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Full-Text Articles in Law

Supporting Mothers With Mental Illness: Postpartum Mental Health Service Linkage As A Matter Of Public Health And Child Welfare Policy, Jesse Krohn, Msed, Jd, Meredith Matone, Drph, Mhs Jul 2017

Supporting Mothers With Mental Illness: Postpartum Mental Health Service Linkage As A Matter Of Public Health And Child Welfare Policy, Jesse Krohn, Msed, Jd, Meredith Matone, Drph, Mhs

Journal of Law and Health

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young ...


Covering The Care: Health Insurance Coverage In New Hampshire, Jo Porter, Lucy Hodder Jun 2017

Covering The Care: Health Insurance Coverage In New Hampshire, Jo Porter, Lucy Hodder

Law Faculty Scholarship

the first in a series of data and policy briefs that seek to inform the current conversations about health reform happening across the state. The first brief uses data from the American Community Survey to provide information about the health insurance coverage landscape in NH.


Managing Medicaid, Isaac D. Buck Jan 2017

Managing Medicaid, Isaac D. Buck

Saint Louis University Journal of Health Law & Policy

In a steady but rapid march, managed care has come to Medicaid. Privatization has undoubtedly rebuilt the Medicaid landscape across America over the last three decades. Now, as managed care programs administer health care to three-in-four Medicaid beneficiaries nationwide, whether or not managed care is adequately managing America’s largest public insurance program has become an increasingly important question.

Of particular note have been states’ difficulties in constructing and organizing the bidding and selection processes of the private companies tasked with overseeing the administration of private Medicaid plans. Legal challenges to various states’ bid procurement processes have been well documented ...


N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice Jan 2017

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and ...


Wrongly “Identified”: Why An Actual Knowledge Standard Should Govern Health Care Providers’ False Claims Act Obligations To Report And Return Medicare And Medicaid Overpayments, Nicholas J. Goldin Jan 2017

Wrongly “Identified”: Why An Actual Knowledge Standard Should Govern Health Care Providers’ False Claims Act Obligations To Report And Return Medicare And Medicaid Overpayments, Nicholas J. Goldin

Washington University Law Review

In 2015, Medicare spent $632 billion on health care for America’s elderly (and other covered groups). Medicaid spent another $554 billion to provide health care to America’s needy. The government estimates that improper payments account for as much as 10% of Medicare and Medicaid spending. Given the vast amount of money at stake, and the fact that there is bipartisan support for recovering taxpayer dollars, it is no surprise the federal government has made it a priority to recoup the money lost to health care fraud each year. The results are noticeable: annual recoveries for health care fraud ...


Implementing Medicaid Health Homes To Provide Medication Assisted Treatment To Opioid Dependent Medicaid Beneficiaries, Page M. Smith Jan 2017

Implementing Medicaid Health Homes To Provide Medication Assisted Treatment To Opioid Dependent Medicaid Beneficiaries, Page M. Smith

Kentucky Law Journal

No abstract provided.


Health Information Equity, Craig Konnoth Jan 2017

Health Information Equity, Craig Konnoth

Articles

In the last few years, numerous Americans’ health information has been collected and used for follow-on, secondary research. This research studies correlations between medical conditions, genetic or behavioral profiles, and treatments, to customize medical care to specific individuals. Recent federal legislation and regulations make it easier to collect and use the data of the low-income, unwell, and elderly for this purpose. This would impose disproportionate security and autonomy burdens on these individuals. Those who are well-off and pay out of pocket could effectively exempt their data from the publicly available information pot. This presents a problem which modern research ethics ...


Southern New England Practice Transformation Network: Thinking Outside The Box Solved Our Enrollment Challenges, David Polakoff Dec 2016

Southern New England Practice Transformation Network: Thinking Outside The Box Solved Our Enrollment Challenges, David Polakoff

Commonwealth Medicine Publications

The strategies used by the Southern New England Practice Transformation Network (SNE-PTN), a collaborative led by UMass Medical School and UConn Health, to enroll more than 5,000 clinicians from a variety of specialties by the end of October 2016. The strategies led SNE-PTN to achieve 186 percent of the year one enrollment target.

SNE-PTN is one of 29 practice transformation networks across the country chosen by the Centers for Medicare and Medicaid Services to be part of its Transforming Clinical Practices Initiative. This practice transformation program aims to bring together specialty and primary care clinicians to work individually and ...


