxostat in chronic gout patients: a U.S. payer perspective.

PubMed

Gandhi, Pranav K; Gentry, William M; Ma, Qinli; Bottorff, Michael B

2015-02-01

Gout is a chronic inflammatory condition associated with poor urate metabolism. Xanthine oxidase inhibitors such as allopurinol and febuxostat are recommended to reduce uric acid levels and to prevent gout attacks in adult patients. Under budget-driven constraints, health care payers are faced with the broader challenge of assessing the economic value of these agents for formulary placement. However, the economic value of allopurinol versus febuxostat has not be assessed in patients with gout over a 5-year time period in the United States. To evaluate the cost-effectiveness of allopurinol versus febuxostat in adult patients with gout over a 5-year time period from a U.S. health care payer's perspective. A Markov model was developed to compare the total direct costs and success of serum uric acid (sUA) level reduction associated with allopurinol and febuxostat. Treatment success was defined as patient achievement of a sUA level less than  6 mg/dL (0.36 mmol/L) at 6 months. Event probabilities were based on published phase III randomized clinical trials and included long-term sequelae from open-label extension studies. A hypothetical cohort of 1,000 adult gout patients with sUA levels of ≥ 8 mg/dL (0.48 mmol/L) who had received either allopurinol 300 mg or febuxostat 80 mg at model entry transitioned among the 4 health states defined by treatment success, treatment failure and switch, treatment dropout, and death. The length of each Markov cycle was 6 months. Costs were gathered from the RED BOOK, Medicare fee schedules, Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, and for a limited number of inputs, expert consultation. Direct costs included treatment drug costs, costs for prophylaxis drugs, diagnostic laboratory tests, and the treatment and management of acute gout flare. Resource utilization was based on clinical evidence and expert consultation. All costs were inflated to 2014 U.S. dollars and were discounted at 3% in the base case

Underinvestment in Employer Training: A Mandate to Spend? Invited Reaction: Employer Training--Is a Mandated Tax the Only Solution?

ERIC Educational Resources Information Center

Bishop, John H.; Lynch, Lisa M.

1993-01-01

Using the example of France, Bishop recommends a U.S. training mandate involving a training tax and incentives. Lynch argues that a broader array of options is needed to meet the training needs of new workers, displaced workers, and the unemployed. (SK)

Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment.

PubMed

Weisner, Constance; Lu, Yun; Hinman, Agatha; Monahan, John; Bonnie, Richard J; Moore, Charles D; Chi, Felicia W; Appelbaum, Paul S

2009-05-01

This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.

Adoption and implementation of mandated diabetes registries by community health centers.

PubMed

Helfrich, Christian D; Savitz, Lucy A; Swiger, Kathleen D; Weiner, Bryan J

2007-07-01

Innovations adopted by healthcare organizations are often externally mandated. However, few studies examine how mandated innovations progress from adoption to sustained effective use. This study uses Rogers's model of organizational innovation to explore community health centers' (CHCs') mandated adoption and implementation of disease registries in the federal Health Disparities Collaborative (HDC). Case studies were conducted on six CHCs in North Carolina participating in the HDC on type 2 diabetes mellitus. Data were collected from semistructured interviews with key staff, and from site-level and individual-level surveys. Although disease registry adoption and implementation were mandated, CHCs exercised prerogative in the timing of registry adoption and the functions emphasized. Executive and medical director involvement, often directly on the HDC teams, was the single most salient influence on adoption and implementation. Staff members' personal experience with diabetes also provided context and gave registries added significance. Participants lauded HDC's technique of small-scale, rapid-cycle change, but valued even more shared problem solving and peer learning among HDC teams. However, lack of cross-training, inadequate resources, and staff turnover posed serious threats to sustainability of the registries. The present study illustrates the usefulness of Rogers's model for studying mandated innovation and highlights several key factors, including direct, personal involvement of organizational leadership, and shared problem solving and peer learning facilitated by the HDC. However, these six CHCs elected to participate early in the HDC, and may not be typical of North Carolina's remaining CHCs. Furthermore, most face important long-term challenges that threaten routinization.

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders.

PubMed

Clark, Colleen; Young, M Scott

2009-12-01

Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related symptoms, and substance use outcomes. Women did better with integrated treatment and with mandated treatment regardless of treatment condition for psychiatric, trauma, and substance use outcomes at both follow-ups. Further research clarifying unintended side effects and change mechanisms of mandated treatment is needed to inform policy decisions.

The CTSA mandate: are we there yet?

PubMed

Sampselle, Carolyn M; Pienta, Kenneth J; Markel, Dorene S

2010-01-01

The ultimate aim of the National Institutes of Health Clinical and Translational Science Award (CTSA) initiative is to accelerate the movement of discoveries that can benefit human health into widespread public use. To accomplish this translational mandate, the contributions of multiple disciplines, such as dentistry, nursing, pharmacy, public health, biostatistics, epidemiology, and bioengineering, are required in addition to medicine. The research community is also mandated to establish new partnerships with organized patient communities and front line health care providers to assure the bidirectional flow of information in order that health priorities experienced by the community inform the research agenda. This article summarizes current clinical research directives, the experience of the University of Michigan faculty during the first 2 years of CTSA support, and recommendations to enhance the effectiveness of future CTSA as well as other interdisciplinary initiatives. While the manuscript focuses most closely on the CTSA Community Engagement mission, the challenges to interdisciplinarity and bidirectionality extend beyond the focus of community engagement.

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

PubMed Central

Weisner, Constance; Lu, Yun; Hinman, Agatha; Monahan, John; Bonnie, Richard J.; Moore, Charles D.; Chi, Felicia W.; Appelbaum, Paul S.

2010-01-01

Objective This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. Methods The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Results Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Conclusions Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence. PMID:19411353

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

PubMed Central

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

2014-01-01

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

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

PubMed

Chaufan, Claudia

2015-01-01

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

Using Certification to Promote Uptake of Real-World Evidence by Payers.

PubMed

Segal, Jodi B; Kallich, Joel D; Oppenheim, Emma R; Garrison, Louis P; Iqbal, Sheikh Usman; Kessler, Marla; Alexander, G Caleb

2016-03-01

Most randomized controlled trials are unable to generate information about a product's real-world effectiveness. Therefore, payers use real-world evidence (RWE) generated in observational studies to make decisions regarding formulary inclusion and coverage. While some payers generate their own RWE, most cautiously rely on RWE produced by manufacturers who have a strong financial interest in obtaining coverage for their products. We propose a process by which an independent body would certify observational studies as generating valid and unbiased estimates of the effectiveness of the intervention under consideration. This proposed process includes (a) establishing transparent criteria for assessment, (b) implementing a process for receipt and review of observational study protocols from interested parties, (c) reviewing the submitted protocol and requesting any necessary revisions, (d) reviewing the study results, (e) assigning a certification status to the submitted evidence, and (f) communicating the certification status to all who seek to use this evidence for decision making. Accrediting organizations such as the National Center for Quality Assurance and the Joint Commission have comparable goals of providing assurance about quality to those who look to their accreditation results. Although we recognize potential barriers, including a slowing of evidence generation and costs, we anticipate that processes can be streamlined, such as when familiar methods or familiar datasets are used. The financial backing for such activities remains uncertain, as does identification of organizations that might serve this certification function. We suggest that the rigor and transparency that will be required with such a process, and the unassailable evidence that it will produce, will be valuable to decision makers.

Evaluation of a Congressionally Mandated Wraparound Demonstration

ERIC Educational Resources Information Center

Bickman, Leonard; Smith, Catherine M.; Lambert, E. Warren; Andrade, Ana Regina

2003-01-01

In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the…

Maternal employment, breastfeeding, and health: evidence from maternity leave mandates.

PubMed

Baker, Michael; Milligan, Kevin

2008-07-01

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. We also look for impacts of the reform on self-reported indicators of maternal and child health captured in our data. For most indicators we find no effect.

A Comparison of Mandated Versus Volunteer Adolescent Participants in Youth Tobacco Cessation Programs

PubMed Central

Houser-Marko, Linda; Curry, Susan J.; Mermelstein, Robin J.; Emery, Sherry; Pugach, Oksana

2012-01-01

A national evaluation of community-based youth cessation programs delivered in group format provided the opportunity to compare mandated and volunteer program participants on demographics, smoking patterns, other health behaviors and motivation to quit. A total of 857 youth participants completed surveys prior to the start of their treatment program. Mandated youth comprised 24% of the sample (n=202). Both bivariate and multivariate comparisons were conducted. Mandated participants reported lower levels of stress, higher extrinsic motivation and lower intrinsic motivation to quit, and were more likely to be in the earlier (precontemplation) stage of readiness to quit. Mandated and volunteer smokers did not differ in their smoking patterns, school-related smoking behaviors, or binge drinking. Rates of smoking, school problems, and binge drinking were higher among cessation program participants than in general samples of youth. Programs with mixed voluntary-mandatory participation may benefit from extra attention to motivational issues. PMID:21550728

Diffracting Mandates for Reflective Practices in Teacher Education and Development: Multiple Readings from Australia, New Zealand, and the United States

ERIC Educational Resources Information Center

Myers, Casey Y.; Smith, Kylie A.; Tesar, Marek

2017-01-01

Despite the ubiquity of reflective practice in education, mandating reflective processes within sanctioned frameworks is inherently problematic, as it may lead to reproduction, standardization, and forced universalities, rather than the critical and innovative pedagogy they intend. This article engages with reflection through both the metaphor and…

The impact of maternity length-of-stay mandates on the labor market and insurance coverage.

PubMed

Sabik, Lindsay M; Laugesen, Miriam J

2012-01-01

To understand the effects of insurance regulation on the labor market and insurance coverage, this study uses a difference-in-difference-in-differences analysis to compare five states that passed minimum maternity length-of-stay laws with states that waited until after a federal law was passed. On average, we do not find statistically significant effects on labor market outcomes such as hours of work and wages. However, we find that employees of small firms in states with maternity length-of-stay mandates experienced a 6.2-percentage-point decline in the likelihood of having employer-sponsored insurance. Implementation of federal health reform that requires minimum benefit standards should consider the implications for firms of differing sizes.

Private sector risk-sharing agreements in the United States: trends, barriers, and prospects.

PubMed

Garrison, Louis P; Carlson, Josh J; Bajaj, Preeti S; Towse, Adrian; Neumann, Peter J; Sullivan, Sean D; Westrich, Kimberly; Dubois, Robert W

2015-09-01

Risk-sharing agreements (RSAs) between drug manufacturers and payers link coverage and reimbursement to real-world performance or utilization of medical products. These arrangements have garnered considerable attention in recent years. However, greater use outside the United States raises questions as to why their use has been limited in the US private sector, and whether their use might increase in the evolving US healthcare system. To understand current trends, success factors, and challenges in the use of RSAs, we conducted a review of RSAs, interviews, and a survey to understand key stakeholders' experiences and expectations for RSAs in the US private sector. Trends in the numbers of RSAs were assessed using a database of RSAs. We also conducted in-depth interviews with stakeholders from pharmaceutical companies, payer organizations, and industry experts in the United States and European Union. In addition, we administered an online survey with a broader audience to identify perceptions of the future of RSAs in the United States. Most manufacturers and payers expressed interest in RSAs and see potential value in their use. Due to numerous barriers associated with outcomes-based agreements, stakeholders were more optimistic about financial-based RSAs. In the US private sector, however, there remains considerable interest--improved data systems and shifting incentives (via health reform and accountable care organizations) may generate more action. In the US commercial payer markets, there is continued interest among some manufacturers and payers in outcomes-based RSAs. Despite continued discussion and activity, the number of new agreements is still small.

Patient Experience with the Patient-Centered Medical Home in Michigan's Statewide Multi-Payer Demonstration: A Cross-Sectional Study.

PubMed

Sarinopoulos, Issidoros; Bechel-Marriott, Diane L; Malouin, Jean M; Zhai, Shaohui; Forney, Jason C; Tanner, Clare L

2017-11-01

The literature on patient-centered medical homes (PCMHs) and patient experience is somewhat mixed. Government and private payers are promoting multi-payer PCMH initiatives to align requirements and resources and to enhance practice transformation outcomes. To this end, the multipayer Michigan Primary Care Transformation (MiPCT) demonstration project was carried out. To examine whether the PCMH is associated with a better patient experience, and whether a mature, multi-payer PCMH demonstration is associated with even further improvement in the patient experience. This is a cross-sectional comparison of adults attributed to MiPCT PCMH, non-participating PCMH, and non-PCMH practices, statistically controlling for potential confounders, and conducted among both general and high-risk patient samples. Responses came from 3893 patients in the general population and 4605 in the high-risk population (response rates of 31.8% and 34.1%, respectively). The Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey, with PCMH supplemental questions, was administered in January and February 2015. MiPCT general and high-risk patients reported a significantly better experience than non-PCMH patients in most domains. Adjusted mean differences were as follows: access (0.35**, 0.36***), communication (0.19*, 0.18*), and coordination (0.33**, 0.35***), respectively (on a 10-point scale, with significance indicated by: *= p<0.05, **= p<0.01, and ***= p<0.001). Adjusted mean differences in overall provider ratings were not significant. Global odds ratios were significant for the domains of self-management support (1.38**, 1.41***) and comprehensiveness (1.67***, 1.61***). Non-participating PCMH ratings fell between MiPCT and non-PCMH across all domains and populations, sometimes attaining statistical significance. PCMH practices have more positive patient experiences across domains characteristic of advanced primary care. A mature multi-payer model has the

A comparison of mandated versus volunteer adolescent participants in youth tobacco cessation programs.

PubMed

Houser-Marko, Linda; Curry, Susan J; Mermelstein, Robin J; Emery, Sherry; Pugach, Oksana

2011-09-01

A national evaluation of community-based youth cessation programs delivered in group format provided the opportunity to compare mandated and volunteer program participants on demographics, smoking patterns, other health behaviors and motivation to quit. A total of 857 youth participants completed surveys prior to the start of their treatment program. Mandated youth comprised 24% of the sample (n=202). Both bivariate and multivariate comparisons were conducted. Mandated participants reported lower levels of stress, higher extrinsic motivation and lower intrinsic motivation to quit, and were more likely to be in the earlier (precontemplation) stage of readiness to quit. Mandated and volunteer smokers did not differ in their smoking patterns, school-related smoking behaviors, or binge drinking. Rates of smoking, school problems, and binge drinking were higher among cessation program participants than in general samples of youth. Programs with mixed voluntary-mandatory participation may benefit from extra attention to motivational issues. Copyright © 2011 Elsevier Ltd. All rights reserved.

Did the Affordable Care Act's dependent coverage mandate increase premiums?

PubMed

Depew, Briggs; Bailey, James

2015-05-01

We investigate the impact of the Affordable Care Act's dependent coverage mandate on insurance premiums. The expansion of dependent coverage under the ACA allows young adults to remain on their parent's private health insurance plans until the age of 26. We find that the mandate has led to a 2.5-2.8 percent increase in premiums for health insurance plans that cover children, relative to single-coverage plans. We are able to conclude that employers did not pass on the entire premium increase to employees through higher required plan contributions. Copyright © 2015 Elsevier B.V. All rights reserved.

Local mandate improves equity of paid sick leave coverage: Seattle's experience.

PubMed

Romich, Jennifer L

2017-01-11

Paid sick leave allows workers to take time off work for personal or family health needs, improving health and potentially limiting infectious diseases. The U.S. has no national sick leave mandate, and many American workers - particularly those at lower income levels - have no right to paid time off for their own or family members' health needs. This article reports on outcomes of a local mandate, the City of Seattle Paid Sick and Safe Time Ordinance, which requires certain employers to provide paid sick leave to eligible workers. Survey collectors contacted a stratified random sample of Seattle employers before the Ordinance went into effect and one year later. Pre- and post- analysis draws on responses to survey items by 345 employers who were subject to the paid sick leave mandate. Awareness of the policy and provision of paid leave grew significantly over the year after the Ordinance was enacted. More employers offered leave to full-time workers (80.8 to 93.9%, p < .001) and part-time workers (47.1 to 66.7%, p < .001) with particularly large increases in the hospitality sector, which includes food workers (coverage of any hospitality employee: 27.5 to 85.0%, p < .001). Absent a federal policy, local paid sick time mandates can increase paid sick leave coverage, an important social determinant of health.

The economic consequences of generic substitution for antiepileptic drugs in a public payer setting: the case of lamotrigine.

PubMed

Duh, Mei Sheng; Andermann, Frederick; Paradis, Pierre Emmanuel; Weiner, Jennifer; Manjunath, Ranjani; Crémieux, Pierre-Yves

2007-08-01

Generic substitution of antiepileptic drugs (AEDs) may increase pharmacy utilization, thus counterbalancing per-pill savings. The purpose of our study was to analyze the economic impact of government-mandated switching from branded to generic lamotrigine. Patients in a Canadian public pharmacy claims database using branded lamotrigine (Lamictal GlaxoSmithKline, UK) in 2002 converted to generic lamotrigine in 2003 and were observed from July 2002 to March 2006. Patients used branded lamotrigine for >or=90 days pre-generic entry and had >or=1 claim for generic lamotrigine post-generic entry. For the generic period, observed per-patient monthly drug costs were calculated as the sum of costs for lamotrigine, other AEDs, and non-AEDs. Expected per-patient drug costs were estimated assuming lamotrigine dose and other prescription drug utilization in the generic period were identical to those observed during the brand period. Differences between observed and expected costs were compared. Among 1,142 branded lamotrigine users, overall average monthly drug costs per person were expected to decrease by $30.55 due to lower pill costs. Instead, they fell by $11.98 from the brand to the generic periods (p < 0.001). Because of dosage changes, lamotrigine costs decreased by $29.92 instead of the anticipated $33.87 (p < 0.001). Increased pharmacy utilization caused other AED costs to rise by $6.29 versus the expected $0.36 (p < 0.001), while non-AED drug cost increased by $11.64 rather than by $2.95 (p < 0.001). We concluded that conversion to generic lamotrigine resulted in lower than expected cost savings. Further research is necessary to determine whether this is due to reduced effectiveness and/or tolerability. Payers may weigh smaller-than-expected cost reductions against a possible decrease in effectiveness to assess the relevance of mandatory generic switching of lamotrigine.

Understanding Teacher Relationships during a Mandated Reform.

ERIC Educational Resources Information Center

Gremillion, Joan; Cody, Caroline B.

This study explored the social world of one school, looked at the web of relationships, and documented the social interactions that occurred in the context of a mandated reform. The study was designed to describe and understand the relationships of teachers in one school as they planned and developed a school-wide strategy for change as required…

Race, Medicine, and Colonial Rule in the Mandated Territory of New Guinea.

PubMed

Cameron-Smith, Alexander

2013-01-01

Public health in the Mandated Territory of New Guinea shared characteristics with regimes in other colonial territories. The protection of European health and ensuring a supply of efficient indigenous labour were the principle aims of the public health regime. Measures to control infectious disease focused on racial segregation of urban spaces, surveillance, and control of indigenous mobility. Yet, if the mandate did not systemically encourage projects in preventive health and social medicine, wider public engagement with the international discourse of indigenous welfare and uplift surrounding it at times shaped colonial administration indirectly. One Director of Public Health in New Guinea, Raphael Cilento, invoked the terms of the mandate during acrimonious debates over nutrition in the 1920s that led to significant changes to rations included in the Native Labour Ordinance.

Do U.S. research institutions meet or exceed federal mandates for instruction in responsible conduct of research? A national survey.

PubMed

Resnik, David B; Dinse, Gregg E

2012-09-01

To explore the extent to which U.S. research institutions are meeting or exceeding National Institutes of Health and National Science Foundation mandates to provide instruction in responsible conduct of research (RCR). In summer 2011, the authors sent an e-mail survey to officials responsible for overseeing RCR instructional programs at the 200 top-funded research institutions in the United States and Puerto Rico. They cross-classified the proportions exceeding federal mandates by the types of additional individuals required to receive training and by medical school presence/absence. Responses were received from 144 institutions (72%); all had an RCR program. Of these 144 institutions, 69 (47.9%) required only federally mandated individuals to take RCR training, whereas 75 (52.1%) required additional individuals to be trained as well. A greater proportion of institutions with medical schools (62.3%; 53/85) went beyond the federal mandates than did those without (37.3%; 22/59). Types of additional individuals required to receive training included all students in selected programs (23.6%; 34/144), all students participating in externally funded research (12.5%; 18/144), all graduate students (11.1%; 16/144), all faculty/staff participating in externally funded research (9.7%; 14/144), all postdoctoral students or fellows (8.3%; 12/144), all doctoral-level students (4.9%; 7/144), all faculty/staff involved in human subjects research (4.9%; 7/144), and all faculty/staff involved in animal research (2.1%; 3/144). More institutions with medical schools exceeded federal RCR training mandates than did those without. The authors encourage other institutions to expand their RCR requirements to promote research integrity.

