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Full-Text Articles in Law

Sb 106 - Patients First Act, Jasmine Nicole Becerra, Leanne E. Livingston Dec 2019

Sb 106 - Patients First Act, Jasmine Nicole Becerra, Leanne E. Livingston

Georgia State University Law Review

The Patients First Act amends both Title 49 and Title 33 of the Official Code of Georgia Annotated, which allows the state to apply for two federal waivers. One being the Section 1115 waiver to the Social Security Act. The second being the Section 1332 waiver to the Affordable Care Act. Section 1115 waivers apply to Medicaid and may be sought to include a maximum income threshold up to 100% of the Federal Poverty Level. The Section 1332 innovation waiver applies to insurance coverage generally.


From Concierge Medicine To Patient-Centered Medical Homes: International Lessons And The Search For A Better Way To Deliver Primary Health Care In The U.S, Gwendolyn R. Majette Oct 2019

From Concierge Medicine To Patient-Centered Medical Homes: International Lessons And The Search For A Better Way To Deliver Primary Health Care In The U.S, Gwendolyn R. Majette

Gwendolyn R. Majette

This paper will proceed in eight parts. Part II explores why primary care is a critical component of a country's health care delivery system. Part III describes patient and physician dissatisfaction with the current state of primary care delivery in the United States. Parts IV and V describe physician-designed solutions and Congress' responses to them. Part VI describes the role of primary care in the delivery of health services in the international context by focusing on the World Health Organization's Health for All policy and the policies supporting primary care in the United Kingdom, the Netherlands, and Belgium ...


Contracting For Healthcare: Price Terms In Hospital Admission Agreements, George A. Nation Iii Oct 2019

Contracting For Healthcare: Price Terms In Hospital Admission Agreements, George A. Nation Iii

Dickinson Law Review

This article discusses the application of contract law principles to the relationship between hospitals and patients to determine how much patients owe for the health care they receive. For patients who are covered by in-network health insurance the exact nature of the contract created with the hospital usually is not relevant to the patient’s financial obligation because the patient’s contract with the hospital is superseded by the contract between the patient’s health insurer and the hospital. Nevertheless, even in-network patients are financially impacted, via increased insurance premiums, by the contract analysis discussed here, and for the increasing ...


Tax, Class, Women, And Elder Care, Nancy E. Shurtz Sep 2019

Tax, Class, Women, And Elder Care, Nancy E. Shurtz

Seattle University Law Review

As the fastest-growing urban area in the United States—and due to its emerging national influence in commercial real estate development and leasing through transformational transactions such as Amazon’s recently completed national HQ2 search—the City of Seattle and related Washington State laws addressing the use of dual agency in commercial transactions present a unique backdrop for examining the findings and recommendations from a 2014 commercial real estate conflicts of interest research study and attendant report, described below, more than four years after its publication. In November 2014, a published research study report made a number of key observations ...


Humanizing Work Requirements For Safety Net Programs, Mary Leto Pareja Sep 2019

Humanizing Work Requirements For Safety Net Programs, Mary Leto Pareja

Pace Law Review

This Article explores the political and policy appeal of work requirements for public benefit programs and concludes that inclusion of such requirements can be a reasonable design choice, but not in their current form. This Article’s proposals attempt to humanize these highly controversial work requirements while acknowledging the equity concerns they are designed to address. Drawing on expansive definitions of “work” found in guidance published by the Centers for Medicare and Medicaid (“CMS”) and in various state waiver applications, this Article proposes that work requirements be approved for Medicaid (as well as other benefit programs) only if they encompass ...


Humanizing Work Requirements For Safety Net Programs, Mary Leto Pareja Sep 2019

Humanizing Work Requirements For Safety Net Programs, Mary Leto Pareja

Faculty Scholarship

This Article explores the political and policy appeal of work requirements for public benefit programs and concludes that inclusion of such requirements can be a reasonable design choice, but not in their current form. This Article’s proposals attempt to humanize these highly controversial work requirements while acknowledging the equity concerns they are designed to address. Drawing on expansive definitions of “work” found in guidance published by the Centers for Medicare and Medicaid (“CMS”) and in various state waiver applications, this Article proposes that work requirements be approved for Medicaid (as well as other benefit programs) only if they encompass ...