Complex Care Management Model Design, Jessica Carpenter Oct 2016

Complex Care Management Model Design, Jessica Carpenter

Commonwealth Medicine Publications

The steps to developing Complex Care Management Model Design for state Medicaid programs with a focus on one single point of entry. In this design, long term services and supports are provided in order for individuals to remain in the community.


Best Practices In Care Coordination & Transitions Of Care Communications, Jessica Carpenter Oct 2016

Best Practices In Care Coordination & Transitions Of Care Communications, Jessica Carpenter

Commonwealth Medicine Publications

Learn the strategies required to deliver patient-centric, quality care for individuals with complex care needs. Successful coordination and management requires networking with multiple care providers and linking each intervention to the individual’s overall care.


Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum Oct 2016

Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such ...


Improving Population Healthcare Through Data Analytics, Visualization, And Reporting Tools, Rick Perro Aug 2016

Improving Population Healthcare Through Data Analytics, Visualization, And Reporting Tools, Rick Perro

Commonwealth Medicine Publications

Policy makers, program planners and health care providers must be able to identify at-risk populations and geographic areas of need, implement programs to effect change, and track and report the results to achieve success in today’s health care environment. Mapping and visualization tools can enhance the use of data to characterize a population’s health and social services needs, target interventions and compare outcomes across different population subgroups. In Massachusetts, visualization and analytic tools are used to manage 1915c Medicaid Waiver programs, track operations, improve efficiency, report quality measures, monitor program integrity and plan for expanded service needs.


A Pathway To Dual Eligible Data Integration: Maximizing Coordination Of Benefits, Services, And Payments Through The Massachusetts Mmis, Jenifer Hartman, Kathleen Melanson Aug 2016

A Pathway To Dual Eligible Data Integration: Maximizing Coordination Of Benefits, Services, And Payments Through The Massachusetts Mmis, Jenifer Hartman, Kathleen Melanson

Commonwealth Medicine Publications

We have partnered with MassHealth, Massachusetts’ Medicaid program, to develop and deploy precision data integration methodologies within the Massachusetts Medicaid Management Information System (MMMIS) to maximize coordination of benefits, services and payments for Medicaid recipients with current or potential dual eligibility for Medicare. Integration strategies and coordination benchmarks are used to ensure accurate Medicaid and Medicare enrollment; fully engage service delivery options (including managed care and integrated care programs); and effectively cost-avoid, reprice, or cost-share to ensure the state’s lowest payment liability.


Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale Jun 2016

Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale

Commonwealth Medicine Publications

A detailed review of the teaching assistance (TA) and shared learning (SL) in the area of behavioral health integration UMass Medical School provided to participants of the Primary Care Payment Reform program, an alternative payment pilot developed by the Massachusetts Medicaid program, MassHealth. PCPR was designed to improve access, patient experience, quality and efficiency. As a result of TA and SL, practices reported higher rates on behavioral health quality measures and milestones.


Paving The Way For Practice Success Under Value-Based Payments, Judith Steinberg, Anita Morris, Valerie Konar, Frederick (Rick) Perro, Pam Senesac, David Polakoff Jun 2016

Paving The Way For Practice Success Under Value-Based Payments, Judith Steinberg, Anita Morris, Valerie Konar, Frederick (Rick) Perro, Pam Senesac, David Polakoff

Commonwealth Medicine Publications

A comprehensive look at The Southern New England Practice Transformation Network (SNE-PTN), which supports implementation of person-centered, high quality, efficient, and coordinated care. SNE-PTN is funded under the Centers for Medicare & Medicaid Services’ Transforming Clinical Practices Initiative.

SNE-PTN is a complex, large-scale care transformation effort that requires a multi-faceted approach and alignment with state and national health care reform efforts. It is important to articulate the value proposition for clinicians.


Medicaid Maximization And Diversion: Illusory State Practices That Convert Federal Aid Into General State Revenue, Daniel L. Hatcher Apr 2016

Medicaid Maximization And Diversion: Illusory State Practices That Convert Federal Aid Into General State Revenue, Daniel L. Hatcher

All Faculty Scholarship

For years, states have been using illusory schemes to maximize federal aid intended for Medicaid services-and then often diverting some or all of the resulting funds to other use. And states have help. Private revenue maximization consultants are hired by states to increase Medicaid claims, often for a contingency fee. We do not know the exact amount of federal Medicaid funds that has been diverted to state revenue and private profit each year, but it is in the billions.