10 CFR 490.305 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Acquisitions satisfying the mandate. 490.305 Section 490.305 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM... after-market converted light duty vehicle (regardless of the model year of manufacture), that was not...

Alcohol Interventions for Mandated College Students: A Meta-Analytic Review

PubMed Central

Carey, Kate B.; Scott-Sheldon, Lori A. J.; Garey, Lorra; Elliott, Jennifer C.; Carey, Michael P.

2016-01-01

Objective When college students violate campus alcohol policies, they typically receive disciplinary sanctions that include alcohol education or counseling. This meta-analysis evaluated the efficacy of these “mandated interventions” to prevent future alcohol misuse. Methods Studies were included if they evaluated an individual- or group-level intervention, sampled students mandated to an alcohol program, used a pretest-posttest design, and assessed alcohol use as an outcome. Thirty-one studies with 68 separate interventions (N = 8,621 participants; 35% women; 85% White) were coded by independent raters with respect to sample, design, methodological features, and intervention content; the raters also calculated weighted mean effect sizes, using random-effects models. A priori predictors were examined to explain variability in effect sizes. Results In the five studies that used assessment-only control groups, mandated students reported significantly less drinking relative to controls (between-group contrasts), d+ ranged from 0.13-0.20 for quantity and intoxication outcomes. In the 31 studies that provided within-group contrasts, significant effects were observed for all outcomes in the short-term (i.e., ≤ 3 months post-intervention), with d+ ranging from 0.14-0.27; however, fewer significant effects appeared at longer follow-ups. Four commercially-available intervention protocols (i.e., BASICS, e-CHUG, Alcohol 101, and Alcohol Skills Training Program) were associated with risk reduction. Conclusions Providing mandated interventions to students who violate campus alcohol policies is an effective short-term risk reduction strategy. Continued research is needed to maintain initial gains, identify the most useful intervention components, and determine the cost-effectiveness of delivery modes. PMID:27100126

Who should be doing what in the international health: a confusion of mandates in the United Nations?

PubMed Central

Lee, K.; Collinson, S.; Walt, G.; Gilson, L.

1996-01-01

Since 1945 at least five United Nations organisations have become substantially involved in international health activities. This has led to considerable confusion among policy makers, scholars, and UN staff over distinct and appropriate mandates. Interviews with staff an a historical analysis have shown that while formal mandates have been complementary, effective mandates have led to an unclear delineation of activities. The process of translating formal into effective mandates have been influenced by the decentralised nature of the UN, lack of a master plan for its activities, the considerable growth in the policy agenda and the shift towards a multisectoral approach to health. The identification of each organisation's comparative advantage, at both the global and country levels, is one way of understanding what each organisation does best and perhaps should be doing. There is a need for improved mechanisms to define effective mandates, taking into account comparative advantages, if the mandates of UN organisations are appropriate to meet future challenges in international health. PMID:8611793

10 CFR 490.202 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Acquisitions satisfying the mandate. 490.202 Section 490.202 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory... (regardless of the model year of manufacture), capable of operating on alternative fuels that was not...

10 CFR 490.202 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Acquisitions satisfying the mandate. 490.202 Section 490.202 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory... (regardless of the model year of manufacture), capable of operating on alternative fuels that was not...

10 CFR 490.202 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Acquisitions satisfying the mandate. 490.202 Section 490.202 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory... (regardless of the model year of manufacture), capable of operating on alternative fuels that was not...

10 CFR 490.202 - Acquisitions satisfying the mandate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Acquisitions satisfying the mandate. 490.202 Section 490.202 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Mandatory... (regardless of the model year of manufacture), capable of operating on alternative fuels that was not...

State-level cancer treatment costs: how much and who pays?

PubMed

Tangka, Florence K; Trogdon, Justin G; Ekwueme, Donatus U; Guy, Gery P; Nwaise, Isaac; Orenstein, Diane

2013-06-15

Cancer treatment accounts for approximately 5% of national health expenditures. However, no state-level estimates of cancer treatment costs have been published. In analyses of data from the Medical Expenditure Panel Survey, the National Nursing Home Survey, the U.S. Census Bureau, the Current Population Survey, and the Centers for Medicare & Medicaid Services, this study used regression modeling to estimate annual state-level cancer care costs during 2004 to 2008 for 4 categories of payers: all payers, Medicare, Medicaid, and private insurance. State-level cancer care costs ranged from $227 million to $13.6 billion (median = $2.0 billion) in 2010 dollars. Medicare paid between 25.1% and 36.1% of these costs (median = 32.5%); private insurance paid between 36.0% and 49.6% (median = 43.3%); and Medicaid paid between 2.0% and 8.8% (median = 4.8%). Cancer treatment accounted for 3.8% to 8.7% of all state-level medical expenditures (median = 7.0%), 8.5% to 15.0% of state-level Medicare expenditures (median = 10.6%), 1.0% to 4.9% of state-level Medicaid expenditures (median = 2.2%), and 5.5% to 10.9% of state-level private insurance expenditures (median = 8.7%). The costs of cancer treatment were substantial in all states and accounted for a sizable fraction of medical expenditures for all payers. The high cost of cancer treatment underscores the importance of preventing and controlling cancer as one approach to manage state-level medical costs. Copyright © 2013 American Cancer Society.

The evolution of Medicare financing policy for graduate medical education and implications for PM&R: a commentary.

PubMed

Verville, R; DeLisa, J A

2001-04-01

Currently, the only explicit payers for graduate medical education (GME) in the United States are the federal and state governments. Of these, Medicare is by far the largest and most predictable payer. Through the prospective payment system, Medicare reimburses teaching institutions for both their direct and indirect costs associated with their GME programs. Because a well-educated workforce benefits patients covered by private, as well as public insurance, various proposals have been advanced to establish an all-payer pool to distribute the financial burden more equitably. Furthermore, Medicare policy affects physician supply. There is increasing recognition of potential physician oversupply, raising policy questions about the government's longstanding support of GME. In comparison with other specialties, physical medical and rehabilitation (PM&R) may receive more favorable treatment under future GME funding plans, for 2 reasons. First, under the formulas used by Medicare, PM&R training slots typically bring in more indirect revenue to teaching hospitals than is consumed in indirect expenses. This makes PM&R a relatively more attractive program to retain in the face of mandated reductions in training slots. Second, in many parts of the country, PM&R is not threatened by oversupply, making cuts less likely. Nevertheless, the high percentage of non-US medical graduates entering PM&R training may make the specialty vulnerable to future reductions in funded training slots.

Economic Evaluation of Global Endometrial Ablation Versus Inpatient and Outpatient Hysterectomy for Treatment of Abnormal Uterine Bleeding: US Commercial and Medicaid Payer Perspectives.

PubMed

Miller, Jeffrey D; Bonafede, Machaon M; Cai, Qian; Pohlman, Scott K; Troeger, Kathleen A; Cholkeri-Singh, Aarathi

2018-03-01

Every year, abnormal uterine bleeding (AUB) exacts a heavy toll on women's health and leads to high costs for the US health care system. The literature shows that endometrial ablation results in fewer complications, shorter recovery and lower costs than more commonly performed hysterectomy procedures. The objective of this study was to model clinical-economic outcomes, budget impact, and cost-effectiveness of global endometrial ablation (GEA) versus outpatient hysterectomy (OPH) and inpatient hysterectomy (IPH) procedures. A decision tree, state-transition (semi-Markov) economic model was developed to simulate 3 hypothetical cohorts of women who received surgical treatment for AUB (GEA, OPH, and IPH) over 1, 2, and 3 years to evaluate clinical and economic outcomes for GEA vs. OPH and GEA vs. IPH. Two versions of the model were created to reflect both commercial health care payer and US Medicaid perspectives, and analyses were conducted for both payer types. Total health care costs in the first year after GEA were substantially lower compared with those for IPH and OPH. Budget impact analysis results showed that increasing GEA utilization yields total annual cost savings of about $906,000 for a million-member commercial health plan and about $152,000 in cost savings for a typical-sized state Medicaid plan with 1.4 million members. Cost-effectiveness analysis results for both perspectives showed GEA as economically dominant (conferring greater benefit at lower cost) over both OPH and IPH in the 1-year commercial scenario. This study demonstrates that, for some patients, GEA may prove to be a safe, uterus-sparing, cost-effective alternative to OPH and IPH for the surgical treatment of AUB.

Assessing relationship quality in mandated community treatment: blending care with control.

PubMed

Skeem, Jennifer L; Louden, Jennifer Eno; Polaschek, Devon; Camp, Jacqueline

2007-12-01

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment.

An Investment Model Analysis of Relationship Stability among Women Court-Mandated to Violence Interventions

ERIC Educational Resources Information Center

Rhatigan, Deborah L.; Moore, Todd M.; Stuart, Gregory L.

2005-01-01

This investigation examined relationship stability among 60 women court-mandated to violence interventions by applying a general model (i.e., Rusbult's 1980 Investment Model) to predict intentions to leave current relationships. As in past research, results showed that Investment Model predictions were supported such that court-mandated women who…

The HHS Mandate and Religious Liberty: A Primer

ERIC Educational Resources Information Center

Keim, Adele Auxier

2013-01-01

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

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

PubMed

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

2014-06-01

The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

2016-01-01

Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

Alcohol Use Problems Mediate the Relation between Cannabis Use Frequency and College Functioning among Students Mandated to an Alcohol Diversion Program

ERIC Educational Resources Information Center

McChargue, Dennis E.; Klanecky, Alicia K.; Anderson, Jennifer

2012-01-01

The present study examined the degree to which alcohol use problems explained the relationship between cannabis use frequency and college functioning. Undergraduates (N = 546) mandated to an alcohol diversion program at a Midwestern United States university completed screening questionnaires between October 2003 and April 2006. Sobel's (1982) test…

Exploring the psychological underpinnings of the moral mandate effect: motivated reasoning, group differentiation, or anger?

PubMed

Mullen, Elizabeth; Skitka, Linda J

2006-04-01

When people have strong moral convictions about outcomes, their judgments of both outcome and procedural fairness become driven more by whether outcomes support or oppose their moral mandates than by whether procedures are proper or improper (the moral mandate effect). Two studies tested 3 explanations for the moral mandate effect. In particular, people with moral mandates may (a) have a greater motivation to seek out procedural flaws when outcomes fail to support their moral point of view (the motivated reasoning hypothesis), (b) be influenced by in-group distributive biases as a result of identifying with parties that share rather than oppose their moral point of view (the group differentiation hypothesis), or (c) react with anger when outcomes are inconsistent with their moral point of view, which, in turn, colors perceptions of both outcomes and procedures (the anger hypothesis). Results support the anger hypothesis.

B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

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

Applanaidu, Shri-Dewi, E-mail: dewi@uum.edu.my; Ali, Anizah Md., E-mail: anizah@uum.edu.my; Abidin, Norhaslinda Zainal, E-mail: nhaslinda@uum.edu.my

The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1{sup st} June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but itmore » is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study

B2, B7 or B10: Which palm-based blend mandate wise to be chosen in Malaysia?

NASA Astrophysics Data System (ADS)

Applanaidu, Shri-Dewi; Abidin, Norhaslinda Zainal; Ali, Anizah Md.

2015-12-01

The diminishing fossil energy resources, coupled with heightened interest in the abatement of greenhouse gas emissions and concerns about energy security have motivated Malaysia to produce palm-based biodiesel and it has been started to be exported since 2006. In line with this issue, the government in Malaysia launched the palm-based biodiesel blending mandate of five percent (B5) in the federal administration of Putrajaya on 1st June 2011. This was then followed by four states: Malacca on July 11, Negeri Sembilan on August 1, Kuala Lumpur on September 1 and Selangor on October 1 of the same year but it is yet to be implemented nationwide. However what is the wise blend mandate to be chosen? Thus, this paper seeks to examine the possible impact of various blend mandates implementation (B2, B7 and B10) on the palm oil industry market variables (stock and price) since the main aim of biodiesel industry in Malaysia is to reduce domestic palm oil stock to below one million tones and provide a floor price to support Crude Palm Oil (CPO) prices at RM2,000 per tonne. A structural econometric model consisting of nine structural equations and three identities was proposed in this study. The model has been estimated by two stage least squares (2SLS) method using annual data for the period 1976-2013. The study indicates that counterfactual simulation of a decrease from B5 to B2 predicts a decrease (11.2 per cent) in CPO domestic consumption for biodiesel usage, 731.02 per cent reduction in CPO stock and an increase of 27.41 percent in domestic price of CPO. However the increase in the blend mandate from B5 to B7 and B10 suggest that domestic consumption of CPO for biodiesel purpose increase 7.40 and 18.55 percent respectively. The interesting findings in this study suggest that no matter whether Malaysian government increase or decrease the blend mandate the increase in the price of CPO are the same with an increase of is 27.41 percent. Hence, this study suggests that the

Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

PubMed

Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

2017-11-01

Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

Shifts in Medicaid and Uninsured Payer Mix at Safety-Net and Non-Safety-Net Hospitals During the Great Recession.

PubMed

Fingar, Kathryn R; Coffey, Rosanna M; Mulcahy, Andrew W; Andrews, Roxanne M; Stocks, Carol

2018-01-01

There has been ongoing concern regarding the viability of safety-net hospitals (SNHs), which care for vulnerable populations. The authors examined payer mix at SNHs and non-SNHs during a period covering the Great Recession using data from the 2006 to 2012 Healthcare Cost and Utilization Project State Inpatient Databases from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable. These study findings suggest that SNHs were losing Medicaid-enrolled patients relative to non-SNHs before the Medicaid expansion under the Affordable Care Act (ACA). Postexpansion, Medicaid stays will likely increase for both SNHs and non-SNHs, but the increase at SNHs may not be as large as expected if competition increases. Because hospital stays with private insurance and Medicaid help SNHs offset uncompensated care, a lower-than-expected increase could affect SNHs' ability to care for the remaining uninsured population. Continued monitoring is needed once post-ACA data become available.

Insurance-mandated medical weight management before bariatric surgery.

PubMed

Horwitz, Daniel; Saunders, John K; Ude-Welcome, Akuezunkpa; Parikh, Manish

2016-01-01

Many insurance companies require a medical weight management (MWM) program as a prerequisite for approval for bariatric surgery. There is debate regarding the benefit of this requirement. The objective of this study is to assess the effect of insurance-mandated MWM programs on weight loss outcomes in our bariatric surgery population. To assess the effect of insurance-mandated MWM programs on weight loss outcomes in our bariatric surgery population. University. A retrospective review of all bariatric surgery cases performed between 2009 and 2013 was conducted. Patients were stratified by payor mix based on whether the insurance company required MWM. To control for differences between groups, a bucket matching algorithm was used to match patients based on gender, age, body mass index (BMI), and surgery type (sleeve gastrectomy, gastric bypass, or gastric band). A repeated-measures regression model was created to estimate percent excess weight loss, percent excess BMI loss, and percent total weight loss. A total of 1432 bariatric surgery patients were reviewed. The bucket-matching algorithm resulted in 560 patients for final analysis. Mean age and BMI were 41 years and 43 kg/m(2), respectively, and 91% were female. The regression model found no significant differences in weight loss outcomes between the MWM group and the comparison group at 1 year and 2 years-percent total weight loss: 21.3% [95% confidence interval [CI] 20.6%-22.1%] versus 20.2% [95%CI 19.7%-20.6%) at 1 year and 23.4% [95%CI 22.6%-24.3%] versus 21.5% [95%CI 21.0%-22.0%] at 2 years. There was no difference in weight loss outcomes up to 2 years in patients who required insurance-mandated MWM programs. Longer-term studies are needed to determine the benefit of this insurance requirement. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Estimating Nitrogen Load Resulting from Biofuel Mandates

PubMed Central

Alshawaf, Mohammad; Douglas, Ellen; Ricciardi, Karen

2016-01-01

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

Estimating Nitrogen Load Resulting from Biofuel Mandates.

PubMed

Alshawaf, Mohammad; Douglas, Ellen; Ricciardi, Karen

2016-05-09

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

Is State-Mandated Redesign an Effective and Sustainable Solution?

ERIC Educational Resources Information Center

Young, Michelle D.

2013-01-01

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

78 FR 78802 - Medicare Program; Right of Appeal for Medicare Secondary Payer Determination Relating to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

...This proposed rule would implement provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act) which require us to provide a right of appeal and an appeal process for liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim directly from the liability insurance (including self-insurance), no fault insurance, or workers' compensation law or plan.

The Faceless Mandates of NCLB. In My View

ERIC Educational Resources Information Center

Newbold, Barry L.

2004-01-01

Nearly every day the author responds to myriad issues related to the implementation of No Child Left Behind (NCLB). He tries to remain positive as he works through the minutiae found in federal and local educational mandates. Increasingly, however, he finds his mind escaping to a place where the focus of the conversation is on real…

Dissemination and adoption of the advanced primary care model in the Maryland multi-payer patient centered medical home program.

PubMed

Khanna, Niharika; Shaya, Fadia; Chirikov, Viktor; Steffen, Ben; Sharp, David

2014-02-01

The Maryland Learning Collaborative together with the Maryland Multi-Payer Program transformed 52 medical practices into patient-centered medical homes (PCMH). The Maryland Learning Collaborative developed an Internet-based 14-question Likert scale survey to assess the impact of the PCMH model on practices and providers, concerning how this new method is affecting patient care and outcomes. The survey was sent to 339 practitioners and 52 care management teams at 18 months into the program. Sixty-seven survey results were received and analyzed. After 18 months of participation in the PCMH initiative, participants demonstrated a better understanding of the PCMH initiative, improved patient access to care, improved care coordination, and increased health information technology optimization (p > .001). The findings from the survey evaluation suggest that practice participation in the Maryland Multi-Payer Program has enhanced access to care, influenced patient outcomes, improved care coordination, and increased use of health information technology.

Access to and use of infertility services in the United States: framing the challenges.

PubMed

Adashi, Eli Y; Dean, Laura A

2016-05-01

An overview of access to and use of general infertility and assisted reproductive technology (ART) services in the United States (U.S.) shows a declining trend for the ever-use of infertility services. Moreover, the use of ART services lags relative to other member nations of the Organization for Economic Co-operation and Development (OECD). Access to and use of general infertility and ART services is primarily undermined by a severely constrained underwriting universe dominated by self-insured employers and by a finite number of state infertility insurance mandates. The contribution of traditional public and private payers to the underwriting of ART is limited. As compared with OECD member nations wherein the access to and underwriting of general infertility and ART services is universal, the current status quo in the U.S. can only be characterized as dismal. Further, the current state of affairs is socially unjust in that the right to build a family in the face of infertility appears to have become a function of economic prowess. Given the dominance of the self-insured employers as underwriters of general infertility and ART services, advocacy directed at this interest group is likely to prove most productive. Improving the state of underwriting of general infertility and ART services in the U.S. must be embraced as a central moral imperative and as an unwavering strategic goal of the professional societies entrusted with the reproductive health of women and men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

PubMed

Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

2017-08-01

Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

HIE sustainability secrets. NeHC report shares HIE success stories of alternate revenue streams and payer buy-in.

PubMed

Prestigiacomo, Jennifer

2011-11-01

Getting effective stakeholder engagement, including that of payers, and creating innovative value-added services that provide alternate revenue streams beyond basic subscription services, are just a couple of the common traits of the flourishing health information exchanges profiled in the sustainability report released in August by the National eHealth Collaborative.

High Stakes Policy and Mandated Curriculum: A Rhetorical Argumentation Analysis to Explore the Social Processes That Shape School Leaders' and Teachers' Strategic Responses

ERIC Educational Resources Information Center

Dulude, Eliane; Spillane, James P.; Dumay, Xavier

2017-01-01

Several social processes guide and shape how school actors engage with high stakes state and district policies relative to mandated curriculum and instruction. In this article, we use rhetorical argumentation analysis to explore how stakeholders mobilize resources through argumentation and rhetorical appeals (logical, emotional, and…

A proposed ethical framework for vaccine mandates: competing values and the case of HPV.

PubMed

Field, Robert I; Caplan, Arthur L

2008-06-01

Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective.

Keep Kids in School: A Collaborative Community Effort to Increase Compliance With State-Mandated Health Requirements.

PubMed

Rogers, Valerie; Salzeider, Christine; Holzum, Laura; Milbrandt, Tracy; Zahnd, Whitney; Puczynski, Mark

2016-05-01

It is important that collaborative relationships exist in a community to improve access to needed services for children. Such partnerships foster preventive services, such as immunizations, and other services that protect the health and well-being of all children. A collaborative relationship in Illinois involving an academic health center, a school district, and county health department to address noncompliance with health examination and immunization requirements was formed. Parents were additional partners. Examinations, screenings, and immunizations increased from previous year baselines. Greater fulfillment of health exam mandates resulted in fewer students (39% fewer) excluded from admission to school. The type of partnerships described is feasible and can result in improved health care for school-aged children who otherwise might be excluded both from health services and from school. © 2016, American School Health Association.

