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Full-Text Articles in Law
Self-Insurance And The Potential Effects Of Health Reform On The Small-Group Market, Kathryn Linehan
Self-Insurance And The Potential Effects Of Health Reform On The Small-Group Market, Kathryn Linehan
National Health Policy Forum
The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers—most often those in very large firms—are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA …
The Elder Justice Act: Addressing Elder Abuse, Neglect, And Exploitation, Carol O'Shaughnessy
The Elder Justice Act: Addressing Elder Abuse, Neglect, And Exploitation, Carol O'Shaughnessy
National Health Policy Forum
Elder abuse, neglect, and exploitation is a social problem that affects older people across all socioeconomic groups and care settings. Although national data on the full extent of the problem are elusive, one study found that 11 percent of older people living in community settings had experienced physical, emotional, or sexual abuse, or potential neglect during one year. Abuse and neglect of residents of nursing facilities and other institutions have been a continuing concern of policymakers and advocates for many years. The Elder Justice Act (EJA), enacted as part of the Patient Protection and Affordable Care Act (PPACA) on March …
Aging And Disability Resource Centers (Adrcs): Federal And State Efforts To Guide Consumers Through The Long-Term Services And Supports Maze, Carol O'Shaughnessy
Aging And Disability Resource Centers (Adrcs): Federal And State Efforts To Guide Consumers Through The Long-Term Services And Supports Maze, Carol O'Shaughnessy
National Health Policy Forum
Since 2003, the U.S. Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS) have made a series of grants to states to develop Aging and Disability Resource Centers (ADRCs). The ADRC program’s purpose is to help people of all ages, disabilities, and income levels more easily access long-term services and supports through single points of entry, make more efficient use of care options, and maximize the services available. Almost $111 million in joint AoA-CMS funding has been devoted to the ADRC initiative since its inception in fiscal year 2003. As of October 2010, 325 ADRC sites …
Premium Assistance: An Update, Cynthia Shirk
Premium Assistance: An Update, Cynthia Shirk
National Health Policy Forum
This background paper explores the use of premium assistance in publicly financed health insurance coverage programs. In Medicaid and the Children’s Health Insurance Program, premium assistance involves using federal and state funds to subsidize premiums for the purchase of private insurance coverage for eligible individuals. This paper reviews the statutory authority for premium assistance, including two new options made available under the Children’s Health Insurance Program Reauthorization Act of 2009. It examines the status of premium assistance programs in the states and offers some insights into how premium assistance programs may fare under the Patient Protection and Affordable Care Act.
The Primary Care Safety Net: Strained, Transitioning, Critical, Jessamyn Taylor
The Primary Care Safety Net: Strained, Transitioning, Critical, Jessamyn Taylor
National Health Policy Forum
This background paper examines the primary care safety net. It describes key primary care safety net providers, including federally qualified health centers, free clinics, local health departments, and safety net hospital outpatient departments and clinics, among others. The paper also explores the changing role of the primary care safety net in a post–health reform marketplace.
High Hopes: Public Health Approaches To Reducing The Need For Health Care, Michele J. Orza
High Hopes: Public Health Approaches To Reducing The Need For Health Care, Michele J. Orza
National Health Policy Forum
Driven in part by a desire to contain health care costs, policymakers are looking beyond medical care for opportunities to reduce the need for expensive services. This paper briefly reviews current public health concepts and strategies for improving health that emphasize nonmedical factors such as behavior, socioeconomic status, and environment. It also provides examples of how these concepts and strategies undergird many of the public health provisions of the Patient Protection and Affordable Care Act, other legislation, and several programs and initiatives. These concepts include prevention, health in all policies, global health, the One Health Initiative, and climate change and …
Governmental Public Health: An Overview Of State And Local Public Health Agencies, Eileen Salinsky
Governmental Public Health: An Overview Of State And Local Public Health Agencies, Eileen Salinsky
National Health Policy Forum
The Patient Protection and Affordable Care Act significantly expands federal support for community prevention and public health. This paper describes the governmental public health infrastructure at both the state and local level in terms of organizational structure, activities, financing, workforce, partnerships, and performance improvement efforts.
