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2002

Health Law and Policy

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Articles 1 - 30 of 105

Full-Text Articles in Law

Independent External Review Of Health Maintenance Organizations' Medical-Necessity Decisions, Wendy K. Mariner Dec 2002

Independent External Review Of Health Maintenance Organizations' Medical-Necessity Decisions, Wendy K. Mariner

Faculty Scholarship

States may have more freedom to regulate the practices of managed-care organizations than many observers previously believed. In the absence of congressional action on the federal Bipartisan Patient Protection Act, the primary source of patient-protection legislation remains at the state level. Nevertheless, the federal Employee Retirement Income Security Act (ERISA) of 19742restricts state regulation of health maintenance organizations (HMOs) that serve private employee group health plans. On June 20, 2002, the U.S. Supreme Court, in Rush Prudential HMO, Inc. v. Moran, upheld an Illinois state law that requires binding independent external review when an HMO disagrees with the …

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Depression: A Decade Of Progress, More To Do, Veronica V. Goff Nov 2002

Depression: A Decade Of Progress, More To Do, Veronica V. Goff

National Health Policy Forum

This issue brief discusses the most recent findings on depression prevalence and cost; examines trends in outpatient treatment, including the dramatic growth in antidepressant use; discusses efforts to improve treatment in primary care; and explores possible public policy avenues for improving treatment access and quality.

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U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin Nov 2002

U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin

National Health Policy Forum

Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.

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Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson Nov 2002

Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson

National Health Policy Forum

This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

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The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore Nov 2002

The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County.

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Mid-Atlantic Ethics Committee Newsletter, Fall 2002 Oct 2002

Mid-Atlantic Ethics Committee Newsletter, Fall 2002

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

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Unwarranted Variations In The Quality Of Health Care: Can The Law Help Medicine Provide A Remedy/Remedies?, Philip G. Peters Jr., John E. Wennberg M.D. Oct 2002

Unwarranted Variations In The Quality Of Health Care: Can The Law Help Medicine Provide A Remedy/Remedies?, Philip G. Peters Jr., John E. Wennberg M.D.

Faculty Publications

This article reviews the essential findings of studies of variations in quality of care according to three categories of care: effective care, preference-sensitive care, and supply-sensitive care. It argues that malpractice liability and informed consent laws should be based on standards of practice that are appropriate to each category of care. In the case of effective care, the legal standard should be that virtually all of those in need should receive the treatment, whether or not it is currently customary to provide it. In the case of preference-sensitive care, the law should recognize the failure of the doctrine of informed …

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A Jurisprudential Analysis Of Government Intervention And Prenatal Drug Abuse, Susan Saab Fortney Oct 2002

A Jurisprudential Analysis Of Government Intervention And Prenatal Drug Abuse, Susan Saab Fortney

Faculty Scholarship

This article addresses the serious public health problem of substance abuse among pregnant women. Part I of this article introduces the national problem of prenatal drug abuse. Part II discuses the appropriateness of government intervention. The article explains the medical consequences of prenatal drug abuse, and then, describes the justification of government intervention. The article details both existing criminal law and new legislation regarding prenatal drug abuse. Part III addresses constitutional concerns and the conflict between a woman’s right on the one hand and the state interest and “fetal rights” on the other. Part IV considers the moral and legal …

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Running On Empty: The State Budget Crisis Worsens, Randy Desonia Sep 2002

Running On Empty: The State Budget Crisis Worsens, Randy Desonia

National Health Policy Forum

This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.

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Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super Sep 2002

Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super

National Health Policy Forum

This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program.

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State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus Sep 2002

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

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Law & Health Care Newsletter, V. 10, No. 1, Fall 2002 Aug 2002

Law & Health Care Newsletter, V. 10, No. 1, Fall 2002

Law & Health Care Newsletter

No abstract provided.

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Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James Aug 2002

Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James

National Health Policy Forum

This paper seeks to provide the basics for understanding the current debate over tax credits as a vehicle for reducing the number of uninsured Americans and focuses attention on some of the associated issues: How is health insurance treated under current tax law? Why tax credits and not deductions? What are the major issues in designing tax credits? Who should be eligible and for what size credit? What changes, if any, would be needed to the insurance market to ensure that policies are available and affordable for people eligible for tax credits? What are the major issues related to administering …

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Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan Aug 2002

Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan

National Health Policy Forum

This issue brief notes the five-year anniversary of the effective date of Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP). It looks at the successes of the program, as well as some of the obstacles SCHIP will face as it moves from childhood into adolescence and attempts to maintain its effectiveness in providing health coverage to uninsured children and families. The paper explores the critical funding impasse created by the downturns in the economy and the financing structure of the SCHIP statute. It also highlights the emerging issue of program retention and the need …

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Federal Child Care Funding For Low-Income Families: How Much Is Needed?, Jane Koppelman Jul 2002

Federal Child Care Funding For Low-Income Families: How Much Is Needed?, Jane Koppelman

National Health Policy Forum

With reauthorization of the 1996 welfare reform law being debated, this paper looks at the Temporary Assistance for Needy Families block grant and the Child Care and Development Fund — key components of congressional proposals to set a dollar amount for government spending on child care. This issue brief provides background on current child care use, arrangements, and cost, as well as research findings on the measurement of quality in child care programs.