Physical therapy mandates by Medicare administrative contractors: effective or wasteful?

PubMed

Fehring, Thomas K; Fehring, Keith; Odum, Susan M; Halsey, David

2013-10-01

Documentation of medical necessity for arthroplasty has come under scrutiny by Medicare. In some jurisdictions three months of physical therapy prior to arthroplasty has been mandated. The purpose of this study was to determine the efficacy and cost of this policy to treat advanced osteoarthritis. A systematic review was performed to assimilate efficacy data for physical therapy in patients with advanced osteoarthritis. The number of arthroplasties performed annually was obtained to calculate cost. Evidence-based studies documenting the efficacy of physical therapy in treating advanced arthritis are lacking with a potential cost of 36-68 million dollars. Physical therapy mandates by administrative contractors are not only ineffective but are costly without patient benefit. Medical necessity documentation should be driven by orthopedists not retroactively by Medicare contractors. Copyright © 2013 Elsevier Inc. All rights reserved.

Postoperative outcomes in bariatric surgical patients participating in an insurance-mandated preoperative weight management program.

PubMed

Schneider, Andrew; Hutcheon, Deborah A; Hale, Allyson; Ewing, Joseph A; Miller, Megan; Scott, John D

2018-05-01

Many insurance companies require patient participation in a medically supervised weight management program (WMP) before offering approval for bariatric surgery. Clinical data surrounding benefits of participation are limited. To evaluate the relationship between preoperative insurance-mandated WMP participation and postoperative outcomes in bariatric surgery patients. Regional referral center and teaching hospital. A retrospective review of patients who underwent vertical sleeve gastrectomy or Roux-en-Y gastric bypass between January 2014 and January 2016 was performed. Patients (N = 354) were divided into 2 cohorts and analyzed according to presence (n = 266) or absence (n = 88) of an insurance-mandated WMP requirement. Primary endpoints included rate of follow-up and percent of excess weight loss (%EWL) at postoperative months 1, 3, 6, and 12. All patients, regardless of the insurance-mandated WMP requirement, followed a program-directed preoperative diet. The majority of patients with an insurance-mandated WMP requirement had private insurance (63.9%). Both patient groups experienced a similar proportion of readmissions and reoperations, rate of follow-up, and %EWL at 1, 3, 6, and 12 months (P = NS). Median operative duration and hospital length of stay were also similar between groups. Linear regression analysis revealed no significant improvement in %EWL at 12 months in the yes-WMP group. These data show that patients who participate in an insurance-mandated WMP in addition to completing a program-directed preoperative diet experience no significant benefit to rate of readmission, reoperation, follow-up, or %EWL up to 12 months postoperation. Our findings suggest that undergoing bariatric surgery without completing an insurance-mandated WMP is safe and effective. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Johnson, Carla C.; Fargo, Jamison D.

2014-11-01

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

Association of insurance status and spinal fusion usage in the United States during two decades.

PubMed

John, Jason; Mirahmadizadeh, Alireza; Seifi, Ali

2018-05-01

This study examined the distribution of spinal fusion usage among payer groups in the United States. Using the National Inpatient Sample (NIS) database, total discharges, length of stay, and mean hospital charges of patients who underwent spinal fusion from 1997 to 2014 in the United States were determined and analyzed. 5,715,625 total discharges with spinal fusion were reported. Among them, 2,875,188 (50.3%) were covered by private insurance, 1,710,182 by Medicare (29.9%), 342,638 (6.0%) by Medicaid, and 91,990 (1.6%) were uninsured. A statistically significant increase in spinal fusion usage occurred within each payer group over the study period (P < 0.001). For every year of the study period, private insurance patients had the most number and uninsured patients had the least number of total discharges with spinal fusion. Furthermore, annual growth in spinal fusion usage was greatest among private insurance patients, and smallest among uninsured patients. Total discharges with spinal fusion increased significantly across all payer groups between 1997 and 2014, but not equally. Further inquiry is indicated to determine the etiology of spinal fusion usage discrepancies between payer groups. Copyright © 2018 Elsevier Ltd. All rights reserved.

Use of Oritavancin in Moderate-to-Severe ABSSSI Patients Requiring IV Antibiotics: A U.S. Payer Budget Impact Analysis.

PubMed

Jensen, Ivar S; Wu, Elizabeth; Fan, Weihong; Lodise, Thomas P; Nicolau, David P; Dufour, Scott; Cyr, Philip L; Sulham, Katherine A

2016-06-01

It is estimated that acute bacterial skin and skin structure infections (ABSSSI) account for nearly 10% of hospital admissions and 3.4-3.8 million emergency department visits per year in the United States. Analyses of hospital discharge records indicate 74% of ABSSSI admissions involve empiric treatment with methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. Analysis has shown that payer costs could be reduced if moderate-to-severe ABSSSI patients were treated to a greater extent in the observational unit followed by discharge to outpatient parenteral antibiotic therapy (OPAT). Oritavancin is a lipoglycopeptide antibiotic with bactericidal activity against gram-positive bacteria, including MRSA. To estimate the impact on a U.S. payer's budget of using single-dose oritavancin in ABSSSI patients with suspected MRSA involvement who are indicated for intravenous antibiotics. A decision analytic model based on current clinical practice was developed to estimate the economic value of decreased hospital resource consumption by using single-dose oritavancin over a 1-year time horizon. Use of antibiotics was informed by an analysis of the Premier Research Database. Demographic and clinical data were derived from a targeted literature review. Emergency department, observation, laboratory, and administration costs used were Medicare National Limitation amounts. Drug costs were 2014 wholesale acquisition costs. For a hypothetical U.S. payer with 1,000,000 members, it is expected that approximately 14,285 members per year will be diagnosed with ABSSSI severe enough to indicate intravenous antibiotics with MRSA activity. Based on this simulation, use of single-dose oritavancin in 26% of these patients was estimated to reduce the number of inpatient admissions, reduce length of stay for patients requiring admission, and reduce the number of days a patient needs to receive daily infusions in the OPAT clinic. The total patient days decreased from 171,125 to 133

Assessing clarity of message communication for mandated USEPA drinking water quality reports.

PubMed

Phetxumphou, Katherine; Roy, Siddhartha; Davy, Brenda M; Estabrooks, Paul A; You, Wen; Dietrich, Andrea M

2016-04-01

The United States Environmental Protection Agency mandates that community water systems (CWSs), or drinking water utilities, provide annual consumer confidence reports (CCRs) reporting on water quality, compliance with regulations, source water, and consumer education. While certain report formats are prescribed, there are no criteria ensuring that consumers understand messages in these reports. To assess clarity of message, trained raters evaluated a national sample of 30 CCRs using the Centers for Disease Control Clear Communication Index (Index) indices: (1) Main Message/Call to Action; (2) Language; (3) Information Design; (4) State of the Science; (5) Behavioral Recommendations; (6) Numbers; and (7) Risk. Communication materials are considered qualifying if they achieve a 90% Index score. Overall mean score across CCRs was 50 ± 14% and none scored 90% or higher. CCRs did not differ significantly by water system size. State of the Science (3 ± 15%) and Behavioral Recommendations (77 ± 36%) indices were the lowest and highest, respectively. Only 63% of CCRs explicitly stated if the water was safe to drink according to federal and state standards and regulations. None of the CCRs had passing Index scores, signaling that CWSs are not effectively communicating with their consumers; thus, the Index can serve as an evaluation tool for CCR effectiveness and a guide to improve water quality communications.

Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

PubMed

Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

2017-01-01

New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Two-year continuation of intrauterine devices and contraceptive implants in a mixed-payer setting: a retrospective review.

PubMed

Sanders, Jessica N; Turok, David K; Gawron, Lori M; Law, Amy; Wen, Lonnie; Lynen, Richard

2017-06-01

As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined 2-year continuation rates for the levonorgestrel 52-mg intrauterine device, the copper T380A intrauterine device, and the 68-mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. The purpose of this study was to examine the proportion and characteristics of women who continue intrauterine device and implant use to 2 years and to relate continuation to device type when controlling for patient characteristics. This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004, and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence risk ratios and to relate the probability of 2-year continuous use to device type. Data on 8603 device insertions were obtained with the following distribution: levonorgestrel 52-mg intrauterine devices (6459; 75.1%), copper T380A intrauterine devices (1136; 13.2%), and 68-mg etonogestrel implant (1008; 11.7%). Two-year continuation rates were 77.8%, 73.1%, and 75.9%, respectively. There was no statistical difference in 2-year continuation between levonorgestrel 52-mg intrauterine device users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) and 68-mg etonogestrel implant users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0-1.1) compared with copper device users, after we controlled for age, Hispanic ethnicity, payer type, and year of insertion. Older-age, self-pay, or public payer insurance (reference commercial payer) and Hispanic ethnicity were associated with 2-year continuation. Three-quarters of women with an

States Stepping up Mandates for School Safety Drills

ERIC Educational Resources Information Center

Shah, Nirvi

2013-01-01

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

Education Policy Mediation: Principals' Work with Mandated Literacy Assessment

ERIC Educational Resources Information Center

Comber, Barbara; Cormack, Phil

2011-01-01

Mandated literacy assessment is now a ubiquitous practice in many western educational systems. While educational researchers, principals, teachers and education unions continue to offer vociferous resistance in some nations, in others it is now commonplace in the educational landscape and built into the rhythms of the school year. This paper is…

The effects of insurance mandates on choices and outcomes in infertility treatment markets.

PubMed

Hamilton, Barton H; McManus, Brian

2012-08-01

For the 10% to 15% of American married couples who experience reproductive problems, in vitro fertilization (IVF) is the leading technologically advanced treatment procedure. However, IVF's expense may prevent many couples from receiving treatment, and those who are treated may take an overly aggressive approach to reduce the probability of failure. Aggressive treatment, which occurs through an increase in the number of embryos transferred during IVF, can lead to medically dangerous multiple births. We evaluated the principle policy proposal-insurance mandates-for improving IVF access and outcomes. We used data from US markets during 1995-2003 to show that broad insurance mandates for IVF result in not only large increases in treatment access but also significantly less aggressive treatment. More limited insurance mandates, which may apply to a subset of insurers or provide weaker guidelines for insurer behavior, generally have little effect on IVF markets. Copyright © 2011 John Wiley & Sons, Ltd.

42 CFR 137.69 - May a statutorily mandated grant program added to a funding agreement be redesigned?

Code of Federal Regulations, 2010 CFR

2010-10-01

...-GOVERNANCE Statutorily Mandated Grants § 137.69 May a statutorily mandated grant program added to a funding agreement be redesigned? No, unless it is permitted under the statute authorizing the grant or under the...

Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.

PubMed

Coupet, Edouard; Karp, David; Wiebe, Douglas J; Kit Delgado, M

2018-03-28

Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. We analyzed all emergency department (ED) visits from 2009 to 2014 with diagnosis codes for violent injury in the Nationwide Emergency Department Sample (NEDS). We used sample weights to estimate total charges with adjusted generalized linear models to estimate charges for the 15% of ED visits with missing charge data. We then calculated the share attributable by payer and determined the difference in proportion by payer from 2013 to 2014. Between 2009 and 2013, the uninsured accounted for 28.2-31.3% of annual charges for the acute care of violent injury, while Medicaid was responsible for a similar amount (29.0-31.0%). In 2014, there were $10.7 billion in total charges for violent injury. Medicaid assumed the greatest share, 39.8% (95% CI: 38.0-41.5%, $3.5-5.1 billion), while the uninsured accounted for 23.6% (95% CI: 22.2-24.9%, $2.0-3.0 billion), and Medicare accounted for 7.8% (95% CI: 7.7-8.0%, $0.7-1.0 billion). After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. These findings highlight the benefit to state Medicaid programs of preventing interpersonal violence. Published by Elsevier Inc.

Mandating nutrient menu labeling in restaurants: potential public health benefits.

PubMed

Stran, Kimberly A; Turner, Lori W; Knol, Linda

2013-03-01

Many Americans have replaced home-cooked meals with fast food and restaurants meals. This contributes to increased incidences of overweight and obesity. Implementing policies that require restaurants to disclose nutrition information has the potential to improve nutrition knowledge and food behaviors. The purpose of this paper was to examine the potential health benefits of nutrient menu labeling in restaurants, the progress of this legislation and to provide results regarding the implementation of these policies. Data sources were obtained from a search of multiple databases including PubMed, Science Direct, Academic Search Premier, and Google Scholar. Study inclusion criteria were publication in the past ten years, obesity prevention, and utilization of nutrition labeling on menus in restaurants. The initial policies to provide consumers with nutrition information in restaurant settings began at the state levels in 2006. These laws demonstrated success, other states followed, and a national law was passed and is being implemented. Mandating nutrient menu disclosure has the potential to influence a large number of people; this legislation has the opportunity to impact Americans who dine at a fast food or chain restaurant. Given the growing obesity epidemic, continued research is necessary to gauge the effectiveness of this new law and its effects on the health status of the American people.

"I'm Not Teaching English, I'm Teaching Something Else!": How New Teachers Create Curriculum under Mandates of Educational Reform

ERIC Educational Resources Information Center

Costigan, Arthur

2018-01-01

This study presents how beginning teachers create and teach an English Language Arts (ELA) curriculum in urban schools in the context of an educational reform movement driven by mandates such as Common Core State Standards (CCSS), high stakes tests, and prescribed curricula. They serve in schools with each using unique and individual curricula due…

A Review of Open Access Self-Archiving Mandate Policies

ERIC Educational Resources Information Center

Xia, Jingfeng; Gilchrist, Sarah B.; Smith, Nathaniel X. P.; Kingery, Justin A.; Radecki, Jennifer R.; Wilhelm, Marcia L.; Harrison, Keith C.; Ashby, Michael L.; Mahn, Alyson J.

2012-01-01

This article reviews the history of open access (OA) policies and examines the current status of mandate policy implementations. It finds that hundreds of policies have been proposed and adopted at various organizational levels and many of them have shown a positive effect on the rate of repository content accumulation. However, it also detects…

Effectiveness of vaccination recommendations versus mandates: Evidence from the hepatitis A vaccine.

PubMed

Lawler, Emily C

2017-03-01

I provide novel evidence on the effectiveness of two vaccination policies - simple non-binding recommendations to vaccinate versus mandates requiring vaccination prior to childcare or kindergarten attendance - in the context of the only disease whose institutional features permit a credible examination of both: hepatitis A. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points. These policies also significantly reduced population hepatitis A incidence. My results suggest a range of policy options for addressing suboptimally low population vaccination rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies.

PubMed

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-08-01

Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.

The Role of Professional Background, Case Characteristics, and Protective Agency Response in Mandated Child Abuse Reporting.

ERIC Educational Resources Information Center

Zellman, Gail L.; Bell, Robert M.

This document presents a report on research undertaken to assess the incidence of child abuse reporting and of failure to report among mandated reporters; the contributions of workplace, personal, and institutional factors to reporting behavior; and the interaction of mandated reporters with the child protective agencies to which they report. The…

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

PubMed

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

2006-01-01

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

Wisconsin EE Mandates: The Bad News and the Good News.

ERIC Educational Resources Information Center

Lane, Jennie; And Others

1996-01-01

Examines Wisconsin teachers' perceived competencies in, attitudes toward, and amount of class time devoted to teaching about the environment. Discusses the effects of Wisconsin environmental education mandates concerning preservice preparation in environmental education and K-12 environmental education curriculum plans. Identifies areas where the…

What Color Helmet? Reforming Security Council Peacekeeping Mandates

DTIC Science & Technology

1997-08-01

Security Council mandate may meet the procedural, but not the substantive, requirements of the Charter. Article 2(7) finishes by providing that...established in June 1 99 1 , continues through UNAVEM II I . When UNAVEM I finishe d, Angola requested assistance from the United Nations in implementing...on 27 and 28 October 1 994 . ONUMOZ’s peacekeeping operations actually finished in January 1 995 . 29. UNOSOM I I . The original UN Operation in

42 CFR 137.68 - May funds from a statutorily mandated grant added to a funding agreement be reallocated?

Code of Federal Regulations, 2010 CFR

2010-10-01

... SELF-GOVERNANCE Statutorily Mandated Grants § 137.68 May funds from a statutorily mandated grant added to a funding agreement be reallocated? No, unless it is permitted under the statute authorizing the...

Payer leverage and hospital compliance with a benchmark: a population-based observational study

PubMed Central

Hollingsworth, John M; Krein, Sarah L; Miller, David C; DeMonner, Sonya; Hollenbeck, Brent K

2007-01-01

Background Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in renal transplantation is likely greater, given its coverage of end-stage renal disease. Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance. Methods Nationally representative discharge data for kidney (n = 29,272), liver (n = 7,988), heart (n = 3,530), and lung (n = 1,880) transplants from the Nationwide Inpatient Sample (1993 – 2003) were employed. Logistic regression techniques with robust variance estimators were used to examine the relationship between hospital volume compliance and Medicare market share; generalized estimating equations were used to explore the association between patient-level operative mortality and hospital volume compliance. Results Medicare's transplant market share varied by organ [57%, 28%, 27%, and 18% for kidney, lung, heart, and liver transplants, respectively (P < 0.001)]. Volume-based benchmark compliance varied by transplant type [85%, 75%, 44%, and 39% for kidney, liver, heart, and lung transplants, respectively (P < 0.001)], despite a lower odds of operative mortality at compliant hospitals. Adjusting for organ supply, high market leverage was independently associated with compliance at hospitals transplanting kidneys (OR, 143.00; 95% CI, 18.53 – 1103.49), hearts (OR, 2.84; 95% CI, 1.51 – 5.34), and lungs (OR, 3.24; 95% CI, 1.57 – 6.67). Conclusion These data highlight the influence of payer leverage–an important contextual factor in value-based purchasing initiatives. For uncommon diagnoses, these data suggest that at least 30% of a provider's patients might need to be "at risk" for an incentive to motivate compliance. PMID:17640364

Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

PubMed

Gregory, David; Scotti, Dennis J; Buck, Daniel; Triadafilopoulos, George

2016-05-01

A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

The estimated impact of California’s urban water conservation mandate on electricity consumption and greenhouse gas emissions

NASA Astrophysics Data System (ADS)

Spang, Edward S.; Holguin, Andrew J.; Loge, Frank J.

2018-01-01

In April 2015, the Governor of California mandated a 25% statewide reduction in water consumption (relative to 2013 levels) by urban water suppliers. The more than 400 public water agencies affected by the regulation were also required to report monthly progress towards the conservation goal to the State Water Resources Control Board. This paper uses the reported data to assess how the water utilities have responded to this mandate and to estimate the electricity savings and greenhouse gas (GHG) emissions reductions associated with reduced operation of urban water infrastructure systems. The results show that California succeeded in saving 524 000 million gallons (MG) of water (a 24.5% decrease relative to the 2013 baseline) over the mandate period, which translates into 1830 GWh total electricity savings, and a GHG emissions reduction of 521 000 metric tonnes of carbon dioxide equivalents (MT CO2e). For comparison, the total electricity savings linked to water conservation are approximately 11% greater than the savings achieved by the investor-owned electricity utilities’ efficiency programs for roughly the same time period, and the GHG savings represent the equivalent of taking about 111 000 cars off the road for a year. These indirect, large-scale electricity and GHG savings were achieved at costs that were competitive with existing programs that target electricity and GHG savings directly and independently. Finally, given the breadth of the results produced, we built a companion website, called ‘H2Open’ (https://cwee.shinyapps.io/greengov/), to this research effort that allows users to view and explore the data and results across scales, from individual water utilities to the statewide summary.

Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

PubMed

Palli, Swetha R; Rizzo, John A; Heidrich, Natalie

2018-06-01

The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.

The Views of Low-Income Employees Regarding Mandated Comprehensive Employee Benefits for the Sake of Health

PubMed Central

Adikes, Katherin A.; Hull, Sara C.; Dams, Marion

2013-01-01

Socioeconomic factors stand in the way of good health for low-income populations. We suggest that employee benefits might serve as a means of improving the health of low-wage earners. We convened groups of low-income earners to design hypothetical employee benefit packages. Qualitative analysis of group discussions regarding state-mandated benefits indicated that participants were interested in a great variety of benefits, beyond health care, that address socioeconomic determinants of health. Long-term financial and educational investments were of particular value. These results may facilitate the design of employee benefits that promote the health of low-income workers. PMID:20391255

The views of low-income employees regarding mandated comprehensive employee benefits for the sake of health.

