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Full-Text Articles in Law

New Payment Models For Asthma, Katharine London Oct 2014

New Payment Models For Asthma, Katharine London

Commonwealth Medicine Publications

This presentation discusses new payment models for asthma and provides an overview of the Massachusetts Children's High-risk Asthma Bundled Payment (CHABP) Demonstration Program. It also discusses opportunities and challenges of the new payment models.


Overview Of A Hepatitis C Medication Monitoring Program In A State Medicaid Program, Pavel Lavitas, Kimberly J. Lenz, Tasmina Hydery, Mark Tesell, J. Gagnon, Paul L. Jeffrey Oct 2014

Overview Of A Hepatitis C Medication Monitoring Program In A State Medicaid Program, Pavel Lavitas, Kimberly J. Lenz, Tasmina Hydery, Mark Tesell, J. Gagnon, Paul L. Jeffrey

Commonwealth Medicine Publications

This presentation outlines a successful hepatitis C medication monitoring program instituted by Clinical Pharmacy Services for MassHealth, the Massachusetts Medicaid program. The program used outreach and education strategies to communicate with prescribers about regimens that were the most effective in treating the virus and containing costs. Member adherence to the regimen was monitored and hepatitis C cure rates were tracked through the program.


Cgmp Violations Should Not Be Used As A Basis For Fca Actions Absent Fraud, Kyle Faget Oct 2014

Cgmp Violations Should Not Be Used As A Basis For Fca Actions Absent Fraud, Kyle Faget

Seattle University Law Review

Since Congress amended the False Claims Act (FCA) in 1986, the statute has evolved into a seemingly boundless weapon for enforcing other statutes and regulations applicable to every industry that accepts any form of government funding. Use of the FCA by the Department of Justice (DOJ) and by private citizens bringing actions on behalf of the U.S. government to enforce other statutes and regulations is particularly evident in the field of health care. The FCA has been utilized in actions where the allegations include off-label promotion of drugs, kickbacks, and violations of current good manufacturing practices (cGMPs) by linking ...


Health Care For Low-Income Classes In An Individual Mandate System: Lessons The United States Can Learn From Switzerland, Mason F. Reid Sep 2014

Health Care For Low-Income Classes In An Individual Mandate System: Lessons The United States Can Learn From Switzerland, Mason F. Reid

Georgia Journal of International & Comparative Law

No abstract provided.


Consumer Direction In Medicaid Long Term Care: Autonomy, Commodification Of Family Labor, And Community Resilience, Daniela Kraiem Aug 2014

Consumer Direction In Medicaid Long Term Care: Autonomy, Commodification Of Family Labor, And Community Resilience, Daniela Kraiem

Daniela Kraiem

No abstract provided.


Book Review | The Politics Of Medicaid By Laura Katz Olson, Nicole Huberfeld Jul 2014

Book Review | The Politics Of Medicaid By Laura Katz Olson, Nicole Huberfeld

Nicole Huberfeld

In this book review, Professor Nicole Huberfeld examines The Politics of Medicaid, by Laura Katz Olson, which was published in 2010 by Columbia University Press.


Limiting The Duration Of Medication Assisted Treatment For Opioid Addiction: Will New State Policies Help Or Hurt?, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, William H. Fisher Jun 2014

Limiting The Duration Of Medication Assisted Treatment For Opioid Addiction: Will New State Policies Help Or Hurt?, Robin E. Clark, Jeffrey D. Baxter, Bruce A. Barton, Gideon Aweh, Elizabeth O'Connell, William H. Fisher

Commonwealth Medicine Publications

This presentation details the impact of state Medicaid programs placing lifetime limits on buprenorphine therapy for individuals with opioid dependence. The research reveals that setting limits does not save money or help the patient.


Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin May 2014

Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin

Commonwealth Medicine Publications

This presentation describes Medicaid and CHIP requirements to report performance indicators, describes the marketplace federal reporting requirements, describes and analyzes initial results from the reporting requirements, and reviews the future of federal reporting for Medicaid and CHIP.


Implementing Integrated Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala Mar 2014

Implementing Integrated Clinical Care Management In The Patient-Centered Medical Home, Jeanne Z. Cohen, Christine Johnson, Judith Steinberg, Sai Cherala

Commonwealth Medicine Publications

Clinical Care Management (CCM) of the highest risk, most complex and costly patients is a key element of the Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI), and is a new service for most primary care practices. There is much confusion about the role of the Care Manager (CM), and a lack of awareness of key foundational elements critical to successful implementation of CCM. This poster describes the shared approach to implementation of CCM in the MA PCMHI, use of care management and care coordination clinical quality measures to monitor implementation progress, and shared lessons learned in the implementation process.