Privacy Rights And Public Families, Khiara Bridges Jul 2019

Privacy Rights And Public Families, Khiara Bridges

Khiara M Bridges

This Article is based on eighteen months of anthropological fieldwork conducted among poor, pregnant women receiving prenatal care provided by the Prenatal Care Assistance Program (“PCAP”) at a large public hospital in New York City. The Prenatal Care Assistance Program (“PCAP”) is a special program within the New York State Medicaid program that provides comprehensive prenatal care services to otherwise uninsured or underinsured women. This Article attempts to accomplish two goals. The first goal is to argue that PCAP’s compelled consultations – with social workers, health educators, nutritionists, and financial officers – function as a gross and substantial intrusion by the ...


The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Ba, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stewart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd May 2019

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Ba, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stewart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.


Biting The Hands That Feed “The Alligators”: A Case Study In Morbid Obesity Extremes, End-Of-Life Care, And Prohibitions On Harming And Accelerating The End Of Life, Michael J. Malinowski Mar 2019

Biting The Hands That Feed “The Alligators”: A Case Study In Morbid Obesity Extremes, End-Of-Life Care, And Prohibitions On Harming And Accelerating The End Of Life, Michael J. Malinowski

Michael J. Malinowski

Obesity, recognized as a disease in the U.S. and at times as a terminal illness due to associated medical complications, is an American epidemic according to the Centers for Disease Control and Prevention (“CDC”), American Heart Association (“AHA”), and other authorities. More than one third of Americans (39.8% of adults and 18.5% of children) are medically obese. This article focuses on cases of “extreme morbid obesity” (“EMO”)—situations in which death is imminent without aggressive medical interventions, and bariatric surgery is the only treatment option with a realistic possibility of success. Bariatric surgeries themselves are very high ...


Deciphering State Medicaid Programs, Rachel Gershon Jan 2019

Deciphering State Medicaid Programs, Rachel Gershon

Commonwealth Medicine Publications

State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.


Threats To Medicaid And Health Equity Intersection, Mary Crossley Jan 2019

Threats To Medicaid And Health Equity Intersection, Mary Crossley

Saint Louis University Journal of Health Law & Policy

The year 2017 proved politically tumultuous in the U.S. on many fronts, but perhaps none more so than health care. For enrollees in the Medicaid program, it was a “year of living precariously.” Long-promised Republican efforts to repeal the Affordable Care Act also took aim at Medicaid, with proposals to fundamentally restructure the program and drastically cut its federal funding. These proposals provoked pushback from multiple fronts, including formal opposition from groups representing people with disabilities and people of color and individual protesters. Opposition by these groups should not have surprised the proponents of “reforming” Medicaid. Both people of ...


The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah Jan 2019

The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah

Faculty Scholarship

North Carolina Medicaid covers one-fifth of the state’s population and makes up approximately one-third of the budget. Yet the state has experienced increasing costs and worsening health outcomes over the past decade, while socioeconomic disparities persist among communities. In this article, the authors explore the factors that influence these trends and provide a series of policy lessons to inform the state’s current reform efforts following the recent approval of North Carolina’s Section 1115 waiver by the Centers for Medicare and Medicaid Services. The authors used health, social, and financial data from the state Department of Health and ...


Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor Nov 2018

Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor

Commonwealth Medicine Publications

Mckenzie Taylor continues our monthly conversation on the strategies presented in The Trump Administration Blueprint to Low Drug Prices and Reduce Out-of-Pocket Costs, discussing the ways new negotiations between payers and manufacturers are helping to reduce drug prices.


Limiting State Flexibility In Drug Pricing, Nicholas Bagley, Rachel E. Sachs Sep 2018

Limiting State Flexibility In Drug Pricing, Nicholas Bagley, Rachel E. Sachs

Articles

Throughout the United States, escalating drug prices are putting immense pressure on state budgets. Several states are looking for ways to push back. Last year, Massachusetts asked the Trump administration for a waiver that would, among other things, allow its Medicaid program to decline to cover costly drugs for which there is limited or inadequate evidence of clinical efficacy. By credibly threatening to exclude such drugs from coverage, Massachusetts hoped to extract price concessions and constrain the fastest-growing part of its Medicaid budget.


Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman Aug 2018

Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman

Commonwealth Medicine Publications

Dual eligible recipients represent a critical population for state Medicaid programs. To get a better understanding of this unique demographic, MassHealth partnered with UMass Medical School to design data analytics programs around the objective of protecting Medicaid as the payer of last resort.

Over the last three years, these programs achieved over $68 million in new savings by optimizing benefits for dual eligible members. The program also identified and recovered over $21 million in Medicare premium overpayments for Medicaid members with discrepancies in Medicare entitlement and premium charges.

Jenifer Hartman of the Center for Healthcare Financing presented UMass Medical School ...


Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter Aug 2018

Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter

Commonwealth Medicine Publications

Health plans and accountable care organizations are working with Medicaid programs to transition fee-for-services long-term services and supports (LTSS) to a managed care model known as managed LTSS. With more individuals with disabilities seeking to living in their own homes or in community settings, payers must take proactive steps to ensure individuals receive the right service and in the right setting. This white paper details the actions health plan decision makers should consider while developing a comprehensive managed LTSS program.


Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan Aug 2018

Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan

Commonwealth Medicine Publications

Practice transformation networks from across the country are going public with their successful results on patients and clinical practices. UMass Medical School’s Southern New England Practice Transformation Network (SNE-PTN) was one of the networks sharing its positive outcomes.


Stewart V. Azar – What Does It Mean For New Hampshire's Medicaid Work And Community Engagement Requirement?, Lucy C. Hodder Jul 2018

Stewart V. Azar – What Does It Mean For New Hampshire's Medicaid Work And Community Engagement Requirement?, Lucy C. Hodder

Law Faculty Scholarship

Lucy C. Hodder, Director of Health Law and Policy at UNH's Institute for Health Policy and Practice has written an article summarizing the recent federal court decision vacating Kentucky’s Medicaid waiver including its work and community engagement requirements and discussing what it might mean for New Hampshire.


The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton Jun 2018

The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton

Commonwealth Medicine Publications

This presentation describes the managed long-term services and supports (MLTSS) national landscape since 2012 as well as some LTSS utilization trends. A key part of the presentation is our MLTSS best practice framework and the role of LTSS clinical guidelines in that framework. The presentation includes a case study.

Experts from Disability Community Services and the Office of Clinical affairs gave the presentation during a webinar hosted by the Association for Community Affiliated Plans.


Covering The Care: Medicaid, Work, And Community Engagement, Lucy C. Hodder, Jo Porter Jun 2018

Covering The Care: Medicaid, Work, And Community Engagement, Lucy C. Hodder, Jo Porter

Law Faculty Scholarship

Part of "Informing the Conversation" data and policy brief series. This brief reviews the major parameters of the work and community engagement requirements being implemented in the New Hampshire Medicaid program, and the overall landscape of employment in the state.


Work/Community Engagement Requirement Stakeholder Roundtable, Lucy C. Hodder, Jo Porter Jun 2018

Work/Community Engagement Requirement Stakeholder Roundtable, Lucy C. Hodder, Jo Porter

Law Faculty Scholarship

Over the next twelve months, New Hampshire will transition to a new coverage model for the Medicaid expansion program (the "Granite Advantage Program"), and will implement a demonstration engagement requirement, approved focus on the population covered by an emphasis on work status and New Hampshire, see Covering the Care: A Focus on the NH Marketplace).


Research To Practice: Medicaid Involvement In Employment-Related Programs- Findings From The National Survey Of State Systems And Employment For People With Disabilities, Jennifer Sullivan Sulewski, Dana Scott Gilmore, Susan Foley May 2018

Research To Practice: Medicaid Involvement In Employment-Related Programs- Findings From The National Survey Of State Systems And Employment For People With Disabilities, Jennifer Sullivan Sulewski, Dana Scott Gilmore, Susan Foley

Jennifer Sulewski

This brief analyzes data from ICI's National Survey of State Systems and Employment for People with Disabilities regarding the priority Medicaid agencies place on employment and their involvement in recent policy initiatives.


Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar May 2018

Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar

Articles

In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was meant to be the government’s innovation laboratory for health care: an entity with the independence to break with past practices and the power to experiment with bold new approaches. Over the past year, however, the Department of Health and Human Services (HHS) has quietly hobbled CMMI, imperiling its ability to generate meaningful ...


Pasrr: A Unique Gateway To Community Services, Jessica Carpenter Apr 2018

Pasrr: A Unique Gateway To Community Services, Jessica Carpenter

Commonwealth Medicine Publications

The Omnibus Budget Reconciliation Act of 1987 required state Medicaid programs to implement a Pre-Admission Screening and Resident Review (PASRR) process, which required every person entering or residing in a Medicaid funded or certified long-term care nursing facility be screened for evidence of serious mental illness, and/or intellectual disability, developmental disability or related conditions, such as autism and cerebral palsy. The PASRR review confirms those individuals with a PASRR-related diagnosis and determines the least restrictive environment to meet their needs, and identifies disability focused services to promote the individuals’ highest level of function and independence.