PubMed

Adikes, Katherin A; Hull, Sara C; Danis, Marion

2010-01-01

Socioeconomic factors stand in the way of good health for low-income populations. We suggest that employee benefits might serve as a means of improving the health of low-wage earners. We convened groups of low-income earners to design hypothetical employee benefit packages. Qualitative analysis of group discussions regarding state-mandated benefits indicated that participants were interested in a great variety of benefits, beyond health care, that address socioeconomic determinants of health. Long-term financial and educational investments were of particular value. These results may facilitate the design of employee benefits that promote the health of low-income workers.

Using cost and health impacts to prioritize the targeted testing of tuberculosis in the United States.

PubMed

Miller, Thaddeus L; Hilsenrath, Peter; Lykens, Kristine; McNabb, Scott J N; Moonan, Patrick K; Weis, Stephen E

2006-04-01

Evaluation improves efficiency and effectiveness. Current U.S. tuberculosis (TB) control policies emphasize the treatment of latent TB infection (LTBI). However, this policy, if not targeted, may be inefficient. We determined the efficiency of a state-law mandated TB screening program and a non state-law mandated one in terms of cost, morbidity, treatment, and disease averted. We evaluated two publicly funded metropolitan TB prevention and control programs through retrospective analyses and modeling. Main outcomes measured were TB incidence and prevalence, TB cases averted, and cost. A non state-law mandated TB program for homeless persons in Tarrant County screened 4.5 persons to identify one with LTBI and 82 persons to identify one with TB. A state-law mandated TB program for jail inmates screened 109 persons to identify one with LTBI and 3274 persons to identify one with TB. The number of patients with LTBI treated to prevent one TB case was 12.1 and 15.3 for the homeless and jail inmate TB programs, respectively. Treatment of LTBI by the homeless and jail inmate TB screening programs will avert 11.9 and 7.9 TB cases at a cost of 14,350 US dollars and 34,761 US dollars per TB case, respectively. Mandated TB screening programs should be risk-based, not population-based. Non mandated targeted testing for TB in congregate settings for the homeless was more efficient than state-law mandated targeted testing for TB among jailed inmates.

Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate.

PubMed

Mackay, Christine B; Antonelli, Kaitlyn R; Bruinooge, Suanna S; Saint Onge, Jarron M; Ellis, Shellie D

2017-08-01

The Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation; however, the impact of this provision on cancer centers' efforts to accrue patients to clinical trials has not been well described. First, members of cancer research centers and community-based institutions (n = 252) were surveyed to assess the status of insurance denials, and then, a focused survey (n = 77) collected denial details. Univariate and multivariate analyses were used to examine associations between the receipt of denials and site characteristics. Overall, 62.7% of the initial survey respondents reported at least 1 insurance denial during 2014. Sites using a precertification process were 3.04 times more likely to experience denials (95% confidence interval, 1.55-5.99; P ≤ .001), and similar rates of denials were reported from sites located in states with preexisting clinical trial coverage laws versus states without them (82.3% vs 85.1%; χ = 50.7; P ≤ .001). Among the focused survey sites, academic centers reported denials more often than community sites (71.4% vs 46.4%). The failure of plans to cover trial participation was cited as the most common reason provided for denials (n = 33 [80.5%]), with nearly 80% of sites (n = 61) not receiving a coverage response from the insurer within 72 hours. Despite the ACA's mandate for most insurers to cover routine care costs for cancer clinical trial participation, denials and delays continue. Denials may continue because some insurers remain exempt from the law, or they may signal an implementation failure. Delays in coverage may affect patient participation in trials. Additional efforts to eliminate this barrier will be needed to achieve federal initiatives to double the pace of cancer research over the next 5 years. Future work should assess the law's effectiveness at the patient level to inform these efforts

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

PubMed

Woolhandler, Steffie; Himmelstein, David U; Angell, Marcia; Young, Quentin D

2003-08-13

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program

Mandating coverage of biologic therapies for rheumatic disease: where evidence and politics meet.

PubMed

Bair, Yali A; White, Richard H; Kravitz, Richard L

2006-06-15

In this issue of Arthritis Care & Research, we inaugurate an occasional series of commentaries entitled Policy Matters. In all of clinical research, our goal is to improve patient outcomes. Usually, that means focusing on the medical, demographic, and socioeconomic factors at the level of individuals with rheumatic diseases; sometimes, our scope of inquiry expands to encompass the impact of the communities in which they live. However, increasingly, the welfare of persons with rheumatic conditions is also affected by health policies through such diverse mechanisms as reimbursement decisions for specific treatments, insurance coverage, manpower, and NIH budgets (the foregoing list is hardly exhaustive).Recently, a piece of legislation was introduced in California (SB913) that has the potential to alter the availability of biologic response modifying agents (BRMs) by mandating that health plans that provide coverage for one such agent include all on their formularies (a revised version would preclude a trial of another disease-modifying antirheumatic drug before use of a BRM). In this state, the California Health Benefits Review Program (CHBRP) provides evidence reviews of the medical effectiveness, cost, and public health impact of proposed health insurance mandates for the legislature. The analysts from the University of California who conducted the medical effectiveness review of SB913 for CHBRP provide a legislative history of the proposed law in this article. We hope that the readership of Arthritis Care & Research find this article informative as an exemplar of the policies that could dramatically alter the welfare of our patients.

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

ERIC Educational Resources Information Center

Angelo, Elin

2016-01-01

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

San Francisco's 'pay or play' employer mandate expanded private coverage by local firms and a public care program.

PubMed

Colla, Carrie H; Dow, William H; Dube, Arindrajit

2013-01-01

In 2008 San Francisco implemented a pay-or-play employer mandate that required firms operating in the city to provide health insurance coverage for employees or contribute to the city's "public option" health access program, Healthy San Francisco. Using data from our Bay Area Employer Health Benefits Survey, we found that in the first two years after implementation, more employers offered insurance and provided employee health benefit coverage relative to employers outside San Francisco not subject to the mandate. Sixty-seven percent reported in 2009 that they had expanded benefits since 2007. Although 22 percent of firms responding to the survey reported contributing to Healthy San Francisco for some employees, we observed no crowd-out of private insurance. Premium changes between 2007 and 2009 were similar in San Francisco and surrounding areas, but more of the burden of premium contributions in San Francisco shifted from workers to employers. Overall, 64 percent of firms responding to the survey supported the employer mandate. San Francisco's experience indicates that such a mandate is feasible, increases access, and is acceptable to many employers, which bodes well for the national employer mandate that will take effect under the Affordable Care Act in 2014.

Time to take action to meet GS1 mandate.

PubMed

Doyle, Chris

2014-10-01

A recent paper, NHS eProcurement Strategy,(1) published earlier this year by the Department of Health, mandated the use of GS1 standards throughout the NHS in England. The Strategy requires all NHS Trusts in England to produce a Board-approved adoption plan. Chris Doyle, head of Healthcare at independent global supply chain standards organization, GS1 UK, explains the next steps to becoming compliant.

42 CFR 137.66 - May a Self-Governance Tribe keep interest earned on statutorily mandated grant funds?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May a Self-Governance Tribe keep interest earned on...-GOVERNANCE Statutorily Mandated Grants § 137.66 May a Self-Governance Tribe keep interest earned on statutorily mandated grant funds? Yes, a Self-Governance Tribe may keep Interest Earned on Statutorily...

Sexuality education policies and sexually transmitted disease rates in the United States of America.

PubMed

Hogben, M; Chesson, H; Aral, S O

2010-04-01

The aim of the study was to test for relationships between state-level sex educational policies and sexually transmitted disease (STD) rates. We analysed US case reports of gonorrhoea and chlamydial infection for 2001-2005 against state policies for abstinence coverage in sexuality education, using the proportion of the population per state who identified as black (aged 15-24 years) as a covariate. We also tested for effects on 15-19 year olds versus 35-39 year olds and tuberculosis rates (the latter to ensure findings applied only to STD). States with no mandates for abstinence had the lowest mean rates of infection among the overall population and among adolescents. States with mandates emphasizing abstinence had the highest rates; states with mandates to cover (but not emphasize) abstinence fell in between. Rates in some states covering abstinence changed faster than in others, as reflected in sharper declines (gonorrhoea) or slower increases (chlamydial infection). These effects were not shown for tuberculosis or 35-39 year olds. Having no abstinence education policy has no apparent effect on STD rates for adolescents. For states with elevated rates, policies mandating coverage may be useful, although policies emphasizing abstinence show no benefit.

Prior Authorization Requirements for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Across US Private and Public Payers.

PubMed

Doshi, Jalpa A; Puckett, Justin T; Parmacek, Michael S; Rader, Daniel J

2018-01-01

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) are an innovative treatment option for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease who require further lowering of low-density lipoprotein cholesterol. However, the high costs of these agents have spurred payers to implement utilization management policies to ensure appropriate use. We examined prior authorization (PA) requirements for PCSK9is across private and public US payers. We conducted an analysis of 2016 formulary coverage and PA data from a large, proprietary database with information on policies governing >95% of Americans with prescription drug coverage (275.3 million lives) within 3872 plans across the 4 major insurance segments (commercial, health insurance exchange, Medicare, and Medicaid). The key measures included administrative PA criteria (prescriber specialty, number of criteria in PA policy or number of fields on PA form, requirements for medical record submission, reauthorization requirements) and clinical/diagnostic PA criteria (approved conditions, required laboratories or other tests, required concomitant therapy, step therapy requirements, continuation criteria) for each of 2 Food and Drug Administration-approved PCSK9is. Select measures (eg, number of PA criteria/fields, medical record submission requirements) were obtained for 2 comparator cardiometabolic drugs (ezetimibe and liraglutide). Between 82% and 97% of individuals were enrolled in plans implementing PA for PCSK9is (depending on insurance segment), and one third to two thirds of these enrollees faced PAs restricting PCSK9i prescribing to a specialist. For patients with familial hypercholesterolemia, diagnostic confirmation via genetic testing or meeting minimum clinical scores/criteria was also required. PA requirements were more extensive for PCSK9is as compared with the other cardiometabolic drugs (ie, contained 3×-11× the number of PA criteria or fields on PA

Selection of a hospital for a transfer: the roles of patients, families, physicians and payers.

PubMed

Gombeski, W R; Konrad, D; Kanoti, G; Ulreich, S; Skilogianis, J; Clough, J

1997-01-01

This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center. A thirty-three item questionnaire and clinical data from the hospital's discharge database. A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed. (1) Almost 58% of transfers were patient-initiated or -influenced; the remainder were physician- (38%) or payer-directed (4%); (2) More than 78% of the patients identified lack of clinical expertise/technology at originating hospital as the main reason for transferring. Other reasons included: established CCH patient status (43%), CCH marketing (31%), and concerns regarding quality of care at originating hospital (10%). Financial and quality dumping were not identified as reasons for the transfer. New patients to CCH were more likely to indicate that marketing and lack of clinical resources at originating hospital were reasons for selecting CCH than previous patients. Patients significantly influenced the transfer decision and the transfer decision-making process can be influenced by marketing. The opinions of the consumer should not be underestimated, especially by those seeking non-marketing solutions to health care reform.

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

PubMed

Quadagno, Jill

2014-02-01

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

Relational Contexts and Aesthetics: Achieving Positive Connections with Mandated Clients

ERIC Educational Resources Information Center

McKaig, Ann McCullough

2003-01-01

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

Class Size: What Research Says and What It Means for State Policy

ERIC Educational Resources Information Center

Whitehurst, Grover J.; Chingos, Matthew M.

2011-01-01

Class size is one of the small number of variables in American K-12 education that are both thought to influence student learning and are subject to legislative action. Legislative mandates on maximum class size have been very popular at the state level. In recent decades, at least 24 states have mandated or incentivized class-size reduction…

Payer incentives and physical rehabilitation therapy for nonelderly institutional long-term care residents: evidence from Michigan and Ontario.

PubMed

Wodchis, Walter P; Fries, Brant E; Pollack, Harold

2004-02-01

To examine the effect of payment incentives on the provision of rehabilitation therapy to non elderly nursing home residents. Retrospective cross-sectional study. Nursing homes in Michigan or complex continuing care facilities in Ontario, Canada, in 1998 or 1999. Non elderly nursing home residents (N=5189) admitted to nursing homes. Not applicable. The effect of payment on access to physical therapy (PT) and occupational therapy (OT) and total weekly time for each therapy type. A Medicare policy change from cost-based to a patient-specific case-mix payment method was associated with greater likelihood of receiving OT but reduced weekly minutes of PT and OT provided to residents. Medicare cost-based and private insurance were associated with greater likelihood of receiving OT and PT and more therapy time for both types of therapy compared with private-pay residents. Global budget payment was associated with greater access to PT but fewer weekly minutes of OT and PT. Little information exists to describe the characteristics and treatment of non elderly nursing home residents. This study found that many of these residents received rehabilitation and that residents whose care was paid for by more generous payers, such as Medicare, received more therapy than those paid for by less generous payers.

Hospitalization of Nursing Home Residents: The Effects of States' Medicaid Payment and Bed-Hold Policies

PubMed Central

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-01-01

Objective Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Data Sources/Study Setting Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Study Design Prospective cohort study of 570,614 older (≥65-year-old), non-MCO (Medicare Managed Care), long-stay (≥90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Principal Findings Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91–0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12–1.63). Conclusions State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting. PMID:17610442

"You Can't Mandate What Matters": Bumping Visions against Practices

ERIC Educational Resources Information Center

Merz, Alice H.; Swim, Terri Jo

2011-01-01

In this study, an American public school principal's vision of promoting growth in her teachers and students was inspired by the Reggio Emilia approach. Unlike other educational approaches, this approach did not involve a product, i.e., "to become Reggio", and it did not involve a set of rules or mandates. Instead, the principal had her…

Keeping Children Safe: Afterschool Staff and Mandated Child Maltreatment Reporting

ERIC Educational Resources Information Center

Gandarilla, Maria; O'Donnell, Julie

2014-01-01

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

High School CPR/AED Training in Washington State.

PubMed

Salvatierra, Gail G; Palazzo, Steven J; Emery, Allison

2017-05-01

Describe the rates of CPR/AED training in high schools in the state of Washington after passage of legislation mandating CPR/AED training. A web-based survey was sent to administrators at 660 public and private high schools in the state of Washington. The survey was completed by 148 schools (22%); 64% reported providing CPR training and 54% provided AED training. Reported barriers to implementation included instructor availability, cost, and a lack of equipment. Descriptive statistics were used to describe the sample characteristics and implementation rates. Mandates without resources and support do not ensure implementation of CPR/AED training in high schools. Full public health benefits of a CPR mandate will not be realized until barriers to implementation are identified and eliminated through use of available, accessible public health resources. © 2016 Wiley Periodicals, Inc.

Supporting the advancement of science: open access publishing and the role of mandates.

PubMed

Phelps, Lisa; Fox, Bernard A; Marincola, Francesco M

2012-01-24

In December 2011 the United States House of Representatives introduced a new bill, the Research Works Act (H.R.3699), which if passed could threaten the public's access to US government funded research. In a digital age when professional and lay parties alike look more and more to the online environment to keep up to date with developments in their fields, does this bill serve the best interests of the community? Those in support of the Research Works Act argue that government open access mandates undermine peer-review and take intellectual property from publishers without compensation, however journals like Journal of Translational Medicine show that this is not the case. Journal of Translational Medicine in affiliation with the Society for Immunotherapy of Cancer demonstrates how private and public organisations can work together for the advancement of science.

42 CFR 137.67 - How may a Self-Governance Tribe use interest earned on statutorily mandated grant funds?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false How may a Self-Governance Tribe use interest earned on statutorily mandated grant funds? 137.67 Section 137.67 Public Health PUBLIC HEALTH SERVICE... SELF-GOVERNANCE Statutorily Mandated Grants § 137.67 How may a Self-Governance Tribe use interest...

Health economic evaluations help inform payers of the best use of scarce health care resources.

PubMed

O'Reilly, Daria; Gaebel, Kathryn; Xie, Feng; Tarride, Jean-Eric; Goeree, Ron

2011-09-01

The number of new health technologies has risen over the past decade. These new technologies usually are more effective but they also cost more compared to existing ones. In a publicly funded health care system such as Canada, the aim is to maximize the health of the population within the resources available. As a result, it is unavoidable that choices and trade-offs have to be made because there will always be more treatment options than resources will allow (i.e., scarcity of resources) as well as alternative uses for those resources (i.e., opportunity costs). The objective of this paper is to provide an overview of economic evaluations and how these tools can be used to help inform payers of the best use of scarce health care resources. This descriptive paper includes a summary of key consepts and definitions in economic appraisal and draws upon recently published papers as illustrations. Background on the necessity and role of economic evaluations is provided, followed by a description of the approaches for, and types of, economic evaluations. Two illustrative examples are used and some implications for rural, remote and circumpolar communities are discussed. There are 2 main approaches for conducting an economic evaluation (trial- and model-based) and 3 types of evaluations which can be considered to inform payers of the best use of health care resources (cost-effectiveness, cost-utility and cost-benefit analyses). Techniques of economic evaluation are useful tools and an important input into the decision-making process. Although these techniques have universal application, there are issues specific to rural, remote and circumpolar communities which can affect the results of economic appraisals.

Challenges and Choices: A Multidistrict Analysis of Statewide Mandated Democratic Engagement

ERIC Educational Resources Information Center

Marsh, Julie A.; Hall, Michelle

2018-01-01

This article seeks to deepen our understanding of the nature and quality of democratic participation in educational reform by examining the first-year implementation of California's Local Control Funding Formula (LCFF) mandating civic engagement in district decision-making. Drawing on democratic theory, empirical literature, and data from 10…

Urban Educators' Perceptions of Culturally Relevant Pedagogy and School Reform Mandates

ERIC Educational Resources Information Center

Esposito, Jennifer; Davis, Corrie L.; Swain, Ayanna N.

2012-01-01

In this article, we examine urban teachers' perceptions of school reform models (SRMs) and culturally relevant pedagogy (CRP). In particular, we examined how urban educators altered mandated reform models in the best interests of their culturally and linguistically diverse students. We discuss data from a phenomenological study, which included…

The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate.

PubMed

Griffin, M; Panak, W F

1998-07-01

To examine the costs and outcomes of infertility-related services in Massachusetts during a time of expanded use of assisted reproductive technology (ART). Cost data were obtained from the Massachusetts Department of Insurance Rate-Setting Commission and 9 large group insurance plans for the period 1986-1993. Utilization and success rates of ART were examined, and the cost per live delivery with the use of ART in 1993 was estimated. The state of Massachusetts, in which access to infertility-related services has been mandated by law since 1989. The study population consisted of 8 large health maintenance organization plans and the Blue Cross/Blue Shield indemnity plan. None. Per capita infertility-related expenditures, infertility-related expenditures as a percentage of total expenditures, live deliveries per initiated ART cycle, and cost per live delivery. Expenditures for infertility services increased at a rate similar to or slower than inflation during the years 1988-1992. Increases were slowest in health maintenance organizations, probably as a result of provider arrangements. Infertility services accounted for 0.41% of total expenditures within the indemnity plan in 1993 (approximately $1.71 per contract-month). Examination of ART utilization showed no evidence of overutilization by patients with a low chance of success. The cost per live delivery with the use of ART in 1993 was $59,484. Mandated infertility coverage was associated with increased use of ART but not with excessive increases in consumer cost for infertility insurance coverage.

Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing.

PubMed

Becker, Nora V; Polsky, Daniel

2015-07-01

The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the intrauterine device and $255 annually for the oral contraceptive pill. Our results suggest that the mandate has led to large reductions in total out-of-pocket spending on contraceptives and that these price changes are likely to be salient for women with private health insurance. Project HOPE—The People-to-People Health Foundation, Inc.

Theme and Variations: One Middle School's Interpretation of Mandated Action Research

ERIC Educational Resources Information Center

Sheridan-Thomas, Heather K.

2006-01-01

In the current climate of accountability, action research is one way for teachers to evaluate instructional changes designed to improve assessment results. It may become increasingly common for administrators to mandate teacher involvement in action research, yet few studies have been conducted in such settings. This article focuses on one middle…

Changes in Intimate Partner Violence among Women Mandated to Community Services

ERIC Educational Resources Information Center

Macy, Rebecca J.; Rizo, Cynthia F.; Guo, Shenyang; Ermentrout, Dania M.