The states' revenue strategies take advantage of the matching-grant structure of the Medicaid program. When state funds are spent on eligible ...


Productivity And Affinity In The Age Of Dignity, Stephen Lee Apr 2016

Productivity And Affinity In The Age Of Dignity, Stephen Lee

Michigan Law Review

This Review proceeds as follows. Part I summarizes The Age of Dignity. Part II explains how this segment of immigrant workers challenges the productivity/affinity binary that dominates immigration law’s formal migration rules. Part III shows how this binary sets up dual migration streams, both of which could account for future flows of care workers. As Part III shows, the example of the eldercare industry nicely illustrates how the employment based and family-based migration systems simply represent two different ways of filling labor needs. I then conclude.


Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris Mar 2016

Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris

Commonwealth Medicine Publications

Primary Care Payment Reform (PCPR) is an alternative payment pilot program of MassHealth, with learning collaborative support from UMass Medical School, that introduces the principles of accountable care, behavioral health integration and patient-centered medical homes in primary care practices. The pilot demonstrated that behavioral health integration is a necessary component of whole-person care and a complex, but highly accomplishable task; numerous transformation strategies can support the clinical, financial and cultural challenges to integration; and alternative payment models are essential to support sustainable, expandable and successful behavioral health services in primary care.


Stories From The Frontline: Patient-Centered Medical Home Care Transitions, Anita Morris, Joan Johnston, Sai Cherala, Ruth Aboagye, Pam Senesac, Judith L. Steinberg, Jaime Vallejos Mar 2016

Stories From The Frontline: Patient-Centered Medical Home Care Transitions, Anita Morris, Joan Johnston, Sai Cherala, Ruth Aboagye, Pam Senesac, Judith L. Steinberg, Jaime Vallejos

Commonwealth Medicine Publications

The Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI) was a three-year multi-payer demonstration designed to promote clinical model transformation in practices across the state and prepare the practices for PCMHI recognition. It was a partnership between MassHealth, the Massachusetts Medicaid program, and UMass Medical School. An analysis of the project at 46 participating practices finds that primary care practice transformation takes time; care transitions, including emergency room and post-discharge follow-up care, require the development of new clinical workflows; and the processes of care are more likely to improve before outcomes are affected. These lessons learned can aid provider organizations nationwide ...


Administrative Oversight Of State Medicaid Payment Policies:Giving Teeth To The Equal Access Provision, Julia Bienstock Feb 2016

Administrative Oversight Of State Medicaid Payment Policies:Giving Teeth To The Equal Access Provision, Julia Bienstock

Fordham Urban Law Journal

No abstract provided.


Health Care And The Myth Of Self-Reliance, Nicole Huberfeld, Jessica L. Roberts Jan 2016

Health Care And The Myth Of Self-Reliance, Nicole Huberfeld, Jessica L. Roberts

Law Faculty Scholarly Articles

King v. Burwell asked the Supreme Court to decide if, in providing assistance to purchase insurance “through an Exchange established by the State,” Congress meant to subsidize policies bought on the federally run exchange. With its ruling, the Court saved the Patient Protection and Affordable Care Act’s low-income subsidy. But King is only part of a longer, more complex story about health care access for the poor. In a move toward universal coverage, two pillars of the ACA facilitate health insurance coverage for low-income Americans, one private and one public: (1) the subsidy and (2) Medicaid expansion. Although both ...


Premiums And Section 1115 Waivers: What Cost Medicaid Expansion?, Sidney D. Watson Jan 2016

Premiums And Section 1115 Waivers: What Cost Medicaid Expansion?, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

States reluctant to adopt the Affordable Care Act’s Medicaid expansion are demanding that the U.S. Department of Health and Human Services grant them Section 1115 demonstration waivers that allow them to charge poor people premiums.

The U.S. Department of Health and Human Services has yielded to these demands, granting five states waivers of long standing federal statutory protections that limit state discretion to impose premiums for Medicaid. These premium waivers present a fundamental problem of law because the Secretary of the U.S. Department of Health and Human Services has no statutory authority to grant Section 1115 ...


Key Issues Facing Medicaid After The Affordable Care Act, Marybeth Musumeci Jan 2016

Key Issues Facing Medicaid After The Affordable Care Act, Marybeth Musumeci

Saint Louis University Journal of Health Law & Policy

No abstract provided.