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Tobacco Regulation Review, V. 1, No. 1, July 2002 Jul 2002

Tobacco Regulation Review, V. 1, No. 1, July 2002

Tobacco Regulation Review

No abstract provided.

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Income Tax Planning For Long-Term Care, David M. English Jul 2002

Income Tax Planning For Long-Term Care, David M. English

Faculty Publications

Planning for long-term involves more than the preparation of powers of attorney and counseling on possible asset transfers to qualify for Medicaid reimbursement. Steps should also be taken to make certain that the person receiving care continues to file an income tax return and does so at a minimum possible income tax cost. Practitioners should be familiar with the procedure for filing a return on behalf of an incapacitated individual. The medical expense deduction, while of little importance for most taxpayers, is critical for many elderly, particularly for those receiving long-term care. Long-term care insurance and life insurance may be …

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All My Rights, Carl E. Schneider Jul 2002

All My Rights, Carl E. Schneider

Articles

Diane Pretty was an Englishwoman in her early 40s who had been married nearly a quarter of a century. In November 1999, she learned she had amyotrophic lateral sclerosis-in Britain, motor neurone disease. Her condition deteriorated rapidly, and soon she was "essentially paralysed from the neck downwards." She had "virtually no decipherable speech" and was fed by a tube. She was expected to live only a few months or even weeks. AB a court later explained, however, "her intellect and capacity to make decisions are unimpaired. The final stages of the disease are exceedingly distressing and undignified. AB she is …

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Hatch-Waxman, Generics, And Patents: Balancing Prescription Drug Innovation, Competition, And Affordability, Robin J. Strongin Jun 2002

Hatch-Waxman, Generics, And Patents: Balancing Prescription Drug Innovation, Competition, And Affordability, Robin J. Strongin

National Health Policy Forum

This paper explores the complex connections among intellectual property protection, competition, and access to affordable prescription drug products. It focuses on several provisions of the Drug Price Competition and Patent Term Restoration Act of 1984 (Hatch-Waxman) and discusses the debate swirling around its reform. An overview of landmark intellectual property laws and a description of the generic drug approval process are also included.

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Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee Jun 2002

Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee

National Health Policy Forum

This issue brief examines approaches to delivering and financing health services for persons with advanced chronic illness. It focuses on the nature and structure of the Medicare hospice benefit and its use as a model for Medicaid and other federal programs. The paper also looks at palliative-care approaches along the continuum of inpatient and post-acute services and raises cost, quality, and access issues for end-of-life care. In addition, it provides an overview of coverage through private insurance, including indemnity, point-of-service, and preferred-provider-organization products.

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1115 Ways To Waive Medicaid And Schip Rules, Jennifer Ryan Jun 2002

1115 Ways To Waive Medicaid And Schip Rules, Jennifer Ryan

National Health Policy Forum

This issue brief explores the history and context of the Section 1115 Medicaid waiver authority, discusses the Health Insurance Flexibility and Accountability (HIFA) initiative under way in the Bush administration, and considers some of the potential impacts that HIFA could have on state budgets and access to health care for low-income families. Finally, it considers the future of Section 1115 waivers as a vehicle for modifying Medicaid and the State Children's Health Insurance Program.

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Improving Oral Health: Promise And Prospects, Jennifer Ryan Jun 2002

Improving Oral Health: Promise And Prospects, Jennifer Ryan

National Health Policy Forum

This background paper examines the variety of issues affecting access to oral health care in the United States. It considers the possibilities and challenges presented by public financing sources for dental care for low-income children and families—including Medicaid, the State Children’s Health Insurance Program, and other safety net programs—and reviews a sampling of privately funded efforts at improving oral health access. The paper illustrates some of the major barriers to dental care, particularly the shortage of dentists willing to serve low-income and uninsured patients and the overall lack of growth in the dental workforce. It also considers the changing roles …

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Will The Nation Be Ready For The Next Bioterrorism Attack? Mending Gaps In The Public Health Infrastructure, Eileen Salinsky Jun 2002

Will The Nation Be Ready For The Next Bioterrorism Attack? Mending Gaps In The Public Health Infrastructure, Eileen Salinsky

National Health Policy Forum

This paper provides an overview of critical weaknesses in public health preparedness capabilities and discusses policy initiatives to address these shortcomings. It examines developmental needs related to communication and coordination, information systems, laboratories, the development and distribution of vaccines and other countermeasures, emergency medical preparedness and response, and the public health workforce. The paper summarizes the status of federal and state plans to respond to these developmental needs and touches on the challenges likely to emerge as these plans are implemented.