2013-01-01

Increasingly, female victims of intimate partner violence (IPV) are charged with IPV perpetration and mandated by courts or child protective services to receive domestic violence services. A critical need exists for evidence-based interventions targeting the needs of this unique population, but such research is scarce. To address this gap, we…

More than "An Apple a Day": New Mandates for School Wellness

ERIC Educational Resources Information Center

Woods, Amelia Mays; Weasmer, Jerie

2006-01-01

In this article, the authors discuss how, due to the increasing problems of obesity and sedentary lifestyles among children, schools have been mandated to instruct students on the importance of good nutritional habits and daily physical activity. Approaches to stimulating faculty to integrate wellness concepts and activities into curricula depend…

The dynamic model on the impact of biodiesel blend mandate (B5) on Malaysian palm oil domestic demand: A preliminary finding

NASA Astrophysics Data System (ADS)

Abidin, Norhaslinda Zainal; Applanaidu, Shri-Dewi; Sapiri, Hasimah

2014-12-01

Over the last ten years, world biofuels production has increased dramatically. The biodiesel demand is driven by the increases in fossil fuel prices, government policy mandates, income from gross domestic product and population growth. In the European Union, biofuel consumption is mostly driven by blending mandates in both France and Germany. In the case of Malaysia, biodiesel has started to be exported since 2006. The B5 of 5% blend of palm oil based biodiesel into diesel in all government vehicles was implemented in February 2009 and it is expected to be implemented nationwide in the nearest time. How will the blend mandate will project growth in the domestic demand of palm oil in Malaysia? To analyze this issue, a system dynamics model was constructed to evaluate the impact of blend mandate implementation on the palm oil domestic demand influence. The base run of simulation analysis indicates that the trend of domestic demand will increase until 2030 in parallel with the implementation of 5 percent of biodiesel mandate. Finally, this study depicts that system dynamics is a useful tool to gain insight and to experiment with the impact of changes in blend mandate implementation on the future growth of Malaysian palm oil domestic demand sector.

Assessing Relationship Quality in Mandated Community Treatment: Blending Care with Control

ERIC Educational Resources Information Center

Skeem, Jennifer L.; Louden, Jennifer Eno; Polaschek, Devon; Camp, Jacqueline

2007-01-01

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n = 90; n = 322), the authors developed and validated the revised Dual-Role…

Nudges or mandates? The ethics of mandatory flu vaccination.

PubMed

Dubov, Alex; Phung, Connie

2015-05-21

According to the CDC report for the 2012-2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011-2012, to 72% in 2012-2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions. Copyright © 2015 Elsevier Ltd. All rights reserved.

How would business react to an employer mandate?

PubMed

McArdle, F B

As difficult and controversial as it is to pass an employer mandate, implementation will be even harder. Business reactions will not be monolithic, but diverse and complicated, often diametrically opposed. Reactions also will vary dramatically with the actual design of the provision in question, for which there are many alternatives. "What exists out there now" has overt and subtle variations from employer to employer, from region to region, and from sector to sector. If an employer obligation were designed to be more respectful and reflective of that diversity, the odds of gaining greater acceptance and successful implementation by business would improve.

Randomized Controlled Trial of BASICS for Heavy Drinking Mandated and Volunteer Undergraduates: 12-Month Outcomes

PubMed Central

Terlecki, Meredith A.; Buckner, Julia D.; Larimer, Mary E.; Copeland, Amy L.

2014-01-01

This is the first randomized trial testing whether heavy drinking undergraduates mandated to the Brief Alcohol Screening and Intervention for College Students (BASICS) program following a campus alcohol violation would benefit as much as heavy drinking volunteers up to one year post-intervention using control groups with high-risk drinkers to model disciplinary-related and naturalistic changes in drinking. Participants (61% male; 51% mandated; 84% Caucasian; Mage = 20.14 years) were screened for heavy drinking and randomized to BASICS (n = 115) or assessment-only control (n = 110). Outcome measures (drinking, alcohol problems) were collected at baseline, 4 weeks, 3, 6, and 12 months post-intervention. At 4 weeks post-intervention, intent-to-treat multilevel longitudinal models showed that regardless of referral group (mandated or volunteer) BASICS significantly decreased weekly drinking, typical drinks, and peak drinks relative to controls (ds = .41-.92). BASICS had a large effect on decreases in alcohol problems (d = .87). At 12 months post-intervention, BASICS participants (regardless of referral group) reported significantly fewer alcohol problems (d = .56) compared to controls. Significant long-term intervention gains for peak and typical drinks were sustained in both referral groups relative to controls (ds = .42; .11). Referral group had no significant main effect and did not interact with intervention condition to predict outcomes. Given that BASICS was associated with less drinking and fewer alcohol problems (even among heavier drinking mandated students up to one year post-intervention), provision of BASICS-style programs within disciplinary settings may help reduce heavy and problematic drinking among at-risk students. PMID:25844834

The Lower-Order Expectations of High-Stakes Tests: A Four-State Analysis of Social Studies Standards and Test Alignment

ERIC Educational Resources Information Center

DeWitt, Scott W.; Patterson, Nancy; Blankenship, Whitney; Blevins, Brooke; DiCamillo, Lorrei; Gerwin, David; Gradwell, Jill M.; Gunn, John; Maddox, Lamont; Salinas, Cinthia; Saye, John; Stoddard, Jeremy; Sullivan, Caroline C.

2013-01-01

This study indicates that the state-mandated high-stakes social studies assessments in four states do not require students to demonstrate that they have met the cognitive demands articulated in the state-mandated learning standards. Further, the assessments do not allow students to demonstrate the critical thinking skills required by the…

Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery.

PubMed

Xie, Yang; Tang, Yuexin; Wehby, George L

2015-08-01

Utilization of breast reconstruction services remains low among women who underwent mastectomy despite the improvement in quality of life associated with this treatment. The objective of this study is to identify the effect of the Women's Health and Cancer Rights Act (WHCRA)-an understudied ongoing federal law that mandated insurance coverage of breast reconstruction following mastectomy beginning in 1999-on use of reconstructive surgery after mastectomy. We use a difference-in-differences (DD) approach to identify the change in breast reconstruction utilization induced by WHCRA by comparing the pre- and post-policy changes in utilization between states that did not have existing laws mandating coverage before the WHCRA (treatment group) and those that had such state laws (control group). The data are from the Surveillance, Epidemiology, and End Results program. The main sample includes 15,737 female patients who were under the age of 64 and underwent mastectomy within 4 months of diagnosis of early stage breast cancer during 1998 and 2000. Based on the DD model, the odds of using reconstruction services in the states without preexisting laws increased after the WHCRA by 31% in 1999 and 36% in 2000 (compared with 1998 before the WHCRA). These effects are masked in a simple pre/post model for change in reconstruction across all states. Additional analyses through 2007 indicate that the WHCRA had long-term effects on utilization. Furthermore, analyses by state indicate that most states in the treatment group experienced a significance increase in utilization. The use of breast reconstruction after mastectomy significantly increased after the WHCRA. At a minimum, our estimates may be considered the lower bound of the real policy effect.

The Payer and Patient Cost Burden of Open Breast Conserving Procedures Following Percutaneous Breast Biopsy.

PubMed

Kimball, Chloe C; Nichols, Christine I; Vose, Joshua G

2018-01-01

Percutaneous core-needle biopsy (PCNB) is the standard of care to biopsy and diagnose suspicious breast lesions. Dependent on histology, many patients require additional open procedures for definitive diagnosis and excision. This study estimated the payer and patient out-of-pocket (OOP) costs, and complication risk, among those requiring at least 1 open procedure following PCNB. This retrospective study used the Truven Commercial database (2009-2014). Women who underwent PCNB, with continuous insurance, and no history of cancer, chemotherapy, radiation, or breast surgery in the prior year were included. Open procedures were defined as open biopsy or lumpectomy. Study follow-up ended at chemotherapy, radiation, mastectomy, or 90 days-whichever occurred first. In total, 143 771 patients (mean age 48) met selection criteria; 85.1% underwent isolated PCNB, 12.4% one open procedure, and 2.5% re-excision. Incidence of complications was significantly lower among those with PCNB alone (9.2%) vs 1 open procedure (15.6%) or re-excision (25.3%, P  < .001). Mean incremental commercial payments were US $13 190 greater among patients with 1 open procedure vs PCNB alone (US $17 125 vs US $3935, P  < .001), and US $4767 greater with re-excision (US $21 892) relative to 1 procedure. Mean patient OOP cost was US $858 greater for 1 open procedure vs PCNB alone (US $1527 vs US $669), and US $247 greater for re-excision vs 1 procedure. A meaningful proportion of patients underwent open procedure(s) following PCNB which was associated with increased complication risk and costs to both the payer and the patient. These results suggest a need for technologies to reduce the proportion of cases requiring open surgery and, in some cases, re-excision.

Economic impact of angioplasty salvage techniques, with an emphasis on coronary stents: a method incorporating costs, revenues, clinical effectiveness and payer mix.

PubMed

Vaitkus, P T; Witmer, W T; Brandenburg, R G; Wells, S K; Zehnacker, J B

1997-10-01

We sought to broaden assessment of the economic impact of percutaneous transluminal coronary angioplasty (PTCA) revascularization salvage strategies by taking into account costs, revenues, the off-setting effects of prevented clinical complications and the effects of payer mix. Previous economic analyses of PTCA have focused on the direct costs of treatment but have not accounted either for associated revenues or for the ability of costly salvage techniques such as coronary stenting to reduce even costlier complications. Procedural costs, revenues and contribution margins (i.e., "profit") were measured for 765 consecutive PTCA cases to assess the economic impact of salvage techniques (prolonged heparin administration, thrombolysis, intracoronary stenting or use of perfusion balloon catheters) and clinical complications (myocardial infarction, coronary artery bypass graft surgery [CABG] or acute vessel closure with repeat PTCA). To assess the economic impact of various salvage techniques for failed PTCA, we used actual 1995 financial data as well as models of various mixes of fee-for-service, diagnosis-related group (DRG) and capitated payers. Under fee-for-service arrangements, most salvage techniques were profitable for the hospital. Stents were profitable at almost any level of clinical effectiveness. Under DRG-based systems, most salvage techniques such as stenting produced a financial loss to the hospital because one complication (CABG) remained profitable. Under capitated arrangements, stenting and other salvage modalities were profitable only if they were clinically effective in preventing complications in > 50% of cases in which they were used. The economic impact of PTCA salvage techniques depends on their clinical effectiveness, costs and revenues. In reimbursement systems dominated by DRG payers, salvage techniques are not rewarded, whereas complications are. Under capitated systems, the level of clinical effectiveness needed to achieve cost savings is

New Mandates and Imperatives in the Revised "ACA Code of Ethics"

ERIC Educational Resources Information Center

Kaplan, David M.; Kocet, Michael M.; Cottone, R. Rocco; Glosoff, Harriet L.; Miranti, Judith G.; Moll, E. Christine; Bloom, John W.; Bringaze, Tammy B.; Herlihy, Barbara; Lee, Courtland C.; Tarvydas, Vilia M.

2009-01-01

The first major revision of the "ACA Code of Ethics" in a decade occurred in late 2005, with the updated edition containing important new mandates and imperatives. This article provides interviews with members of the Ethics Revision Task Force that flesh out seminal changes in the revised "ACA Code of Ethics" in the areas of confidentiality,…

42 CFR 137.65 - May a Self-Governance Tribe receive statutorily mandated grant funding in an annual lump sum...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May a Self-Governance Tribe receive statutorily mandated grant funding in an annual lump sum advance payment? 137.65 Section 137.65 Public Health PUBLIC... HUMAN SERVICES TRIBAL SELF-GOVERNANCE Statutorily Mandated Grants § 137.65 May a Self-Governance Tribe...

Hospital revenue cycle management and payer mix: do Medicare and Medicaid undermine hospitals' ability to generate and collect patient care revenue?

PubMed

Rauscher, Simone; Wheeler, John R C

2010-01-01

The continuing efforts of government payers to contain hospital costs have raised concerns among hospital managers that serving publicly insured patients may undermine their ability to manage the revenue cycle successfully. This study uses financial information from two sources-Medicare cost reports for all US hospitals for 2002 to 2007 and audited financial statements for all bond-issuing, not-for-profit hospitals for 2000 to 2006 to examine the relationship between hospitals' shares of Medicare and Medicaid patients and the amount of patient care revenue they generate as well as the speed with which they collect their revenue. Hospital-level fixed effects regression analysis finds that hospitals with higher Medicare and Medicaid payer mix collect somewhat higher average patient care revenues than hospitals with more privately insured and self-pay patients. Hospitals with more Medicare patients also collect on this revenue faster; serving more Medicaid patients is not associated with the speed of patient revenue collection. For hospital managers, these findings may represent good news. They suggest that, despite increases in the number of publicly insured patients served, managers have frequently been able to generate adequate amounts of patient revenue and collect it in a timely fashion.

Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students

PubMed Central

Miller, Mary Beth; Borsari, Brian; Fernandez, Anne C.; Yurasek, Ali M.; Hustad, John T. P.

2016-01-01

Background Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear. Objective The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy. Method Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N=212, 41% female, 80% White, Mage =19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims. Results Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication. Conclusions/Importance Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol. PMID:27070480

Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students.

PubMed

Miller, Mary Beth; Borsari, Brian; Fernandez, Anne C; Yurasek, Ali M; Hustad, John T P

2016-07-02

Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear. The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy. Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims. Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication. Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.

A College Administrator's Framework to Assess Compliance with Accreditation Mandates

ERIC Educational Resources Information Center

Davis†, Jerry M.; Rivera, John-Juan

2014-01-01

A framework to assess the impact of complying with college accreditation mandates is developed based on North's (1996) concepts of transaction costs, property rights, and institutions; Clayton's (1999) Systems Alignment Model; and the educational production function described by Hanushek (2007). The framework demonstrates how sought…

Congress, courts, and commerce: upholding the individual mandate to protect the public's health.

PubMed

Hodge, James G; Brown, Erin C Fuse; Orenstein, Daniel G; O'Keefe, Sarah

2011-01-01

Among multiple legal challenges to the Patient Protection and Affordable Care Act (PPACA) is the premise that PPACA's "individual mandate" (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is inviolate of Congress' interstate commerce powers because Congress lacks the power to regulate commercial "inactivity." Several courts initially considering this argument have rejected it, but federal district courts in Virginia and Florida have concurred, leading to numerous appeals and prospective review of the United States Supreme Court. Despite creative arguments, the dispositive constitutional question is not whether Congress' interstate commerce power extends to commercial inactivity. Rather, it is whether Congress may regulate individual decisions with significant economic ramifications in the interests of protecting and promoting the public's health. This article offers a counter-interpretation of the scope of Congress' interstate commerce power to regulate in furtherance of the public's health. © 2011 American Society of Law, Medicine & Ethics, Inc.

From Birth Control to Sex Control: Unruly Young Women and the Origins of the National Abstinence-Only Mandate.

PubMed

Ehrlich, J Shoshanna

2013-01-01

In the early 1980s, conservative politicians in the United States argued that the federal government was promoting promiscuity by providing teens with confidential access to government-funded family planning services. Claiming the problem was not that young women were getting pregnant but that they were having sex, they promised a new national policy-one that would stress self-discipline and family values over sexual indulgence. As argued in this paper, the resulting abstinence-only federal mandate both draws upon and reinforces traditional sexual scripts, which hold young women responsible for keeping male passion in check, thus selectively burdening them with the work of "doing abstinence."

State insurance parity legislation for autism services and family financial burden.

PubMed

Parish, Susan; Thomas, Kathleen; Rose, Roderick; Kilany, Mona; McConville, Robert

2012-06-01

We examined the association between states' legislative mandates that private insurance cover autism services and the health care-related financial burden reported by families of children with autism. Child and family data were drawn from the National Survey of Children with Special Health Care Needs (N  =  2,082 children with autism). State policy characteristics were taken from public sources. The 3 outcomes were whether a family had any out-of-pocket health care expenditures during the past year for their child with autism, the expenditure amount, and expenditures as a proportion of family income. We modeled the association between states' autism service mandates and families' financial burden, adjusting for child-, family-, and state-level characteristics. Overall, 78% of families with a child with autism reported having any health care expenditures for their child for the prior 12 months. Among these families, 54% reported expenditures of more than $500, with 34% spending more than 3% of their income. Families living in states that enacted legislation mandating coverage of autism services were 28% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. Families living in states that enacted parity legislation mandating coverage of autism services were 29% less likely to report spending more than $500 for their children's health care costs, net of child and family characteristics. This study offers preliminary evidence in support of advocates' arguments that requiring private insurers to cover autism services will reduce families' financial burdens associated with their children's health care expenses.

Mandated fuel economy standards as a strategy for improving motor vehicle fuel economy.

DOT National Transportation Integrated Search

1978-10-19

The major domestic motor vehicle manufacturers have projected that their new car fleet average fuel economy will meet the federal mandated fuel economy standard for 1985, of 27.5 miles per gallon. Assuming that these projections hold true, in one dec...

State Testing Standards versus Creativity.

ERIC Educational Resources Information Center

Ediger, Marlow

The balance between conformity to state standards and creativity in providing for individual differences in the classroom is discussed. With the current emphases on accountability and standards, learning opportunities for students are supposed to be aligned with state-mandated objectives. This may lead to a situation in which rote learning,…

Costs of Chronic Diseases at the State Level: The Chronic Disease Cost Calculator

PubMed Central

Murphy, Louise B.; Khavjou, Olga A.; Li, Rui; Maylahn, Christopher M.; Tangka, Florence K.; Nurmagambetov, Tursynbek A.; Ekwueme, Donatus U.; Nwaise, Isaac; Chapman, Daniel P.; Orenstein, Diane

2015-01-01

Introduction Many studies have estimated national chronic disease costs, but state-level estimates are limited. The Centers for Disease Control and Prevention developed the Chronic Disease Cost Calculator (CDCC), which estimates state-level costs for arthritis, asthma, cancer, congestive heart failure, coronary heart disease, hypertension, stroke, other heart diseases, depression, and diabetes. Methods Using publicly available and restricted secondary data from multiple national data sets from 2004 through 2008, disease-attributable annual per-person medical and absenteeism costs were estimated. Total state medical and absenteeism costs were derived by multiplying per person costs from regressions by the number of people in the state treated for each disease. Medical costs were estimated for all payers and separately for Medicaid, Medicare, and private insurers. Projected medical costs for all payers (2010 through 2020) were calculated using medical costs and projected state population counts. Results Median state-specific medical costs ranged from $410 million (asthma) to $1.8 billion (diabetes); median absenteeism costs ranged from $5 million (congestive heart failure) to $217 million (arthritis). Conclusion CDCC provides methodologically rigorous chronic disease cost estimates. These estimates highlight possible areas of cost savings achievable through targeted prevention efforts or research into new interventions and treatments. PMID:26334712

Controversies over the Pledge of Allegiance in Public Schools: Case Studies Involving State Law, 9/11, and the Culture Wars

ERIC Educational Resources Information Center

Montgomery, Jennifer J.

2015-01-01

This dissertation examines state-level efforts to mandate the Pledge of Allegiance in public schools, especially following 9/11. Despite longstanding Supreme Court precedent declaring mandatory flag salutes unconstitutional, various state legislatures sought to institute or strengthen pledge mandates irrespective of students' civil liberties.…

The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services.

PubMed

Shane, Dan M; Wehby, George L

2017-09-01

Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. 2006-2013 Medical Expenditure Panel Surveys. We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.

Perfect Storm: Analyzing Strategic Issues Confronting Program Executive Office, Missiles and Space

DTIC Science & Technology

2007-03-30

question or challenge affecting an organization’s mandates, mission, and values; product or service level and mix ; clients, users, or payers; or...the people are the right mix . This also includes the rewards program that provides motivation and incentives for the achievement of goals. The...visible indicators of organizational success (e.g., exploding Starbucks growth). Outputs can be described in terms of three factors. How successfully

Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases.

PubMed

Nikpay, Sayeh; Freedman, Seth; Levy, Helen; Buchmueller, Tom

2017-08-01

We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014. Analyses controlled for state-level demographic and economic characteristics. We found that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in nonexpansion states after 2014 (95% confidence interval [CI] 1.1 to 3.9). Among the visit types that could be measured, increases in ED visits were largest for injury-related visits and for states with the largest changes in Medicaid enrollment. Compared with nonexpansion states, in expansion states the share of ED visits covered by Medicaid increased 8.8 percentage points (95% CI 5.0 to 12.6), whereas the uninsured share decreased by 5.3 percentage points (95% CI -1.7 to -8.9). The ACA's Medicaid expansion has resulted in changes in payer mix. Contrary to other studies of the ACA's effect on ED visits, our study found that the expansion also increased use of the ED, consistent with polls of emergency physicians. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Obtaining evidence for use by healthcare payers on the success of chronic obstructive pulmonary disease management.