Medicaid, Managed Care, And The Mission For The Poor, John V. Jacobi Jan 2016

Medicaid, Managed Care, And The Mission For The Poor, John V. Jacobi

Saint Louis University Journal of Health Law & Policy

Medicaid has financed care for the poor for five decades. During that time it has balanced two important missions: providing for the particular health needs of the poor, and mainstreaming care for the poor. These roles have been consistent as all insurance payors—public and private—have shifted away from passively funding fragmented care to actively supporting patient-centered coordinated care. But the health needs of the poor go beyond medical interventions; the health status of the poor depends on the provision of social services to address social determinants of health, including housing, nutrition, and employment training services. Unlike non-poor insureds ...


Pin The Tail On The Donkey: Beneficiary Enforcement Of The Medicaid Act Over Time, Jane Perkins Jan 2016

Pin The Tail On The Donkey: Beneficiary Enforcement Of The Medicaid Act Over Time, Jane Perkins

Saint Louis University Journal of Health Law & Policy

During the twentieth century, Congress enacted legislation designed to improve the lives of low-income Americans. A number of these laws were enacted by Congress pursuant to the Constitution’s Spending Clause, including the Medicaid Act, which entitles certain low-income individuals to publicly funded health insurance coverage. As enacted in 1965, the Medicaid Act did not include a provision authorizing the statute’s beneficiaries to bring private enforcement actions in court. Since the early 1970s, however, program beneficiaries relied upon the Constitution’s Supremacy Clause or, more frequently, 42 U.S.C. § 1983 for the cause of action allowing them to ...


On The Expansion Of “Welfare” And “Health” Under Medicaid, Laura D. Hermer Jan 2016

On The Expansion Of “Welfare” And “Health” Under Medicaid, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

Medicaid was intended from its inception to provide financial access to health care for certain categories of impoverished Americans. While rooted in historical welfare programs, it was meant to afford the “deserving” poor access to the same sort of health care that other, wealthier Americans received. Yet despite this seemingly innocuous and laudable purpose, it has become a front in the political and social battles waged over the last several decades on the issues of welfare and the safety net. The latest battleground pits competing visions of Medicaid. One vision seeks to transform Medicaid from a health care program into ...


Wage Theft As Public Larceny, Elizabeth J. Kennedy Jan 2016

Wage Theft As Public Larceny, Elizabeth J. Kennedy

Brooklyn Law Review

Home care for the elderly and disabled is a rapidly expanding industry in which structural and regulatory factors contribute to worker vulnerability and exploitation. Systemic exclusion from core federal employment and labor laws, as well as many state and local regulations, results in minimal consequences for employers who violate standards. Despite recent movement at the federal level to create a “new mindset” of rights and regulations, home care workers must be equipped with creative ways to enforce these new rights and to challenge existing gaps in enforcement. With the understanding that two-thirds of the home care industry is financed by ...


Reforming Healthcare Reform, Jacqueline Fox Jan 2016

Reforming Healthcare Reform, Jacqueline Fox

University of Richmond Law Review

No abstract provided.


On The Expansion Of “Health” And “Welfare” Under Medicaid, Laura Hermer Jan 2016

On The Expansion Of “Health” And “Welfare” Under Medicaid, Laura Hermer

Faculty Scholarship

Medicaid was intended from its inception to provide financial access to health care for certain categories of impoverished Americans. While rooted in historical welfare programs, it was meant to afford the "deserving" poor access to the same sort of health care that other, wealthier Americans received. Yet despite this seemingly innocuous and laudable purpose, it has become a front in the political and social battles waged over the last several decades on the issues of welfare and the safety net. The latest battleground pits competing visions of Medicaid. One vision seeks to transform Medicaid from a health care program into ...


Reimagining The Risk Of Long-Term Care, Allison K. Hoffman Jan 2016

Reimagining The Risk Of Long-Term Care, Allison K. Hoffman

Faculty Scholarship at Penn Law

U.S. law and policy on long-term care fail to address the insecurity American families face due to prolonged illness and disability — a problem that grows more serious as the population ages and rates of disability rise. This Article argues that, even worse, we have focused on only part of the problem. It illuminates two ways that prolonged disability or illness can create insecurity. The first arises from the risk of becoming disabled or sick and needing long-term care, which could be called “care-recipient” risk. The second arises out of the risk of becoming responsible for someone else’s care ...