Medicare Physician Fees: The Data Behind The Numbers, Laura A. Dummit
Medicare Physician Fees: The Data Behind The Numbers, Laura A. Dummit
National Health Policy Forum
Medicare’s physician fee schedule distributes nearly $60 billion annually and is a critical determinant of individual physicians’ incomes, beneficiaries' access to health care services, and Medicare spending, as well as the basis for physician fees used by many private payers. The Centers for Medicare & Medicaid Services (CMS) relies on data derived from expert judgment and other sources to update the fee schedule. Although CMS’s methods and data for maintaining the fee schedule have improved over the years, concerns remain about medical specialty society involvement and the lack of an effective ”counterweight” to vested interests in establishing and updating the …
Tapping The Potential Of The Health Care Workforce: Scope-Of-Practice And Payment Policies For Advanced Practice Nurses And Physician Assistants, Robert Cunningham
Tapping The Potential Of The Health Care Workforce: Scope-Of-Practice And Payment Policies For Advanced Practice Nurses And Physician Assistants, Robert Cunningham
National Health Policy Forum
Expanding coverage and increasing delivery of team-based care are likely to entail a growing role in the
health system for advanced practice nurses (APNs), physician assistants (PAs), and other nonphysician clinicians. These professions have already grown rapidly and have increased access to primary and specialty care, especially in rural and other underserved areas. This background paper provides an overview of the role of APNs and PAs. It reviews the primary features of the training and credentialing of these health professions, including the impact of public policies and market forces on their growth and deployment. It describes variations in state scope-of-practice …
Keeping Health Insurance After A Job Loss: Cobra Continuation Coverage And Subsidies, Kathryn Linehan
Keeping Health Insurance After A Job Loss: Cobra Continuation Coverage And Subsidies, Kathryn Linehan
National Health Policy Forum
Many Americans under 65 have health insurance through an employer. Beginning in 1985, a federal law known as COBRA required that eligible workers and their dependents have the option to continue employer-based group health coverage when employment is terminated. Because premiums for COBRA coverage can be very expensive, the 111th Congress included provisions in the American Recovery and Reinvestment Act of 2009 (and subsequent legislation) to temporarily subsidize premiums for those who have lost their jobs since September 2008. This issue brief outlines the eligibility rules for COBRA as well as the current COBRA subsidies. It also discusses the possible …
Health Care Shortage Designations: Hpsa, Mua, And Tbd, Eileen Salinsky
Health Care Shortage Designations: Hpsa, Mua, And Tbd, Eileen Salinsky
National Health Policy Forum
A wide variety of federal programs designed to improve access to health care services rely on specific criteria to designate areas and populations eligible for funding and other types of aid. Two related yet distinct designations, the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA), are most commonly used to identify underserved people or places. This background paper reviews the methodologies currently utilized in these designations, identifies the federal programs that use these designations to allocate resources, describes proposals that have been advanced to consolidate and improve these designations, and discusses key issues and challenges for future …
Heath Care Spending: Why Is Miami An Outlier?, Laura A. Dummit, Mary Ellen Stahlman
Heath Care Spending: Why Is Miami An Outlier?, Laura A. Dummit, Mary Ellen Stahlman
National Health Policy Forum
The National Health Policy Forum’s site visit to Miami focused on the complex factors that drive health care spending and is the latest in a series on the dynamics of health care markets. Miami has long been recognized as having among the highest Medicare per capita spending in the country, along with high rates of uninsured, strong managed care presence, and a history of health care fraud. This colorful health care market brings into stark relief many of the reasons for high and growing health care spending across the country. It also highlights several issues involved in building and maintaining …
Physician Assessment: Measuring Competence And Performance, Lisa Sprague
Physician Assessment: Measuring Competence And Performance, Lisa Sprague
National Health Policy Forum
No abstract provided.
Information And Incentives: Improving The Health Of New York City's Low-Income Population, Kathryn Linehan, Lisa Sprague
Information And Incentives: Improving The Health Of New York City's Low-Income Population, Kathryn Linehan, Lisa Sprague
National Health Policy Forum
The National Health Policy Forum sponsored a site visit to New York City (NYC) in April 2010 to explore health care delivery for Medicaid beneficiaries and the uninsured in New York City’s hospital-dominated market. New York offers real-time examples of government policy and provider initiatives in health information technology (IT) and quality improvement being played out on a large, complex, and dynamic stage with multiple stakeholders. Site visit participants heard from providers and others who discussed efforts to improve the quality of care for low-income New Yorkers through a variety of methods, such as the adoption and use of electronic …
The State Health Insurance Assistance Program (Ship), Carol O'Shaughnessy
The State Health Insurance Assistance Program (Ship), Carol O'Shaughnessy
National Health Policy Forum
The State Health Insurance Assistance Program (SHIP), created by section 4360 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 and administered by the Centers for Medicare & Medicaid Services (CMS), supports grants to states and jurisdictions to provide information, counseling, and assistance to Medicare beneficiaries and their families on Medicare and other health insurance questions. This publication describes the program and presents its funding history.
Oral Health Checkup: Progress In Tough Fiscal Times?, Cynthia Shirk
Oral Health Checkup: Progress In Tough Fiscal Times?, Cynthia Shirk
National Health Policy Forum
Almost ten years after the surgeon general’s report designating dental disease as the “silent epidemic,” the nation continues to struggle with adequate access to and utilization of dental services. This is particularly true for low-income individuals, who experience more than twice the amount of untreated dental disease as their higher-income peers. This issue brief reviews sources of dental coverage for low-income children and adults and the challenges these programs face. It highlights some examples of state Medicaid initiatives to improve access and utilization for children and the progress of these initiatives. Finally, it examines the potential effects of the economy …
The Ryan White Hiv/Aids Program, Jessamyn Taylor
The Ryan White Hiv/Aids Program, Jessamyn Taylor
National Health Policy Forum
This publication describes the basics of the Ryan White HIV/AIDS Program, the largest federal program solely focused on treating people living with HIV/AIDS in the United States. The program funds cities, states, and community-based organizations to provide primary care, prescription drugs, and support services to low-income, uninsured, and underinsured people living with HIV/AIDS.
The Medical Education Of Physicians, Jonathan Saxton
The Medical Education Of Physicians, Jonathan Saxton
National Health Policy Forum
This background paper provides a descriptive overview of the process of education, licensing, certification, and continuing education involved in becoming and continuing to practice as a physician.