PubMed

Mapel, D; Pearson, M

2002-08-01

Healthcare payers make decisions on funding for treatments for diseases, such as chronic obstructive pulmonary disease (COPD), on a population level, so require evidence of treatment success in appropriate populations, using usual routine care as the comparison for alternative management approaches. Such health outcomes evidence can be obtained from a number of sources. The 'gold standard' method for obtaining evidence of treatment success is usually taken as the randomized controlled prospective clinical trial. Yet the value of such studies in providing evidence for decision-makers can be questioned due to the restricted entry criteria limiting the ability to generalize to real life populations, narrow focus on individual parameters, use of placebo for comparison rather than usual therapy and unrealistic intense monitoring of patients. Evidence obtained from retrospective and observational studies can supplement that from randomized clinical trials, providing that care is taken to guard against bias and confounders. However, very large numbers of patients must be investigated if small differences between drugs and treatment approaches are to be detected. Administrative databases from healthcare systems provide an opportunity to obtain observational data on large numbers of patients. Such databases have shown that high healthcare costs in patients with COPD are associated with co-morbid conditions and current smoking status. Analysis of an administrative database has also shown that elderly patients with COPD who received inhaled corticosteroids within 90 days of discharge from hospital had 24% fewer repeat hospitalizations for COPD and were 29% less likely to die during the 1-year follow-up period. In conclusion, there are a number of sources of meaningful evidence of the health outcomes arising from different therapeutic approaches that should be of value to healthcare payers making decisions on resource allocation.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A nationwide survey of state-mandated evaluation practices for domestic violence agencies.

PubMed

Riger, Stephanie; Staggs, Susan L

2011-01-01

Many agencies serving survivors of domestic violence are required to evaluate their services. Three possible evaluation strategies include: a) process measurement, which typically involves a frequency count of agency activities, such as the number of counseling hours given; b) outcome evaluation, which measures the impact of agency activities on clients, such as increased understanding of the dynamics of abuse; or c) performance measurement, which assesses the extent to which agencies achieve their stated goals. Findings of a telephone survey of state funders of domestic violence agencies in the United States revealed that most states (67%) require only process measurement, while fewer than 10% require performance measurement. Most (69%) funders reported satisfaction with their evaluation strategy and emphasized the need for involvement of all stakeholders, especially grantees, in developing an evaluation.

How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

PubMed

Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

2017-06-01

While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction.

PubMed

Mahmoudi, Elham; Lu, Yiwen; Metz, Allan K; Momoh, Adeyiza O; Chung, Kevin C

2017-08-01

With the stabilization of breast cancer incidence and substantial improvement in survival, more attention has focused on postmastectomy breast reconstruction (PBR). Despite its demonstrated benefits, wide disparities in the use of PBR remain. Physician-patient communication has an important role in disparities in health care, especially for elective surgical procedures. Recognizing this, the State of New York enacted Public Health Law (NY PBH Law) 2803-o in 2011 mandating that physicians communicate about reconstructive surgery with patients undergoing mastectomy. To evaluate whether mandated physician-patient communication is associated with reduced racial/ethnic disparities in immediate PBR (IPBR). This retrospective study used state inpatient data from January 1, 2008, through December 31, 2011, in New York and California to evaluate a final sample of 42 346 women aged 20 to 70 years, including 19 364 from New York (treatment group) and 22 982 from California (comparison group). The primary hypothesis tested the effect of the New York law on racial/ethnic disparities, using California as a comparator. The National Academy of Medicine's (formerly Institute of Medicine) definition of a disparity was applied, and a difference-in-differences method (before-and-after comparison design) was used to evaluate the association of NY PBH Law 2803-o mandating physician-patient communication with disparities in IPBR. Data were analyzed from July 1, 2016, to February 24, 2017. New York PBH Law 2803-o was implemented on January 1, 2011. The preexposure period included January 1, 2008, through December 31, 2010 (3 years); the postexposure period, January 1 through December 31, 2011 (1 year). The primary outcome was use of IPBR among white, African American, Hispanic, and other minority groups before and after the implementation of NY PBH Law 2803-o. Among the 42 346 women (mean [SD] age, 53 [10] years), 65.3% (27 654) were white, 12.7% (5365) were Hispanic, 9.4% (3976

Sequence-Mandated, Distinct Assembly of Giant Molecules

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

Zhang, Wei; Lu, Xinlin; Mao, Jialin

Although controlling the primary structure of synthetic polymers is itself a great challenge, the potential of sequence control for tailoring hierarchical structures remains to be exploited, especially in the creation of new and unconventional phases. A series of model amphiphilic chain-like giant molecules was designed and synthesized by interconnecting both hydrophobic and hydrophilic molecular nanoparticles in precisely defined sequence and composition to investigate their sequence-dependent phase structures. Not only compositional variation changed the self-assembled supramolecular phases, but also specific sequences induce unconventional phase formation, including Frank-Kasper phases. The formation mechanism was attributed to the conformational change driven by the collectivemore » hydrogen bonding and the sequence-mandated topology of the molecules. Lastly, these results show that sequence control in synthetic polymers can have a dramatic impact on polymer properties and self-assembly.« less

Sequence-Mandated, Distinct Assembly of Giant Molecules

DOE PAGES

Zhang, Wei; Lu, Xinlin; Mao, Jialin; ...

2017-10-24

Although controlling the primary structure of synthetic polymers is itself a great challenge, the potential of sequence control for tailoring hierarchical structures remains to be exploited, especially in the creation of new and unconventional phases. A series of model amphiphilic chain-like giant molecules was designed and synthesized by interconnecting both hydrophobic and hydrophilic molecular nanoparticles in precisely defined sequence and composition to investigate their sequence-dependent phase structures. Not only compositional variation changed the self-assembled supramolecular phases, but also specific sequences induce unconventional phase formation, including Frank-Kasper phases. The formation mechanism was attributed to the conformational change driven by the collectivemore » hydrogen bonding and the sequence-mandated topology of the molecules. Lastly, these results show that sequence control in synthetic polymers can have a dramatic impact on polymer properties and self-assembly.« less

Cost-utility analysis of duloxetine in osteoarthritis: a US private payer perspective.

PubMed

Wielage, Ronald C; Bansal, Megha; Andrews, J Scott; Klein, Robert W; Happich, Michael

2013-06-01

Duloxetine has recently been approved in the USA for chronic musculoskeletal pain, including osteoarthritis and chronic low back pain. The cost effectiveness of duloxetine in osteoarthritis has not previously been assessed. Duloxetine is targeted as post first-line (after acetaminophen) treatment of moderate to severe pain. The objective of this study was to estimate the cost effectiveness of duloxetine in the treatment of osteoarthritis from a US private payer perspective compared with other post first-line oral treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), and both strong and weak opioids. A cost-utility analysis was performed using a discrete-state, time-dependent semi-Markov model based on the National Institute for Health and Clinical Excellence (NICE) model documented in its 2008 osteoarthritis guidelines. The model was extended for opioids by adding titration, discontinuation and additional adverse events (AEs). A life-long time horizon was adopted to capture the full consequences of NSAID-induced AEs. Fourteen health states comprised the structure of the model: treatment without persistent AE, six during-AE states, six post-AE states and death. Treatment-specific utilities were calculated using the transfer-to-utility method and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores from a meta-analysis of osteoarthritis clinical trials of 12 weeks and longer. Costs for 2011 were estimated using Red Book, The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project database, the literature and, sparingly, expert opinion. One-way and probabilistic sensitivity analyses were undertaken, as well as subgroup analyses of patients over 65 years old and a population at greater risk of NSAID-related AEs. In the base case the model estimated naproxen to be the lowest total-cost treatment, tapentadol the highest cost, and duloxetine the most effective after considering AEs. Duloxetine

24 CFR 5.233 - Mandated use of HUD's Enterprise Income Verification (EIV) System.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Mandated use of HUD's Enterprise Income Verification (EIV) System. 5.233 Section 5.233 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Disclosure...

Do coverage mandates affect direct-to-consumer advertising for pharmaceuticals? Evidence from parity laws.

PubMed

Nathenson, Robert; Richards, Michael R

2018-01-29

Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws. We focus on mental health parity statutes and related drug therapies-a potentially ripe setting for inducing stronger consumer demand. We find no clear indication that firms expect greater value from DTCA after these regulatory changes. DTCA appears driven by other considerations (e.g., product debut); however, it remains a possibility that firms respond to these laws through other, unobserved channels (e.g., provider detailing).

The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.

PubMed

Kesselheim, Aaron S; Avorn, Jerry; Sarpatwari, Ameet

The increasing cost of prescription drugs in the United States has become a source of concern for patients, prescribers, payers, and policy makers. To review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs. We reviewed the peer-reviewed medical and health policy literature from January 2005 to July 2016 for articles addressing the sources of drug prices in the United States, the justifications and consequences of high prices, and possible solutions. Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products. Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs. Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription

Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

PubMed

Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

2015-08-01

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

Substance use disorder patients who are mandated to treatment: characteristics, treatment process, and 1- and 5-year outcomes.

PubMed

Kelly, John F; Finney, John W; Moos, Rudolf

2005-04-01

A substantial number of patients with substance use disorders (SUDs) are mandated to treatment by the justice system. However, little is known about their characteristics and how they fare during treatment and in the longer term compared with nonmandated, justice-system-involved patients and patients not involved in the justice system. This prospective study (n=2,095) examined differences in pretreatment characteristics, treatment perceptions and satisfaction, during-treatment changes, and 1- and 5-year outcomes among these three types of patients and tested whether differences in pretreatment characteristics or during-treatment changes could help explain posttreatment outcome similarities or differences. Mandated patients had a less severe clinical profile at treatment intake, yet this did not account for their observed similar/better outcomes, which appeared because of the similar therapeutic gains made during treatment. Treatment perceptions and satisfaction were also comparable across groups. These findings appear to support the idea that judicial mandates can provide an opportunity for offenders with SUDs to access and benefit from needed treatment.

Disparities in Assisted Reproductive Technology Utilization by Race and Ethnicity, United States, 2014: A Commentary.

PubMed

Dieke, Ada C; Zhang, Yujia; Kissin, Dmitry M; Barfield, Wanda D; Boulet, Sheree L

2017-06-01

Disparities in infertility and access to infertility treatments, such as assisted reproductive technology (ART), by race/ethnicity, have been reported. However, identifying disparities in ART usage may have been hampered by missing race/ethnicity information in ART surveillance. We review infertility prevalence and treatment disparities, use recent data to examine ART use in the United States by race/ethnicity and residency in states with mandated insurance coverage for in vitro fertilization (IVF), and discuss approaches for reducing disparities. We used 2014 National ART Surveillance System (NASS) data to calculate rates of ART procedures per million women 15-44 years of age, a proxy measure of ART utilization, for Census-defined racial/ethnic groups in the United States; rates were further stratified by the presence of insurance mandates for IVF treatment. Missing race/ethnicity data (35.6% of cycles) were imputed. Asian/Pacific Islander (A/PI) women had the highest rates of ART utilization at 5883 ART procedures per million women 15-44 years of age in 2014, whereas American Indian/Alaska Native non-Hispanic women had the lowest rates at 807 per million, compared with other racial/ethnic groups. In each racial/ethnic category, ART utilization rates were higher for women in states with an insurance mandate for IVF treatment versus those without. In 2014, A/PI women had the highest rates of ART utilization. ART utilization for all racial/ethnic groups was higher in states with insurance mandates for IVF than those without, although disparities were still evident. Although mandates may increase access to infertility treatments, they are not sufficient to eliminate these disparities.

Law, Language, and the Multiethnic State.

ERIC Educational Resources Information Center

De Varennes, Fernand

1996-01-01

Examines why language policies should be considered in a multiethnic state and suggests that there are human rights issues that mandate some recognition of language demands and usage beyond what some states may provide. The article emphasizes that questions of language, ethnicity, and nationalism must be addressed in a rational and coherent…

South African Educators' Mutually Inclusive Mandates to Promote Human Rights and Positive Discipline

ERIC Educational Resources Information Center

Coetzee, Susan; Mienie, Cathrine

2013-01-01

South African educators are mandated by international and national law to observe and promote human rights. However, given the realities of the limited teaching time available, educators cannot fulfill this obligation solely by teaching the curriculum. Another avenue needs to be found for educators to fulfill this obligation. Educators are also…

The Impact of Increased State Regulation of Campus Sexual Assault Practices: Perspectives of Campus Personnel

ERIC Educational Resources Information Center

Brubaker, Sarah Jane; Mancini, Christina

2017-01-01

Seeking to improve university accountability and compliance with federal mandates, states are considering new reforms including mandating reporting of campus sexual assault allegations. These new policies remain an empirical "black box." To address these gaps, the current exploratory study draws upon a recent survey that examines the…

Human papillomavirus vaccine recommendations and agreement with mandated human papillomavirus vaccination for 11-to-12-year-old girls: a statewide survey of Texas physicians.

PubMed

Kahn, Jessica A; Cooper, H Paul; Vadaparampil, Susan T; Pence, Barbara C; Weinberg, Armin D; LoCoco, Salvatore J; Rosenthal, Susan L

2009-08-01

The purpose of this study was to examine Texas physicians' recommendations for the quadrivalent human papillomavirus (HPV) vaccine in 11-to-12-year-old girls, intention to recommend HPV vaccines to 11-to-12-year-old boys, and attitudes about mandated HPV vaccination for 11-to-12-year-old girls. We conducted a cross-sectional, web-based survey of Texas physicians who provide direct patient care in family medicine, pediatrics, obstetrics/gynecology, and internal medicine in September 2008. The three outcome variables were: HPV vaccine recommendations to 11-to-12-year-old girls, likelihood of recommending the vaccine to 11-to-12-year-old boys, and agreement with mandated vaccination of 11-to-12-year-old girls. Univariate and logistic regression analyses were used to determine practice-related and attitudinal factors associated with each outcome. Of the 1,122 respondents, 48.5% stated they always recommended HPV vaccines to girls, 68.4% were likely to recommend the vaccine to boys, and 41.7% agreed with mandated vaccination. In multivariate logistic regression models, variables independently associated with recommendation to 11-to-12-year-old girls included: percentage of patients with Medicaid [odds ratio (OR), 1.02; 95% confidence interval (95% CI), 1.01-1.03], academic versus nonacademic practice (OR, 2.11; 95% CI, 1.05-4.23), office procedures to maximize vaccination (OR, 1.25; 95% CI, 1.01-1.56), HPV knowledge (OR, 1.25; 95% CI, 1.04-1.49), valuing HPV vaccine information from both professional organizations (OR, 1.90; 95% CI, 1.15-3.16) and professional conferences (OR, 1.68; 95% CI, 1.10-2.57), belief in mandated HPV vaccination (OR, 5.38; 95% CI, 3.28-8.83), and barriers to vaccination (OR, 1.08; 95% CI, 1.00-1.16). Half of the physicians in this study did not follow current recommendations for universal HPV vaccination of 11-to-12-year-old girls. Factors linked to vaccine recommendations may be targeted in educational or policy interventions.

State Policies To Improve Undergraduate Teaching: Administrator and Faculty Responses.

ERIC Educational Resources Information Center

Colbeck, Carol L.

2002-01-01

Compared faculty and administrator responses at Ohio State University and Youngstown State University versus the University of Tennessee, Knoxville and Tennessee Technological University to their states' policies to improve undergraduate instruction. Found that responses to Ohio's faculty workload mandate versus Tennessee's performance funding…

State School Finance Litigation: A Background Paper.

ERIC Educational Resources Information Center

Larson, Lisa

In October 1988, 48 suburban and greater Minnesota school districts, representing approximately 20 percent of the state's public elementary and secondary school students, filed a lawsuit claiming that Minnesota's school financing system violates the state's constitutional mandate for equality of educational opportunity. (A ruling in the case is…

Mandated Psychological Assessments for Suicide Risk in a College Population: A Pilot Study

ERIC Educational Resources Information Center

Kirchner, Grace L.; Marshall, Donn; Poyner, Sunney R.

2017-01-01

This study was conducted to evaluate the impact of a protocol mandating psychological assessment of college students exhibiting specific signs of suicide risk and/or nonsuicidal self-harm. Thirty-seven current and former students who had been documented as at risk completed a structured interview in person or by phone. Outcomes suggest this…

Mandated Literacy Assessment and the Reorganisation of Teachers' Work: Federal Policy, Local Effects

ERIC Educational Resources Information Center

Comber, Barbara

2012-01-01

This paper explores how mandated literacy assessment is reorganising teachers' work in the context of Australia's National Assessment Program--Literacy and Numeracy, which was implemented in 2008. Students in Years 3, 5, 7 and 9 are tested annually, with school results publicly available. The wider policy context and the emergence of different…

States as Change Agents under ESSA

ERIC Educational Resources Information Center

Weiss, Joanne; McGuinn, Patrick

2016-01-01

Under the Every Student Succeeds Act (ESSA), federal education mandates will be decreasing, which means states will have more flexibility and authority than they've had in decades. State education agency (SEA) leaders are confronting great change and great opportunity as many agencies move away from a focus on compliance with federal regulations,…

Optimal Mandates and The Welfare Cost of Asymmetric Information: Evidence from The U.K. Annuity Market*

PubMed Central

Einav, Liran; Finkelstein, Amy; Schrimpf, Paul

2009-01-01

Much of the extensive empirical literature on insurance markets has focused on whether adverse selection can be detected. Once detected, however, there has been little attempt to quantify its welfare cost, or to assess whether and what potential government interventions may reduce these costs. To do so, we develop a model of annuity contract choice and estimate it using data from the U.K. annuity market. The model allows for private information about mortality risk as well as heterogeneity in preferences over different contract options. We focus on the choice of length of guarantee among individuals who are required to buy annuities. The results suggest that asymmetric information along the guarantee margin reduces welfare relative to a first best symmetric information benchmark by about £127 million per year, or about 2 percent of annuitized wealth. We also find that by requiring that individuals choose the longest guarantee period allowed, mandates could achieve the first-best allocation. However, we estimate that other mandated guarantee lengths would have detrimental effects on welfare. Since determining the optimal mandate is empirically difficult, our findings suggest that achieving welfare gains through mandatory social insurance may be harder in practice than simple theory may suggest. PMID:20592943

Optimal Mandates and The Welfare Cost of Asymmetric Information: Evidence from The U.K. Annuity Market.

PubMed

Einav, Liran; Finkelstein, Amy; Schrimpf, Paul

2010-05-01

Much of the extensive empirical literature on insurance markets has focused on whether adverse selection can be detected. Once detected, however, there has been little attempt to quantify its welfare cost, or to assess whether and what potential government interventions may reduce these costs. To do so, we develop a model of annuity contract choice and estimate it using data from the U.K. annuity market. The model allows for private information about mortality risk as well as heterogeneity in preferences over different contract options. We focus on the choice of length of guarantee among individuals who are required to buy annuities. The results suggest that asymmetric information along the guarantee margin reduces welfare relative to a first best symmetric information benchmark by about £127 million per year, or about 2 percent of annuitized wealth. We also find that by requiring that individuals choose the longest guarantee period allowed, mandates could achieve the first-best allocation. However, we estimate that other mandated guarantee lengths would have detrimental effects on welfare. Since determining the optimal mandate is empirically difficult, our findings suggest that achieving welfare gains through mandatory social insurance may be harder in practice than simple theory may suggest.

Insights into Education's Race to the Top: Correlational Survey Exploring Perceptions of Organizational Culture and Change Ambivalence during the Implementation of a Mandated Performance Evaluation System in a Northeast U.S. School District

ERIC Educational Resources Information Center

Schwamb, Andrea B.

2013-01-01

American public schools are currently facing a new mandated evaluation system that will create substantial change by requiring districts to evaluate professional staff based on two quantified measures: (a) state testing, and (b) a district determined measure. Although reforms have been at the forefront of policymakers' agendas, these initiatives…

Real-World Evidence: Useful in the Real World of US Payer Decision Making? How? When? And What Studies?

PubMed

Malone, Daniel C; Brown, Mary; Hurwitz, Jason T; Peters, Loretta; Graff, Jennifer S

2018-03-01

To examine how real-world evidence (RWE) is currently perceived and used in managed care environments, especially to inform pharmacy and therapeutic (P&T) committee decisions, to assess which study factors (e.g., data, design, and funding source) contribute to RWE utility in decisions, and to identify barriers to consideration of RWE studies in P&T decision making. We conducted focus groups/telephone-based interviews and surveys to understand perceptions of RWE and assess awareness, quality, and relevance of two high-profile examples of published RWE studies. A purposive sample comprised 4 physicians, 15 pharmacists, and 1 researcher representing 18 US health plans and health system organizations. Participants reported that RWE was generally used, or useful, to inform safety monitoring, utilization management, and cost analysis, but less so to guide P&T decisions. Participants were not aware of the two sample RWE studies but considered both studies to be valuable. Relevant research questions and outcomes, transparent methods, study quality, and timely results contribute to the utility of published RWE. Perceived organizational barriers to the use of published RWE included lack of skill, training, and timely study results. Payers recognize the value of RWE, but use of such studies to inform P&T decisions varies from organization to organization and is limited. Relevance to payers, timeliness, and transparent methods were key concerns with RWE. Participants recognized the need for continuing education on evaluating and using RWE to better understand the study methods, findings, and applicability to their organizations. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.