Medicaid Expansion As Completion Of The Great Society, Nicole Huberfeld, Jessica L. Roberts Jan 2014

Medicaid Expansion As Completion Of The Great Society, Nicole Huberfeld, Jessica L. Roberts

Law Faculty Scholarly Articles

On the doorstep of its fiftieth anniversary, Medicaid at last could achieve the ambitious goals President Lyndon B. Johnson enunciated for the Great Society upon signing Medicare and Medicaid into law in 1965. Although the spotlight shone on Medicare at the time, Medicaid was the “sleeper program” that caught America’s neediest in its safety net—but only some of them. Medicaid’s exclusion of childless adults and other “undeserving poor” loaned an air of “otherness” to enrollees, contributing to its stigma and seeming political fragility. Now, Medicaid touches every American life. One in five Americans benefits from Medicaid’s ...


Rationalizing Home And Community-Based Services Under Medicaid, Laura D. Hermer Jan 2014

Rationalizing Home And Community-Based Services Under Medicaid, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

No abstract provided.


Missing The Forest For The Trees: Why Supplemental Needs Trusts Should Be Exempt From Medicaid Determinations, Jeffrey R. Grimyser Jan 2014

Missing The Forest For The Trees: Why Supplemental Needs Trusts Should Be Exempt From Medicaid Determinations, Jeffrey R. Grimyser

Chicago-Kent Law Review

Supplemental needs trusts are trusts designed to assist individuals with disabilities by paying for services and items that Medicaid will not pay for. Federal law, however, is unclear as to whether using one of these trusts automatically disqualifies someone from receiving Medicaid, thereby causing the circuit courts to split on their interpretation. Some circuits have held that the Medicaid statute allows states to enact laws prohibiting the use of these trusts while receiving Medicaid benefits based on the federal law’s statutory language. While other circuits have ruled that individuals can simultaneously receive Medicaid benefits and use supplemental needs trusts ...


Crafting A Narrative For The Red State Option, Elizabeth Weeks Leonard Jan 2014

Crafting A Narrative For The Red State Option, Elizabeth Weeks Leonard

Scholarly Works

This Article examines the current state of play following the Supreme Court's decision in NFIB v. Sebelius to allow states the option of expanding their Medicaid programs in accordance with the Patient Protection and Affordable Care Act (ACA). Holding that mandatory expansion was unconstitutionally coercive, the Court created the Red State Option. Despite the enormously generous federal financial support for Medicaid expansion, close to half of the states have declined. At the same time, at least eight Republican-led states have crossed Tea Party lines to accept federal funding for expansion. Drawing lessons from these states, including Arkansas, Arizona, Michigan ...


Observing Observational Status -- Auditors And Inequities Jan 2014

Observing Observational Status -- Auditors And Inequities

Marquette Elder's Advisor

No abstract provided.


On The Uneasy Relationship Between Medicaid And Charity Care, Laura D. Hermer, Merle Lenihan Jan 2014

On The Uneasy Relationship Between Medicaid And Charity Care, Laura D. Hermer, Merle Lenihan

Faculty Scholarship

Medicaid and charity care have a lengthy relationship fraught with complications. These complications will remain and in some respects become even more acute following the implementation of the Patient Protection and Affordable Care Act.

This article focuses on the uneasy relationship between Medicaid and charity care, one that becomes particularly acute in the context of Medicaid reimbursement. It traces the lineage of Medicaid in charity, and uses Medicaid reimbursement and supplemental payments as lenses through which to examine the relationship between Medicaid and charity care. The tension that we uncover will need to be resolved if Medicaid is to come ...


Rationalizing Home And Community-Based Services Under Medicaid, Laura Hermer Jan 2014

Rationalizing Home And Community-Based Services Under Medicaid, Laura Hermer

Faculty Scholarship

This article examines efforts states are making to expand access to community-based services for elderly and disabled Medicaid beneficiaries and suggests several options that might improve such access nationally. Like much of Medicaid, Medicaid long term services and supports (LTSS) have developed through a complex process of accretion. Policymakers appear only rarely to have considered an overarching view of such services and the needs of those who require them. Rationalizing Medicaid LTSS will accordingly require not only additions but also substantial pruning, and may even warrant a reconsideration of who should have ultimate authority to develop and direct such services ...


Response To: "Pay-To-Play: The Impact Of Group Purchasing Organizations On Drug Shortages", Curtis Rooney Jan 2014

Response To: "Pay-To-Play: The Impact Of Group Purchasing Organizations On Drug Shortages", Curtis Rooney

American University Business Law Review

No abstract provided.


Equal Protection, Immigrants And Access To Health Care And Welfare Benefits – A 2014 Update, Mel Cousins Dec 2013

Equal Protection, Immigrants And Access To Health Care And Welfare Benefits – A 2014 Update, Mel Cousins

Mel Cousins

The introduction of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) led to considerable litigation on the rights of immigrants to welfare benefits and access to health care. There was significant divergence between the approaches adopted by the different courts (both federal and State) based, in part, on the different statutory schemes involved but also on different approaches to equal protection. However, none of the cases reached the Supreme Court so the ‘correct’ approach remained unclarified. In response to the Great Recession and subsequent budget crises, several States have again excluded certain legal immigrants from the scope ...