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Articles 31 - 60 of 412

Full-Text Articles in Health Law and Policy

Public Retirement System Medical Board Reviews: Elements Of Success, Jody Simpson Jul 2018

Public Retirement System Medical Board Reviews: Elements Of Success, Jody Simpson

Commonwealth Medicine Publications

Comprehensive evaluations of disability benefit applications is a vital responsibility for public retirement systems. Incomplete or incorrect evaluations can lead to costly mistakes in both financial and human terms. The Disability Evaluation Services team shares an framework for success public retirement systems can use to ensure their Medical Boards receive disability determinations that are complete and clinically sound.


Advancing The Science And Practice Of Health Care For Justice-Involved Individuals, Dyana Nickl Jun 2018

Advancing The Science And Practice Of Health Care For Justice-Involved Individuals, Dyana Nickl

Commonwealth Medicine Publications

Our nation’s correctional population is about 6.6 million including those individuals supervised by probation and/or parole agencies, according to the latest figures from the U.S. Bureau of Justice Statistics. Over two million of those are incarcerated and in the custody of a state or federal prison or local jail. It has been reported time and time again that inmates have greater health needs than those living in the community, including higher rates of Hepatitis C, HIV/AIDS, mental health issues and substance use disorder. There is still much we can improve upon in the way we ...


Informed Consent And The Role Of The Treating Physician, Eric Feldman, Holly Fernandez Lynch, Steven Joffe Jun 2018

Informed Consent And The Role Of The Treating Physician, Eric Feldman, Holly Fernandez Lynch, Steven Joffe

Faculty Scholarship at Penn Law

In the century since Justice Benjamin N. Cardozo famously declared that “[e]very human being of adult years and sound mind has a right to determine what shall be done with his own body,” informed consent has become a central feature of American medical practice. In an increasingly team-based and technology-driven system, however, who is — or ought to be — responsible for obtaining a patient’s consent? Must the treating physician personally provide all the necessary disclosures, or can the consent process, like other aspects of modern medicine, take advantage of specialization and division of labor? Analysis of Shinal v. Toms ...


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.


Massoptions Transforms The Way Elderly And People With Disabilities Get Much Needed Long-Term Services And Supports In Massachusetts, Jeff A. Auger, Kerrie Topi Jun 2018

Massoptions Transforms The Way Elderly And People With Disabilities Get Much Needed Long-Term Services And Supports In Massachusetts, Jeff A. Auger, Kerrie Topi

Commonwealth Medicine Publications

Some of the Commonwealth’s most underserved populations—the elderly, people with disabilities, and their caregivers— now have simplified access to the long-term services and supports (LTSS) they need, thanks to MassOptions, an innovative collaboration between UHealthSolutions, the nonprofit business affiliate of UMass Medical School, and the Massachusetts Executive Office of Elder Affairs.


Women’S Health Must Be A Criminal Justice Concern, Robert Delanders May 2018

Women’S Health Must Be A Criminal Justice Concern, Robert Delanders

Commonwealth Medicine Publications

One of the most compelling arguments for improvements to healthcare for individuals who are incarcerated is the fact that “[a]t least 95% of all state prisoners will be released…”1 Further, pursuant to a 2014 study by the Sentencing Project, more than 215,332 women and girls are now incarcerated in the U.S.2 This figure represents both a record percentage of the total prison population in the U.S. and an eight-fold rise in the incarceration of females since 1980.3 Critically, more than two thirds of these women are mothers and 60% of these women have ...


Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry May 2018

Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry

Commonwealth Medicine Publications

There is wide geographic variation in Social Security Disability Insurance and Supplementary Security Income participation across the United States. Some policymakers and members of the public may assume that interregional administrative inconsistencies are a major reason for the geographic variation. To test this assumption, and to reveal other potential explanations for the variation, we decompose the total variation into components by examining regional differences in disability prevalence and in program participation among persons with disabilities as well as the correlation between those two factors. We further decompose the variation in participation among persons with disabilities into socioeconomic components. Our findings ...


Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff May 2018

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year ...


Justice Involvement Has A Profound Link To Social Determinants Of Health, Warren J. Ferguson Apr 2018

Justice Involvement Has A Profound Link To Social Determinants Of Health, Warren J. Ferguson

Commonwealth Medicine Publications

Social determinants are strong predictors of a person’s health, those being employment, income, housing, food security and social inclusion. What are the outcomes, then, when one characteristic has downstream impact on all the determinants?