PubMed

Morgan, Steven G; Vogler, Sabine; Wagner, Anita K

2017-04-01

Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favorable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggest that the list prices for medicines bear limited resemblance to what many institutional payers actually pay. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Understanding modern energy policy: An evaluation of RPS mandates and behavioral nudges

NASA Astrophysics Data System (ADS)

Brannan, Deborah Lynn Baker

Climate change has emerged as one of the leading policy issues of the early 21st century. In response, a variety of policies and programs have been adopted encouraging renewable energy, energy efficiency and energy conservation. My dissertation consists of three research papers which evaluate two classes of modern energy policy in the United States: renewable energy mandates and behavioral nudges. The Renewable Portfolio Standard (RPS) is the most prominent state-level renewable energy policy in the United States and has been debated several times at the federal level. Using a fixed-effects panel data model I study the existing experience of the RPS to help inform the policy debate. In contrast with the previous literature that has predominantly studied the average effect of the RPS on renewable capacity investments I explore factors resulting in the heterogeneous effect of the RPS policy. Relying on a basic understanding the electric utility industry and the electricity dispatch process I provide insight into existing experience with the RPS. Spurred by political and economic barriers to adopting renewable energy policy, interest has increased in using motivational techniques informed by behavioral science to encourage reductions in energy consumption. Existing research has predominantly addressed residential energy consumption. The remainder of my dissertation applies well-established motivational techniques to the transportation sector. Using an experimental design, I test whether real-time feedback and social norms can encourage fuel efficient driving behavior. I find that real-time feedback has a large impact on fuel economy, particularly when aggregated across the entire vehicle fleet. I also find some evidence suggesting that social norms can encourage eco-driving, but perhaps more importantly, identify key challenges associated with using social norms in a transportation setting.

Employee designation and health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital.

PubMed

Feemster, Kristen A; Prasad, Priya; Smith, Michael J; Feudtner, Chris; Caplan, Arthur; Offit, Paul; Coffin, Susan E

2011-02-17

Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009-10. 1388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility. Copyright © 2011 Elsevier Ltd. All rights reserved.

Perceptions of legally mandated public involvement processes in the U.S. Forest Service

Treesearch

S. Andrew Predmore; Marc J. Stern; Michael J. Mortimer; David N. Seesholtz

2011-01-01

Results from an agency-wide survey of U.S. Forest Service personnel indicate that respondents in our sample engage in National Environmental Policy Act (NEPA) public involvement processes primarily to accomplish two goals. The most commonly supported goal was to inform and disclose as mandated by the act. The other goal reflected interests in managing agency...

Alternative fuel options and costs for use in Kansas and surrounding states

DOT National Transportation Integrated Search

1998-09-01

To meet state and federal mandates, state fleets, federal fleets, and fuel provider fleets must acquire alternatively fueled vehicles (AFVs). The Kansas House Bill 95-2161 exceeds the federal energy policy act regulations for state fleets. AFVs inclu...

Washington State Board of Education Strategic Plan, 2010-2011

ERIC Educational Resources Information Center

Washington State Board of Education, 2011

2011-01-01

In 2005, the Washington State Legislature significantly changed the role of the State Board of Education (SBE). While the Board retains some administrative duties, SBE is now mandated to play a broad leadership role in strategic oversight and policy for K-12 education in the state. This paper presents the strategic plan of Washington State Board…

Six Stories about Six States: Programs of Study

ERIC Educational Resources Information Center

Shumer, Rob; Digby, Cynthia

2011-01-01

The purpose of this investigation is to tell the story of how six states are developing Programs of Study (POS) as mandated by the Perkins IV federal legislation. The authors' effort focuses on how states' technical assistance systems evolved and what successes and challenges existed for states developing POS. There was no intent to compare one…

The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

PubMed

Li, Xiaoxue; Ye, Jinqi

2017-09-01

This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevention of Heavy Drinking and Associated Negative Consequences Among Mandated and Voluntary College Students.

ERIC Educational Resources Information Center

Fromme, Kim; Corbin, William

2004-01-01

The Lifestyle Management Class (LMC) was evaluated as a universal and targeted alcohol prevention program among voluntary and mandated college students. The relative efficacy of peer- and professional-led group interventions was also tested in this randomized, controlled design. LMC participants showed decreases in driving after drinking relative…

State funding for local public health: observations from six case studies.

PubMed

Potter, Margaret A; Fitzpatrick, Tiffany

2007-01-01

The purpose of this study is to describe state funding of local public health within the context of state public health system types. These types are based on administrative relationships, legal structures, and relative proportion of state funding in local public health budgets. We selected six states representing various types and geographic regions. A case study for each state summarized available information and was validated by state public health officials. An analysis of the case studies reveals that the variability of state public health systems--even within a given type--is matched by variability in approaches to funding local public health. Nevertheless, some meaningful associations appear. For example, higher proportions of state funding occur along with higher levels of state oversight and the existence of local service mandates in state law. These associations suggest topics for future research on public health financing in relation to local accountability, local input to state priority-setting, mandated local services, and the absence of state funds for public health services in some local jurisdictions.

Impact of an Individual Mandate and Other Health Reforms on Dependent Coverage for Adolescents and Young Adults.

PubMed

Wisk, Lauren E; Finkelstein, Jonathan A; Toomey, Sara L; Sawicki, Gregory S; Schuster, Mark A; Galbraith, Alison A

2018-06-01

To determine the effect of state-level dependent coverage expansion (DCE) with and without other state health reforms on exit from dependent coverage for adolescents and young adults (AYA). Administrative longitudinal data for 131,542 privately insured AYA in Massachusetts (DCE with other reforms) versus Maine and New Hampshire (DCE without other reforms) across three periods: prereform (1/00-12/06), poststate reform (1/07-9/10), and postfederal reform (10/10-12/12). A difference-in-differences estimator was used to determine the rate of exit from dependent coverage, age at exit from dependent coverage, and re-uptake of dependent coverage among AYA in states with comprehensive reforms versus DCE only. Implementation of DCE with other reforms was significantly associated with a 23 percent reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone. Additionally, comprehensive reforms were associated with over two additional years of dependent coverage for the average AYA and a 33 percent increase in the odds of regaining dependent coverage after a prior loss. Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA. © Health Research and Educational Trust.

Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

PubMed Central

Burks, Stephen V.; Anderson, Jon E.; Bombyk, Matthew; Haider, Rebecca; Ganzhorn, Derek; Jiao, Xueyang; Lewis, Connor; Lexvold, Andrew; Liu, Hong; Ning, Jiachen; Toll, Alice; Hickman, Jeffrey S.; Mabry, Erin; Berger, Mark; Malhotra, Atul; Czeisler, Charles A.; Kales, Stefanos N.

2016-01-01

Study Objectives: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes. Methods: Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: “Full Adherence” (n = 682), “Partial Adherence” (n = 571), or “No Adherence” (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed. Results: After the matching date, “No Adherence” cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of “Full Adherence” cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles). Conclusions: Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis

Estimates of state-level health-care expenditures associated with disability.

PubMed

Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Highway bridge inspection : state-of-the-practice survey

DOT National Transportation Integrated Search

2001-04-01

The congressionally mandated National Bridge Inspection program requires States to periodically inventory, inspect, and rate all highway bridges on public roads. The National Bridge Inspection Standards, implemented in 1971, prescribe minimum require...

An Analysis of Bullying Legislation among the Various States

ERIC Educational Resources Information Center

Hallford, Abby Jane Swanson

2009-01-01

Scope and method of study. The purpose of this study is to understand the existing state legislation concerning bullying in schools to determine whether the development, structure, and content of these state mandates parallel any change in reported incidents of bullying by public schools in each of those states. This is a descriptive and…

Transformative Use of an Improved All-Payer Hospital Discharge Data Infrastructure for Community-Based Participatory Research: A Sustainability Pathway

PubMed Central

Salemi, Jason L; Salinas-Miranda, Abraham A; Wilson, Roneé E; Salihu, Hamisu M

2015-01-01

Objective To describe the use of a clinically enhanced maternal and child health (MCH) database to strengthen community-engaged research activities, and to support the sustainability of data infrastructure initiatives. Data Sources/Study Setting Population-based, longitudinal database covering over 2.3 million mother–infant dyads during a 12-year period (1998–2009) in Florida. Setting: A community-based participatory research (CBPR) project in a socioeconomically disadvantaged community in central Tampa, Florida. Study Design Case study of the use of an enhanced state database for supporting CBPR activities. Principal Findings A federal data infrastructure award resulted in the creation of an MCH database in which over 92 percent of all birth certificate records for infants born between 1998 and 2009 were linked to maternal and infant hospital encounter-level data. The population-based, longitudinal database was used to supplement data collected from focus groups and community surveys with epidemiological and health care cost data on important MCH disparity issues in the target community. Data were used to facilitate a community-driven, decision-making process in which the most important priorities for intervention were identified. Conclusions Integrating statewide all-payer, hospital-based databases into CBPR can empower underserved communities with a reliable source of health data, and it can promote the sustainability of newly developed data systems. PMID:25879276

Bring Me Men and Women. Mandated Change at the U.S. Air Force Academy.

ERIC Educational Resources Information Center

Stiehm, Judith Hicks

The planning and problems associated with the 1975 Congressional mandate calling for the integration of women into the U.S. Air Force Academy are described. The book examines how Air Force planners made decisions and whether their decisions were effective. Beliefs that were previously held inviolable--that upper body strength is important, that…

Message in a Model: Teachers' Responses to a Court-Ordered Mandate for Curriculum Reform

ERIC Educational Resources Information Center

Ryan, Sharon

2004-01-01

This article reports the findings of a qualitative case study of two preschool teachers and their responses to a court-ordered mandate to use the High/Scope curriculum model. Analysis of the data record, which included interviews, observations, and documents, reveal that despite a framework for action, both teachers remained confused about their…

Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care

PubMed Central

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

2012-01-01

Objective Over the past two decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on campus alcohol programs. Method Participants in the study (N = 598) were college students mandated to attend an alcohol program following a campus-based alcohol citation. All participants received Step 1: a 15-minute Brief Advice session that included the provision of a booklet containing advice to reduce drinking. Participants were assessed six weeks after receiving the Brief Advice, and those who continued to exhibit risky alcohol use (n = 405) were randomized to Step 2, a 60–90 minute brief motivational intervention (BMI) (n = 211) or an assessment-only control (n = 194). Follow-up assessments were conducted 3, 6, and 9 months after Step 2. Results Results indicated that the participants who received a BMI significantly reduced the number of alcohol-related problems compared to those who received assessment-only, despite no significant group differences in alcohol use. In addition, low risk drinkers (n = 102; who reported low alcohol use and related harms at 6-week follow-up and were not randomized to stepped care) showed a stable alcohol use pattern throughout the follow-up period, indicating they required no additional intervention. Conclusion Stepped care is an efficient and cost-effective method to reduce harms associated with alcohol use by mandated students. PMID:22924334

From data to decisions? Exploring how healthcare payers respond to the NHS Atlas of Variation in Healthcare in England.

PubMed

Schang, Laura; Morton, Alec; DaSilva, Philip; Bevan, Gwyn

2014-01-01

Although information on variations in health service performance is now more widely available, relatively little is known about how healthcare payers use this information to improve resource allocation. We explore to what extent and how Primary Care Trusts (PCTs) in England have used the NHS Atlas of Variation in Healthcare, which has highlighted small area variation in rates of expenditure, activity and outcome. Data collection involved an email survey among PCT Chief Executives and a telephone follow-up to reach non-respondents (total response: 53 of 151 of PCTs, 35%). 45 senior to mid-level staff were interviewed to probe themes emerging from the survey. The data were analysed using a matrix-based Framework approach. Just under half of the respondents (25 of 53 PCTs) reported not using the Atlas, either because they had not been aware of it, lacked staff capacity to analyse it, or did not perceive it as applicable to local decision-making. Among the 28 users, the Atlas served as a prompt to understand variations and as a visual tool to facilitate communication with clinicians. Achieving clarity on which variations are unwarranted and agreeing on responsibilities for action appeared to be important factors in moving beyond initial information gathering towards decisions about resource allocation and behaviour change. Many payers were unable to use information on small area variations in expenditure, activity and outcome. To change this what is additionally required are appropriate tools to understand causes of unexplained variation, in particular unwarranted variation, and enable remedial actions to be prioritised in terms of their contribution to population health. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Global health report. A snapshot of the payer systems, major diseases and workforce trends from around the world.

PubMed

Scalise, Dagmara; Hopkins, Kendra A

2003-07-01

International trade and travel have rendered political and geographic boundaries irrelevant when it comes to diseases. HIV and SARS are among the more recent examples of deadly viruses that spread swiftly from one continent to the next before international health experts can identify them, much less begin to search for a cure. This snapshot of global health issues looks at payer systems from a cross section of nations, lists the world's eight most infectious diseases and their rate of incidence by region, and pays special attention to the shortage of health care workers, which has reached crisis proportions in many areas and is pitting nation against nation in the competition for qualified staff.

How Mandated College Students Talk About Alcohol: Peer Communication Factors Associated with Drinking

PubMed Central

Carey, Kate B.; Lust, Sarah A.; Reid, Allecia E.; Kalichman, Seth C.; Carey, Michael P.

2015-01-01

Relatively little research has examined how peer communication influences alcohol consumption. In a sample of mandated college students, we differentiate conversations about drinking among from conversations about harm prevention and provide evidence for the validity of these communication constructs. Students who violated campus alcohol policies and were referred for alcohol sanctions (N = 345) reported on drinking patterns, use of protective behavioral strategies, perceived descriptive norms for close friends and serving as social leader among their friends; they also reported on the frequency of conversations about drinking, about drinking safety, and about risk reduction efforts. Predicted correlations were found among types of communication and conceptually related variables. General communication was related to consumption but not protective behavioral strategies, whereas safety/risk reduction conversations correlated positively with all protective behavioral strategies. Both types of communication were associated with social leadership. Safety communication moderated the relationship between peer descriptive norms and drinks per week; more frequent talking about safety attenuated the norms-consumption relationship. Peer communication about both drinking and safety may serve as targets for change in risk reduction interventions for mandated college students. PMID:26861808

Re-conceptualising holism in the contemporary nursing mandate: from individual to organisational relationships.

PubMed

Allen, Davina

2014-10-01

Over the last forty years, nursing's claim to professional expertise has been expressed in terms of its care-giving function. Informed by a distinctive 'holistic' approach, models of nursing identify therapeutic relationships as the cornerstone of practice. While 'knowing the patient' has been central to clinicians' occupational identity, research reveals that nurses not only experience significant material constraints in realising these ideals, their contribution to healthcare extends far beyond direct work with patients. Amidst growing concern about healthcare quality, a body of critical commentary has emerged proposing that the contemporary nursing mandate, with its exclusive focus on care-giving, is no longer serving the interests of the profession or the public. Drawing on an ethnographic study of UK hospital nurses' 'organising work' and insights from practice-based approaches and actor network theory, this paper lays the foundations for a re-conceptualisation of holism within the nursing mandate centred on organisational rather than therapeutic relationships. Nurses can be understood as obligatory passage points in health systems and through myriad processes of 'translational mobilisation' sustain the networks through which care is organised. Copyright © 2014 Elsevier Ltd. All rights reserved.

Without the individual mandate, the Affordable Care Act would still cover 23 million; premiums would rise less than predicted.

PubMed

Sheils, John F; Haught, Randall

2011-11-01

Many policy analysts fear that eliminating the individual health insurance mandate and penalty from the Affordable Care Act of 2010 would lead to a "premium spiral," in which healthy people would drop coverage, premiums would soar, and the number of people with coverage would plummet. However, there are other provisions of the law that would greatly mitigate this effect. For example, the subsidies provided in the law to help people purchase coverage through health insurance exchanges would restrain a premium spiral by absorbing much of the impact of premium increases. We estimate that if the mandate were lifted, premiums in the individual market would increase by 12.6 percent-somewhat less than other estimates-with 7.8 million people losing coverage, versus other estimates for coverage loss of 16-24 million people. In sum, the Affordable Care Act would still cover 23 million people who would have been uninsured without the law. Our study suggests that although the mandate would have important effects on premiums and coverage, it might not be essential to the act's successful implementation.

Reimbursement issues facing patients, providers, and payers.

PubMed

Antman, K

1993-11-01

Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

State Adoption of Incentives to Promote Evidence-Based Practices in Behavioral Health Systems.

PubMed

Stewart, Rebecca E; Marcus, Steven C; Hadley, Trevor R; Hepburn, Brian M; Mandell, David S

2018-06-01

Despite the critical role behavioral health care payers can play in creating an incentive to use evidence-based practices (EBPs), little research has examined which incentives are used in public mental health systems, the largest providers of mental health care in the United States. The authors surveyed state mental health directors from 44 states about whether they used any of seven strategies to increase the use of EBPs. Participants also ranked attributes of each incentive on the basis of key characteristics of diffusion of innovation theory (perceived advantage, simplicity, compatibility, observability, and gradually implementable) and perceived effectiveness. Almost three-quarters of state directors endorsed using at least one financial incentive; most paid for training and technical assistance. Few used other incentives. Strategies perceived as simple and compatible were more readily adopted. Enhanced rates and paying for better outcomes were perceived as the most effective but were the least deployed, suggesting that simplicity and organizational compatibility may be the most decisive factors when choosing incentives. Payers are not using the incentives they perceive as most effective, and they are mostly using only one strategy for reasons of simplicity and compatibility. Future work should focus on barriers to measurement that likely hinder the adoption and implementation of paying for better outcomes and enhanced reimbursement rates, with the ultimate goal of measuring the effectiveness of incentives on EBP implementation efforts.

Constitutional Obligations for Public Education: 50-State Review

ERIC Educational Resources Information Center

Parker, Emily

2016-01-01

Within the constitution of each of the 50 states, there is language that mandates the creation of a public education system. The authority for public education falls to states because of a 1973 Supreme Court case which determined that the federal government has no responsibility to provide systems of public education. These constitutional…

The Impact of a Universal Class-Size Reduction Policy: Evidence from Florida's Statewide Mandate

ERIC Educational Resources Information Center

Chingos, Matthew M.

2012-01-01

Class-size reduction (CSR) mandates presuppose that resources provided to reduce class size will have a larger impact on student outcomes than resources that districts can spend as they see fit. I estimate the impact of Florida's statewide CSR policy by comparing the deviations from prior achievement trends in districts that were required to…

Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.

PubMed

Look, Kevin A; Kim, Nam Hyo; Arora, Prachi

2017-01-01

To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence. Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage. © 2016 National Rural Health Association.

State Competencies for Writing: Grades K-6. Technical Note.

ERIC Educational Resources Information Center

Lawlor, Joseph

This paper contains descriptions of mandated minimum competency documents from seven states: Florida, Georgia, Louisiana, Michigan, Oklahoma, Tennessee, and Texas. Each description provides a picture of the general nature of the state requirements and a discussion of the specific writing skills requirements. The procedures used to compile a…

State Minimum Competencies for High School Graduation. Technical Note.

ERIC Educational Resources Information Center

Lawlor, Joseph

This paper contains descriptions of mandated minimum competency programs in 13 states: Connecticut, Delaware, Georgia, Hawaii, Idaho, Kansas, Missouri, New Jersey, New York, North Carolina, South Carolina, Texas, and Vermont. Each description provides the skills assessed in the state, the assessment instruments used, and the overall purposes of…

State Minimum Competency Testing Programs. Resource Catalog. Final Report.

ERIC Educational Resources Information Center

Mills, Gladys H.

Focusing on state-mandated minimum competency testing programs, this annotated bibliography cites 200 items selected from more than 700. The Resource Catalog is intended for state education policy makers and therefore includes resource and study guides; legislative and board action; conference speeches, reports and proceedings; curriculum guides,…

Accommodations for English Language Learners with Disabilities in Federally-Mandated Statewide English Language Proficiency Assessments

ERIC Educational Resources Information Center

Kuti, Laura M.

2011-01-01

The purpose of this research study was to conduct exploratory research to examine federally-mandated annual English language proficiency (ELP) assessment of English language learners (ELLs) and their use of accommodations on the assessment. First the researcher provides a review of the literature regarding accommodations provided for ELLs,…

The Trojan Horse of Educational Reform: A Look at One State's Experience and the Perceptions of Selected School Administrators.

ERIC Educational Resources Information Center

Chance, Edward W.

1993-01-01

A survey addressed the financial impact of state-mandated reforms on 40 rural Oklahoma school districts. A majority of school administrators surveyed reported that they did not receive adequate dollars to meet curriculum standard mandates and the minimum teacher salary schedule. Long-term results may include consolidation. (LP)

The status of school-based nutrition education at the state agency level.