Skilled Nursing Facilities: Too Many Beds, Rebecca Laes-Kushner Mar 2018

Skilled Nursing Facilities: Too Many Beds, Rebecca Laes-Kushner

Commonwealth Medicine Publications

More than 15,500 skilled nursing facilities (SNFs) provide care to more than 1.35 million people in the United States who need assistance with their Activities of Daily Living (ADLs), including going to the toilet, getting out of bed, getting dressed, feeding themselves, and showering, or who have cognitive difficulties, such as from dementia. Nationally, SNF use has declined as people live longer and choose home and community-based services (HCBS) over institutional care. From 2004 to 2014, the percentage of people age 65 and older in nursing homes dropped from 3.6% to 2.5%, a decrease of 24 ...


Are Medicaid Work Requirements Legal?, Nicholas Bagley Mar 2018

Are Medicaid Work Requirements Legal?, Nicholas Bagley

Articles

On January 12, 2018, the Centers for Medicare & Medicaid Services (CMS) approved a waiver allowing Kentucky to impose a work requirement on some nondisabled Medicaid beneficiaries. Similar waivers are sure to follow. Supporters see work requirements as a spur to force the idle poor to work; opponents see the requirements as a covert means of withholding medical care from vulnerable people. Setting the policy debate aside, however, are work requirements legal?


Impact Of A Pilot Outreach Program Upon Provider Awareness And Prescribing Of A Concerning Opioid Combination Regimen, Briana Santaniello, Thomas C. Pomfret, Mark A. Tesell, Nicole M. Trask, Caroline J. Alper, Karen M. Clements, Vincent Palumbo, Kimberly Lenz, Paul L. Jeffrey Feb 2018

Impact Of A Pilot Outreach Program Upon Provider Awareness And Prescribing Of A Concerning Opioid Combination Regimen, Briana Santaniello, Thomas C. Pomfret, Mark A. Tesell, Nicole M. Trask, Caroline J. Alper, Karen M. Clements, Vincent Palumbo, Kimberly Lenz, Paul L. Jeffrey

Commonwealth Medicine Publications

This pilot program was developed in response to a drug utilization review within a large Medicaid population that revealed some hazardous practices. Co-prescribing of opioids with benzodiazepines, gabapentin, and other stimulants occurred in more than 500 members, putting them at risk for additive central nervous system depression, misuse, abuse, and death from overdose.

The poster presentation outlines the objectives, methods, and results of a telephonic outreach program that addressed these safety concerns. It captures prescriber awareness of the presence and risks of potentially deadly medication combinations among members in their care, with some intriguing results.

Our experts provide health plans ...


A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert Feb 2018

A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert

Commonwealth Medicine Publications

In today’s polarized political environment, it is easy to forget that most policy decisions are not black or white, but rather some indeterminate shade of gray. A case in point is Indiana’s Medicaid waiver, which the federal government just approved for a three-year extension.


Putting The Brakes On Consumer Driven Medicaid: The Failures And Harms Of Healthy Indiana Plan (Hip) 2.0, Sidney D. Watson Jan 2018

Putting The Brakes On Consumer Driven Medicaid: The Failures And Harms Of Healthy Indiana Plan (Hip) 2.0, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

In January 2015, the U.S. Department of Health and Human Services (HHS) granted Indiana a Section 1115 Demonstration Waiver to experiment with consumer driven Medicaid. The Healthy Indiana Plan (HIP) 2.0 combines a $2,500 high deductible with a Personal Responsibility and Wellness (POWER) Account, premiums, and copays. Described as “the most significant departure from traditional Medicaid ever approved,” Indiana claims that the POWER Account, the signature feature of HIP 2.0, is “similar to a health savings account (HSA)” and encourages members to be more cost-conscious consumers, helps familiarize members with how commercial health insurance works, and ...


Health Justice In The Age Of Alternative Facts And Tax Cuts: Value-Based Care, Medicaid Reform, And The Social Determinants Of Health, Elizabeth Tobin-Tyler Jan 2018

Health Justice In The Age Of Alternative Facts And Tax Cuts: Value-Based Care, Medicaid Reform, And The Social Determinants Of Health, Elizabeth Tobin-Tyler

Saint Louis University Journal of Health Law & Policy

Some provisions of the Patient Protection and Affordable Care Act of 2010 (ACA) as well as regulatory policies under the Obama administration reflected the overwhelming evidence that to reduce health care costs, and to improve quality of care and population health, the social determinants of health (SDOH) must be addressed. These policies included funding for partnerships between public health agencies, community organizations, and health care institutions, promotion of value-based payment models that incentivize integrated health and social care delivery, and support for Medicaid program innovations that directly address social needs as part of health care. The Trump administration, through a ...