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Articles 91 - 120 of 353
Full-Text Articles in Health Law and Policy
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.
No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky
No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky
National Health Policy Forum
This background paper describes important characteristics of the National School Lunch Program and the School Breakfast Program, reviews U.S. Department of Agriculture rules regarding the nutritional content of school meals, and examines compliance with current nutrition standards. It also considers the dietary status and obesity risk of meal program participants, discusses proposed improvements to nutritional standards and meal requirements, and highlights key legislative issues.
Got Junk? The Federal Role In Regulating “Competitive” Foods, Eileen Salinsky
Got Junk? The Federal Role In Regulating “Competitive” Foods, Eileen Salinsky
National Health Policy Forum
A wide variety of food and beverage items are available in schools in addition to the school meals provided through the National School Lunch Program and School Breakfast Program. A long-standing source of controversy, the need for stronger federal restrictions on foods that compete with school meals is again under debate. This issue brief examines the availability and consumption of competitive foods, explores the regulation of these foods at the federal level, considers trends in state and local restrictions, and summarizes perceived barriers to improving the nutritional quality of competitive food options.
The Role Of Ombudsmen In Assuring Quality For Residents Of Long-Term Care Facilities: Straining To Make Ends Meet, Carol O'Shaughnessy
The Role Of Ombudsmen In Assuring Quality For Residents Of Long-Term Care Facilities: Straining To Make Ends Meet, Carol O'Shaughnessy
National Health Policy Forum
Assuring quality of care for residents in long-term care facilities has been a serious and continuing concern of policymakers for decades. The Older Americans Act’s long-term care ombudsman program is a consumer advocacy model intended to improve quality of care by helping the 2.5 million residents of almost 67,000 nursing and other residential care facilities resolve complaints about their care and protect their rights. Despite broad recognition of its value in assisting residents and its efforts to complement federal and state oversight of long-term care facilities, some observers are concerned about the program’s ability to meet its legislative mandates. Limited …
Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy
Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy
National Health Policy Forum
As part of the diverse discussions around health care reform, many have looked to refining Medicare payment systems as a way to give health care practitioners and providers greater incentives to deliver care more efficiently, and thus slow health care spending growth. Understanding how Medicare currently pays for Part B services, including drugs covered under Part B, is essential to understanding the potential impact of these types of reforms. Most items and services covered under Part B, including most Part B drugs, are paid individually, which means practitioners and providers generally receive more payments for providing more services. Some reform …
Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham
Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham
National Health Policy Forum
The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish health IT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government’s leadership role in promoting health IT. But successful adoption and utilization across the health system will …
The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman
The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman
National Health Policy Forum
The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries—almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have little choice of plans (while non-low-income beneficiaries have dozens of choices), unless they pay out-of-pocket for premium amounts above what the subsidy covers. And third, millions of those who have enrolled in the benefit face the prospect each year of switching drug plans …
A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis
A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis
National Health Policy Forum
Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.
Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan
Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan
National Health Policy Forum
Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers' …
Resilience And Renaissance: Efforts To Rebuild A Healthier New Orleans, Michele J. Orza, Jessamyn Taylor
Resilience And Renaissance: Efforts To Rebuild A Healthier New Orleans, Michele J. Orza, Jessamyn Taylor
National Health Policy Forum
The National Health Policy Forum sponsored a site visit to New Orleans, Louisiana, in May 2009 to explore the city's health challenges, which are similar to those faced by other cities but were all greatly exacerbated by Hurricane Katrina and its aftermath. The agenda focused on three themes: primary care and behavioral health services availability and access, public health preparedness, and rebuilding healthier communities. It examined how these themes and others intersect in two distinct communities within New Orleans: the Holy Cross community surrounding the Lower Ninth Ward Center for Sustainable Engagement and Development and the community surrounding the Mary …
The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan
The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan
National Health Policy Forum
This background paper provides a brief overview of the fundamental elements of the Children’s Health Insurance Program (CHIP). CHIP, which served more than 7 million children in federal fiscal year 2008, is a jointly funded federal-state partnership that was originally enacted in 1997 as a complement to the Medicaid program. CHIP is designed to provide health insurance coverage for children in families who earn too much to qualify for Medicaid but cannot afford to purchase private insurance coverage. The program was reauthorized in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, which included several changes and additions to …
Show Me The Money: The Implications Of Schedule H, Eileen Salinsky
Show Me The Money: The Implications Of Schedule H, Eileen Salinsky
National Health Policy Forum
Responding to policymakers' concerns, the Internal Revenue Service (IRS) implemented significant new hospital community benefit reporting under Schedule H of its revised Form 990, the return used by tax-exempt organizations. This issue brief considers the policy implications of the quantitative and qualitative information that hospitals are now mandated to report through Schedule H, including the costs associated with charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare. The paper examines unresolved issues related to the new reporting requirements, such as controversies regarding the scope of Schedule H, and considers the potential for these reports to influence IRS …
Schedule H: New Community Benefit Reporting Requirements For Hospitals, Eileen Salinsky
Schedule H: New Community Benefit Reporting Requirements For Hospitals, Eileen Salinsky
National Health Policy Forum
In recent years, some policymakers have questioned whether not-for-profit hospitals benefit the communities they serve at a level commensurate with the tax exemptions they receive as charitable organizations. This background paper reviews the new community benefit reporting requirements hospitals will face in 2009 under Schedule H of the Internal Revenue Service's revised Form 990 (the return used by organizations exempt from federal income tax). The paper provides a descriptive summary of the quantitative and qualitative information to be reported on Schedule H, such as charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare.
Coordinating Care For People With Multiple Chronic Conditions: The Guided Care Model And Other Innovative Approaches, Judith D. Moore, Carol O'Shaughnessy
Coordinating Care For People With Multiple Chronic Conditions: The Guided Care Model And Other Innovative Approaches, Judith D. Moore, Carol O'Shaughnessy
National Health Policy Forum
The Forum sponsored two site visits to explore the Johns Hopkins University's research and demonstration program on Guided Care, in April and August 2009. Guided Care is a patient-centered medical home model that uses an interdisciplinary approach to coordinating health care for older people with multiple chronic conditions. Guided Care nurses located in primary care practices work with Medicare patients on a long-term basis, coordinate their care among various providers, provide transitional care, and assist patients with self-management skills. Site visit participants learned about the complexities of caring for frail Medicare patients, some of whom see multiple physicians and other …
The Medicaid Drug Rebate Program, Christie Provost Peters
The Medicaid Drug Rebate Program, Christie Provost Peters
National Health Policy Forum
The Medicaid Drug Rebate Program helps lower Medicaid spending on outpatient prescription drugs by ensuring states receive discounts similar to those provided to private purchasers. Based on manufacturer reported pricing data, Medicaid drug rebates generate significant revenue for the states (and the federal government) that helps offset Medicaid prescription drug expenditures. This publication describes the Medicaid Drug Rebate Program and reviews how it works.
Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague
Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague
National Health Policy Forum
Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …
Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk
Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk
National Health Policy Forum
This document provides a brief overview of some of the policy and programmatic issues that were addressed in legislation to reau¬thorize the State Children’s Health Insurance Program (Title XXI of the Social Security Act) during the summer and fall of 2007. This overview provides a background for understanding the elements for a second round of reauthorization that will likely be debated in the early days of the 111th Congress. The paper reviews several of the key issues under discussion and summarizes some of the related provisions in the reauthorization bills that were considered in 2007.
Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters
Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters
National Health Policy Forum
Medicaid costs for health and long-term care services for low-income individuals are substantial. As a result, each state’s “match rate,” or federal medical assistance percentage (FMAP), which determines the share of Medicaid benefit costs the federal government pays, has enormous implications for state budgets and state economies, as well as for Medicaid beneficiaries and providers. Shifts in the FMAP from year to year, even minor ones, can mean the gain or loss of tens or hundreds of millions of federal matching dollars, depending on the size of the state’s Medicaid program. This paper explains the FMAP formula, examines the limitations …
Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit
Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit
National Health Policy Forum
Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a …