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Average Wholesale Price For Prescription Drugs: Is There A More Appropriate Pricing Mechanism?, Dawn Gencarelli Jun 2002

Average Wholesale Price For Prescription Drugs: Is There A More Appropriate Pricing Mechanism?, Dawn Gencarelli

National Health Policy Forum

This paper defines the average wholesale price (AWP), an important benchmark for prescription drug pricing and reimbursement. The paper briefly explains the AWP's various uses in the pricing of prescription drugs, highlights some of the problems that have emerged as a result of the way it is reported and used, and explores some of the possibilities for reform. The paper also contains a glossary of commonly used terms, as well as an appendix that lists the state Medicaid reimbursement formulas.

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Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague Jun 2002

Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague

National Health Policy Forum

This paper examines the role of quality improvement organizations (QIOs, formerly known as PROs, or peer review organizations) in improving the quality of medical care delivered to Medicare beneficiaries in both fee-for-service and managed care environments. It looks at the expansion of the QIOs' portfolio in their seventh contract cycle to include quality improvement activities in nursing homes, home health services, and physicians' offices as well as responsibilities for public education. The paper explores the evolution of QIOs, changes in their priorities over time, and the projects in which they are engaged. It also considers their role in the formulation …

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Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Jordan Neil, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary Rose Jun 2002

Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Jordan Neil, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary Rose

Mental Health Law & Policy Faculty Publications

Under contract with the Department of Children and Families (DCF) and in accordance with the requirements of Senate Bill (SB)1258, the Louis de la Parte Florida Mental Health Institute (FMHI), University of South Florida, is conducting an ongoing formative evaluation of the financing strategies authorized to be implemented by the legislation. The demonstration sites that were selected were DCF District 1, including Escambia, Okaloosa, Santa Rosa and Walton Counties and DCF District 8, including Charlotte, Collier, Glades, Hendry and Lee Counties. FMHI’s role is to help identify the most effective methods and techniques used to manage, integrate, and deliver behavioral …

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Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Neil Jordan, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary R. Murrin Jun 2002

Evaluation Of Florida’S Mental Health And Substance Abuse System Redesign Strategies: Year 1 Report, Neil Jordan, Julienne Giard, Pat Robinson, Rebecca Larsen, Mary R. Murrin

Mental Health Law & Policy Faculty Publications

No abstract provided.

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Whose Duty Is It Anyway?: The Kennedy Krieger Opinion And Its Implications For Public Health Research, Diane E. Hoffmann, Karen H. Rothenberg Jun 2002

Whose Duty Is It Anyway?: The Kennedy Krieger Opinion And Its Implications For Public Health Research, Diane E. Hoffmann, Karen H. Rothenberg

Faculty Scholarship

In this article, the authors discuss the Maryland Court of Appeals decision in the case of Grimes v. Kennedy Krieger Institute, Inc. and its implications for the tort duty owed by researchers, in particular public health researchers, to their subjects. The Opinion resulted from two lawsuits alleging lead poisoning of children enrolled in a study conducted by the Kennedy Krieger Institute, a world renown pediatric research and treatment facility. The opinion shocked the research establishment with its scathing characterization of researchers and its apparent holding that in Maryland a parent cannot consent to the participation of a child in "nontherapeutic …

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The Federal-State Struggle Over Medicaid Matching Funds: An Update, Karen Matherlee May 2002

The Federal-State Struggle Over Medicaid Matching Funds: An Update, Karen Matherlee

National Health Policy Forum

This background paper updates NHPF Issue Brief No. 760, "The Federal-State Medicaid Match: An Ongoing Tug-of-War over Practice and Policy," December 15, 2000. The paper presents actions taken since then by the Centers for Medicare and Medicaid Services, Department of Health and Human Services, to address what the Bush administration calls abusive funding practices used by states to draw federal Medicaid matching funds. Tracing the Clinton and Bush administrations' policies, the document reviews final regulations, published in January 2001 and January 2002, on these practices. The paper also reports on a lawsuit filed in federal court to block …

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How Vulnerable Is The Nation's Food Supply? Linking Food Safety And Food Security, Robin J. Strongin May 2002

How Vulnerable Is The Nation's Food Supply? Linking Food Safety And Food Security, Robin J. Strongin

National Health Policy Forum

This paper reviews the food safety regulatory apparatus in place today, especially the activities of the two lead agencies in assuring food safety — the Food and Drug Administration within the Department of Health and Human Services and the Food Safety and Inspection Service within the Department of Agriculture. It examines the system's strengths and vulnerabilities, particularly in light of the post–September 11 environment that includes the heightened threat of terrorism. The paper also touches upon legislative and budgetary proposals aimed at improving food security, including the growing but debated interest in a single food safety agency.

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