PubMed

Shannon, B; Mullis, R; Bernardo, V; Ervin, B; Poehler, D L

1992-03-01

The status of school-based nutrition education at the state agency level was examined. Telephone interviews with agencies in all 50 states revealed that nine states mandated nutrition be taught and another 21 included nutrition as a required topic in mandated subjects, frequently health. The other states had initiatives to promote school-based nutrition education but it was not required. Published requirements for teacher certification in elementary education, home economics, and health education seldom (two to three states) specified nutrition as a requirement. However, follow-up investigations revealed many states indirectly promote nutrition preparation for home economics and health education teachers through guidelines for approval of college programs in these areas. An inventory of nutrition education curricular materials revealed they were most frequently directed to grades K-6 and focused mainly on general foods and nutrition or that related to health. Given the links that emerged between health and nutrition, incorporating nutrition into health education may help promote school-based nutrition education.

Analyzing Sustainability Themes in State Science Standards: Two Case Studies

ERIC Educational Resources Information Center

Miller, Hannah K.; Jones, Linda Cronin

2014-01-01

Due to the interdisciplinary nature of environmental education, addressing the range of socioscientific issues included under the umbrella of sustainability can be challenging for educators working within the context of mandated state subject area standards. Two states (Washington and Vermont) have been recognized as leaders in incorporating…

Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark: A Nationwide Survey.

PubMed

Malta Hansen, Carolina; Zinckernagel, Line; Ersbøll, Annette Kjær; Tjørnhøj-Thomsen, Tine; Wissenberg, Mads; Lippert, Freddy Knudsen; Weeke, Peter; Gislason, Gunnar Hilmar; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

2017-03-14

School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9.68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1.57-2.76]). Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. © 2017 The Authors. Published on behalf of the

Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

PubMed

Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

2014-11-13

The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

Handbook of emergency management for state-level transportation agencies.

DOT National Transportation Integrated Search

2010-03-01

The Department of Homeland Security has mandated specific systems and techniques for the management of emergencies in the United States, including the Incident Command System, the National Incident Management System, Emergency Operations Plans, Emerg...

A Report on the Fitness and Health Promotion Delivery System of the United States. Report No. 4.

ERIC Educational Resources Information Center

Bozzo, Robert; And Others

An assessment is presented of the structure of fitness promotion policy and the function of fitness promotion delivery systems in the United States. The focus is upon: (1) how fitness initiatives first arose; (2) how these initiatives were formalized into broad goals, directives, or mandates; (3) to whom and how these mandates were entrusted; (4)…

Alcohol Interventions for Mandated Students: Behavioral Outcomes From a Randomized Controlled Pilot Study

PubMed Central

Logan, Diane E; Kilmer, Jason R; King, Kevin M; Larimer, Mary E

2015-01-01

Objective: This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. Method: This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). Results: Results revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. Conclusions: Results from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions. PMID:25486391

Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study.

PubMed

Logan, Diane E; Kilmer, Jason R; King, Kevin M; Larimer, Mary E

2015-01-01

This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

State adoption of nursing home pay-for-performance.

PubMed

Werner, Rachel M; Tamara Konetzka, R; Liang, Kevin

2010-06-01

Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades-with varying degrees of success-health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives.

State High School Graduation Requirements and Access to Postsecondary Education

ERIC Educational Resources Information Center

Stanton, Roseanna

2010-01-01

This study examined the relationship between state policies mandating increased mathematics credits for high school graduation and access to postsecondary education. The purpose of this study was to determine if the state policy intervention of increasing high school mathematics requirements was related to a higher likelihood that students would…

State Teacher Evaluation and Teacher Education

ERIC Educational Resources Information Center

Marchant, Gregory J.; David, Kristine A.; Rodgers, Deborah; German, Rachel L.

2015-01-01

Current accountability trends suggest an increasing role in state mandates regarding teacher evaluation. With various evaluation models and components serving as the basis for quality teaching, teacher education programs need to recognize the role teacher evaluation plays and incorporate aspects where appropriate. This article makes that case and…

The ACA's Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits.

PubMed

Kirby, James B; Davidoff, Amy J; Basu, Jayasree

2016-12-01

Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy. In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period. Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits. The Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.

State Law, Policy, and Access to Information: The Case of Mandated Openness in Higher Education

ERIC Educational Resources Information Center

McLendon, Michael K.; Hearn, James C.

2010-01-01

Background/Context: Every state in the nation has legal requirements, state "sunshine laws," to ensure accountability and fairness in institutions receiving state funds and operating under state authority. These laws have come to significantly influence the ways in which the business of higher education is conducted. Purpose/Objective/Research…

The OSHA Communication Standard and State Right-to-Know Laws.

ERIC Educational Resources Information Center

Roll, Michalene H.

1990-01-01

As a result of a 1988 federal appellate court mandate, schools and colleges in 24 states and 2 territories with OSHA-approved state plans must inform their employees about hazardous chemicals to which they may be exposed. School administrators should implement a responsible program meeting regulatory compliance, tort liability, and public…

Educational Programs Provided for the Florida State Correctional System. Executive Summary.

ERIC Educational Resources Information Center

Tebo, Jack; Mabe, Shirley

In response to legislative mandate, the Florida State Department of Education conducted a study of the educational programs provided for the state correctional system. Using publications and research documents, the study investigated: (1) the academic, vocational, adult, and compensatory education programs offered within and to the correctional…

Descriptive Norms and Expectancies as Mediators of a Brief Motivational Intervention for Mandated College Students Receiving Stepped Care for Alcohol Use

PubMed Central

Yurasek, Ali M.; Borsari, Brian; Magill, Molly; Mastroleo, Nadine R.; Hustad, John T.P.; Tevyaw, Tracy O'Leary; Barnett, Nancy P.; Kahler, Christopher W.; Monti, Peter M.

2015-01-01

Background and Aims Stepped care approaches for mandated college students provide individual Brief Motivational Interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy, but have yet to be examined in the context of stepped care. Methods Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N=163) or an Assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Results Reductions in perceptions of average student drinking (B = -.24; CI = -.61 to -.04) and negative expectancies (B = -.13; CI = -.38 to -.01) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Conclusions Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts. PMID:26098125

REGIONAL AND STATE VIEWS OF ESTUARINE CONDITION IN NORTHEASTERN UNITED STATE BASED ON 2001 AND 2001 NATIONAL COASTAL ASSESSMENT DATA

EPA Science Inventory

The National Coastal Assessment (NCA) is a probability-based survey that permits assessment of estuarine conditions at national, regional, or large-system scales. Additionally, states may use these data to comply with requirements of the Clean Water Act (CWA), which mandates re...

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

PubMed

Gomez, Marta; Reddy, Amanda L; Dixon, Sherry L; Wilson, Jonathan; Jacobs, David E

Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for

Re-reading nursing and re-writing practice: towards an empirically based reformulation of the nursing mandate.

PubMed

Allen, Davina

2004-12-01

This article examines field studies of nursing work published in the English language between 1993 and 2003 as the first step towards an empirically based reformulation of the nursing mandate. A decade of ethnographic research reveals that, contrary to contemporary theories which promote an image of nursing work centred on individualised unmediated caring relationships, in real-life practice the core nursing contribution is that of the healthcare mediator. Eight bundles of activity that comprise this intermediary role are described utilising evidence from the literature. The mismatch between nursing's culture and ideals and the structure and constraints of the work setting is a chronic source of practitioner dissatisfaction. It is argued that the profession has little to gain by pursuing an agenda of holistic patient care centred on emotional intimacy and that an alternative occupational mandate focused on the healthcare mediator function might make for more humane health services and a more viable professional future.

The impact of Medicaid payer status on hospitalizations in nursing homes

PubMed Central

Cai, Shubing; Miller, Susan C.; Nelson, Dallas L.; Mukamel, Dana B.

2015-01-01

Objectives To examine the association between payer status (Medicaid versus private-pay) and the risk of hospitalizations among long-term stay nursing home (NH) residents who reside in the same facility. Data and study population The 2007–2010 national Medicare Claims and the Minimum Data Set were linked. We identified newly admitted NH residents who became long-stayers and then followed them for 180 days. Analyses Three dichotomous outcomes – all-cause, discretionary and nondiscretionary hospitalizations during the follow-up period – were defined. Linear probability model with facility fixed-effects and robust standard errors were used to examine the within-facility difference in hospitalizations between Medicaid and private-pay residents. A set of sensitivity analyses were performed to examine the robustness of the findings. Results The prevalence of all-cause hospitalization during a 180-day follow-up period was 23.3% among Medicaid residents compared to 21.6% among private-pay residents. After accounting for individual characteristics and facility effects, the probability of any all-cause hospitalization was 1.8 percentage point (P<0.01) higher for Medicaid residents than for private-pay residents within the same facility. We also found Medicaid residents were more likely to be hospitalized for discretionary conditions (5% increase in the likelihood of discretionary hospitalizations), but not for non-discretionary conditions. The findings from the sensitivity analyses were consistent with the main analyses. Conclusion Observed higher hospitalization rates for Medicaid NH residents are at least in part driven by the financial incentive NHs have to hospitalize Medicaid residents. PMID:26067881

Adventures in Collaboration: State Literacy Resource Centers.

ERIC Educational Resources Information Center

Siedow, Mary Dunn

Authorized by the National Literacy Act of 1991, state literacy resource centers (SLRCs) are charged with assisting local public and private nonprofit efforts to enhance literacy. SLRCs have developed innovative approaches to their mandate to stimulate the coordination of literacy services. They have encouraged government and industry…

Connecticut Pledges First State Legal Challenge to NCLB Law

ERIC Educational Resources Information Center

Archer, Jeff

2005-01-01

The backlash against the No Child Left Behind Act (NCLB) was raised to a new level when Connecticut's attorney general announced that his state plans to sue the U.S. Department of Education over the testing mandates in the sweeping federal law. In announcing his intentions, Attorney General Richard Blumenthal said he was inviting other states to…

What "Hard Times" Means: Mandated Curricula, Class-Privileged Assumptions, and the Lives of Poor Children

ERIC Educational Resources Information Center

Dutro, Elizabeth

2010-01-01

In this article, I present a qualitative analysis of third graders' experiences with a unit from their district-mandated commercial reading curriculum in which the children made strong connections between a fictional account of a Depression-era farm family's economic hardships and their own 21st century lives in a city with one of the highest…

Personal Consequences of Compliance and Resistance to Mandated Reforms for Teachers in Low-Performing Schools

ERIC Educational Resources Information Center

Burke, Christopher J. F.; Adler, Martha

2013-01-01

This case study examines the experiences of two fifth grade teachers as they dealt with district mandates while trying to address their high-poverty urban children's learning needs. It reveals their personal struggles that led to both compliance and resistance. In this case, the act of finding the space to engage in the intellectual and creative…

Personal Consequences of Compliance and Resistance to Mandated Reforms for Teachers in Low-Performing Schools

ERIC Educational Resources Information Center

Burke, Christopher J. F.; Adler, Martha

2013-01-01

This case study examines the experiences of two fifth grade teachers as they dealt with district mandates while trying to address their high-poverty urban children's learning needs. It reveals their personal struggles that led to both compliance and resistance. In this case, the act of finding the space to engage in the intellectual and…

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

PubMed

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

2016-01-01

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

Attorney work product privilege trumps mandated child abuse reporting law: The case of Elijah W. v. Superior Court.

PubMed

Lareau, Craig R

2015-01-01

Forensic psychologists and psychiatrists are licensed in their respective professions, but they perform most of their work with attorneys in the legal arena. Both attorneys and mental health professionals place high value on confidentiality of information, reflected in the ethics of their professions and codified into laws governing their work. In psychology and psychiatry, there are some well-known exceptions to confidentiality; two primary exceptions include the mandated reporting of suspected child abuse and various "Tarasoff" duty to warn or protect laws. Generally, however, the corresponding duty for attorneys to report suspected child abuse or to warn or protect intended victims of threatened harm is not as extensive. This difference in mandated reporting responsibilities can create significant difficulties when attorneys need to retain forensic psychologists and psychiatrists to evaluate their clients, especially in criminal contexts. If the retained psychologist or psychiatrist is required to report suspected abuse or threatened harm, the attorney may be harming his or her client's legal interests by using the forensic psychologist or psychiatrist to evaluate his or her client. This article will briefly review the development of mandated reporting laws for psychologists and psychiatrists and juxtapose those with the legal and ethical requirements of confidentiality for attorneys embodied in the attorney-client privilege and attorney work product privilege. The article will then discuss the California Court of Appeals case in Elijah W. v. Superior Court, where the court addressed the issue of whether retained mental health professionals must report suspected child abuse and threatened harm to others as required by law or if they do not need to report because they come under the umbrella of the attorney work product privilege. This California court ultimately concluded that retained psychologists and psychiatrists work under the attorney work product

Protection for Pre-1972 Sound Recordings under State Law and Its Impact on Use by Nonprofit Institutions: A 10-State Analysis. CLIR Publication No. 146

ERIC Educational Resources Information Center

Council on Library and Information Resources, 2009

2009-01-01

This is the third of three studies of copyright and sound recordings commissioned by the National Recording Preservation Board (NRPB) in support of the congressionally mandated study of the state of audio preservation in the United States. All three studies have focused on how laws pertaining to sound recordings made before 1972 affect…

The value of atorvastatin over the product life cycle in the United States.

PubMed

Grabner, Michael; Johnson, Wallace; Abdulhalim, Abdulla M; Kuznik, Andreas; Mullins, C Daniel

2011-10-01

US health care reform mandates the reduction of wasteful health care spending while maintaining quality of care. Introducing new drugs into crowded therapeutic classes may be viewed as offering "me-too" (new drugs with a similar mechanism of action compared to existing drugs) drugs without incremental benefit. This article presents an analysis of the incremental costs and benefits of atorvastatin, a lipid-lowering agent. This analysis models the cost-effectiveness of atorvastatin over the product life cycle. The yearly cost-effectiveness of atorvastatin compared to simvastatin was modeled from 1997 to 2030 from the point of view of a US third-party payer. Estimates for incremental costs (in US $) and effects (in quality-adjusted life-years [QALYs]) for the primary and secondary prevention of cardiovascular events were taken from previously published literature and adjusted for changes in drug prices over time. Estimates of total statin use were derived using the National Health and Nutrition Examination Survey. Sensitivity analyses were conducted to examine variations in study parameters, including drug prices, indications, and discount rates. Assuming increasing statin use over time (with a mean of 1.07 million new users per year) and a 3% discount rate, the cumulative incremental cost-effectiveness ratio (ICER) of atorvastatin versus simvastatin ranged from cost-savings at release to a maximum of $45,066/QALY after 6 years of generic simvastatin use in 2012. Over the full modeled life cycle (1997-2030), the cumulative ICER of atorvastatin was $20,331/QALY. The incremental value of atorvastatin to US payers (after subtracting costs) was estimated at $44.57 to $194.78 billion, depending on willingness to pay. Findings from the sensitivity analyses were similar. A hypothetical situation in which atorvastatin did not exist was associated with a reduction in total expenditures but also a loss of QALYs gained. The cumulative ICER of atorvastatin varied across the

Addressing Alcohol Use and Problems in Mandated College Students: A Randomized Clinical Trial Using Stepped Care

ERIC Educational Resources Information Center

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

2012-01-01

Objective: Over the past 2 decades, colleges and universities have seen a large increase in the number of students referred to the administration for alcohol policies violations. However, a substantial portion of mandated students may not require extensive treatment. Stepped care may maximize treatment efficiency and greatly reduce the demands on…

HPV Vaccination Status and Mandate Support for School-Aged Adolescents among College Females: A Descriptive Study

ERIC Educational Resources Information Center

Wilson, Kelly L.; Smith, Matthew Lee; Rosen, Brittany L.; Pulczinski, Jairus C.; Ory, Marcia G.

2017-01-01

The purpose of this study was to describe college-aged females' human papillomavirus (HPV) knowledge and beliefs, perceptions and perceived benefits of the HPV vaccine, and identify characteristics associated with vaccination status and support for HPV vaccine mandates. Data were collected from 1,105 females by an Internet-delivered questionnaire…

Statewide Mandatory Remediation Policies: National, State, and Institutional Perspectives

ERIC Educational Resources Information Center

Peak, Charity S.

2012-01-01

Despite uncertainty related to student outcomes resulting from remediation (Bettinger & Long, 2009), eleven states mandate remedial education through common placement testing and standardized cutoff scores rather than permitting individual postsecondary institutions to establish remediation guidelines. Colorado, in particular, offers an…

Is the swiss health care system a model for the United States?

PubMed

Chaufan, Claudia

2014-01-01

Both supporters and critics of the Patient Protection and Affordable Care Act (ACA) have argued that it is similar to Switzerland's Federal Law on Health Insurance (LAMal), which currently governs Swiss health care, and have either praised or condemned the ACA on the basis of this alleged similarity. I challenge these observers on the grounds that they overlook critical problems with the Swiss model, such as its inequities in access, and critical differences between it and the ACA, such as the roots in, and continuing commitment to, social insurance of the Swiss model. Indeed, the daunting challenge of attempting to impose the tightly regulated model of operation of the Swiss model on mega-corporations like UnitedHealth, WellPoint, or Aetna is likely to trigger no less ferocious resistance than a fully public, single-payer system would. I also conclude that the ACA might unravel in ways unintended or even opposed by its designers and supporters, as employers, confronted with ever-rising costs, retreat from sponsoring insurance, and workers react in outrage as they confront the unaffordable underinsurance mandated by the ACA. A new political and ideological landscape may then ensue that finally ushers in a truly national health program.

Mandated college students' response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care.

PubMed

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

2016-02-01

Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to 2 interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-min brief advice (BA) session (Step 1) and a 60- to 90-min brief motivational intervention (BMI) delivered by trained interventionists (Step 2). Analyses were completed in 2 stages. First, 3 types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) 6 weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content compared with assessment only (AO) control over the 3-, 6-, and 9-month follow-ups. Participants reporting lower scores on the Alcohol Use Disorders Identification Test, more benefits to changing alcohol use, and those who fit the "Bad Incident" profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that Bad Incident students who received the BMI reported more HED at 9-month follow-up than those who received AO. Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity. (c) 2016 APA, all rights reserved).

State of Washington Strategic Information Technology Plan.

ERIC Educational Resources Information Center

Washington State Dept. of Information Services, Olympia. Policy and Regulation Div.

The Strategic Information Technology Plan of Washington is introduced and explained. The plan is mandated by state law to create a new framework for communication and collaboration to bring together agency technology planning with the achievement of statewide information technology goals and strategies. It provides a point of reference for the…

Sheltered Workshops: United States v. Rhode Island

ERIC Educational Resources Information Center

Yell, Mitchell L.; Katsiyannis, Antonis; Prince, Angela

2017-01-01

Federal legislation, such as the Americans with Disabilities Act, Section 504, and the Individuals With Disabilities Education Act, mandates that individuals with disabilities be integrated in all aspects of life from education to employment to independent living. A recent development involves a settlement reached between the United States and the…

State Insurance Parity Legislation for Autism Services and Family Financial Burden

ERIC Educational Resources Information Center

Parish, Susan; Thomas, Kathleen; Rose, Roderick; Kilany, Mona; McConville, Robert

2012-01-01

We examined the association between states' legislative mandates that private insurance cover autism services and the health care-related financial burden reported by families of children with autism. Child and family data were drawn from the National Survey of Children with Special Health Care Needs (N = 2,082 children with autism). State policy…

Teacher Performance Plays Growing Role in Employment Decisions. Teacher Tenure: Trends in State Laws

ERIC Educational Resources Information Center

Thomsen, Jennifer

2014-01-01

An increasing number of states are mandating teacher performance be considered in educator employment decisions, including awarding tenure and layoffs, according to a 50-state policy review of teacher tenure laws. Tenure laws have historically granted job protections based on years of employment. The Education Commission of the States (ECS)…

The Relationship between Classworks and Georgia State Testing

ERIC Educational Resources Information Center

Baker, Amanda

2014-01-01

As teachers in Georgia utilize formative assessments to ensure successful performance on the state mandated Criterion Referenced Competency Test (CRCT), it is essential that the data they receive from these assessments are accurate. This study examined the correlation between the computer-assisted instructional program, Classworks, and student…

Settling a U.S. Senatorial Debate: Understanding Declines in State Higher Education Funding

ERIC Educational Resources Information Center

Klein, Michael W.

2015-01-01

This paper examines the debate in the U.S. Senate over the reasons why state governments have decreased funding for higher education. One side believes that federal mandates on states to pay for Medicaid have forced them to reduce spending on higher education. The other side believes that states unwisely reduced taxes, which decreased their…

State Energy Efficiency Program Evaluation Inventory

EIA Publications