I learned the answer at the 11th Academic and Health Policy Conference on Correctional Health in Houston on March 22, when leaders from the Association of American Medical Colleges (AAMC), the Academic Consortium on Criminal Justice Health(ACCJH) and JustLeadershipUSA discussed the impact of criminal justice involvement on the health of individuals and their families.


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.


Coverage For Obesity Prevention & Treatment Services: Analysis Of Medicaid & State Employee Health Insurance Programs, Nichole Jannah, Christine Gallagher, William Dietz Apr 2018

Coverage For Obesity Prevention & Treatment Services: Analysis Of Medicaid & State Employee Health Insurance Programs, Nichole Jannah, Christine Gallagher, William Dietz

GW Research Days 2016 - Present

BACKGROUND

Despite the high prevalence of obesity among U.S. adults, coverage for evidence-based obesity treatment modalities is inconsistent across states. The primary objective of this study was to examine changes in coverage for adult obesity prevention and treatment services within Medicaid programs and state employee health plans between 2009 and 2017.

METHODS

Changes in coverage were assessed by comparing data from plan year (PY) 2016/2017 to baseline data collected during PY 2009/2010. Data were obtained through an extensive review of administrative documents, health plan websites, provider manuals, subscriber handbooks, fee schedules, and drug formularies from Medicaid and ...


Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn Apr 2018

Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: Unplanned readmissions, within 30 days following an inpatient hospital admission, are common and costly. Research has identified factors that predict readmissions, and predictive algorithms, such as the LACE index, have been studied and widely adopted by hospitals despite demonstrated variability in predictive ability.

Objectives: To examine the associations between unplanned readmissions and the LACE index, and other variables that reflect patient- and encounter-level factors not currently incorporated in the LACE index.

Methods: A retrospective analysis was conducted utilizing data from electronic health records of inpatients discharged from a large quaternary hospital located in the southeastern United States between January ...


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 ...


Adoption Process For The Model Aquatic Health Code: An Example, William D. Ramos, Allison L. Fletcher, Mike Mettler, Marcus A. Yoder Mar 2018

Adoption Process For The Model Aquatic Health Code: An Example, William D. Ramos, Allison L. Fletcher, Mike Mettler, Marcus A. Yoder

International Journal of Aquatic Research and Education

In 2014 the U.S. Centers for Disease Control and Prevention (CDC) published the first edition of the Model Aquatic Health Code (MAHC). This document represented the inaugural introduction of a federal policy guideline with a direct focus in the area of aquatic venue operation and maintenance with the sole purpose of improving the nature of public health in the field. The Indiana State Department of Health (ISDH) began the review and adoption process soon after the policy’s release. The ISDH process is proposed as one method for others to consider. The background and history of the MAHC are ...


Process Improvement Ensures High-Quality Disability Benefit Evaluation, Jody Simpson Mar 2018

Process Improvement Ensures High-Quality Disability Benefit Evaluation, Jody Simpson

Commonwealth Medicine Publications

Ongoing quality management and review of disability benefit evaluation processes and procedures is critical for state and municipal retirement system administrators. Public retirement systems may be challenged in these areas due to limited time and resources.

Working with a partner who is skilled in assisting organizations with all aspects of their medical review needs can ease the burden. UMass Medical School’s Disability Evaluation Services offers comprehensive disability evaluation solutions with a focus on quality improvement and client satisfaction. Having the clinical expertise to provide medical board review recommendations and case management is just one of our strengths.


Ltss Clinical Guidelines Help Health Plans Navigate The Challenges Of Increased Demand, Jessica Carpenter Feb 2018

Ltss Clinical Guidelines Help Health Plans Navigate The Challenges Of Increased Demand, Jessica Carpenter

Commonwealth Medicine Publications

Long term services and supports (LTSS) clinical guidelines are the foundation of a successful LTSS utilization management program. Strong guidelines help health plans drive LTSS programs toward positive outcomes such as consistency in decision making, clinically appropriate services, contained costs and program integrity. The goal is ensuring individuals receive the right service, in the right setting, and at the right time.

As the independent living movement continues to advance, more individuals with disabilities are seeking to live in their own homes or within a community setting. As such, there has been an increased demand for LTSS. Increased demand combined with ...


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.


New Payment Methods And Delivery System Reforms Can Support Sustainable Funding For Community Health Worker Services, Katharine London Jan 2018

New Payment Methods And Delivery System Reforms Can Support Sustainable Funding For Community Health Worker Services, Katharine London

Commonwealth Medicine Publications

Extensive evidence shows that Community Health Workers (CHWs) can help health systems meet the triple aim: improve population health, improve quality of care and contain costs, while also promoting health equity and community engagement. However, most CHW programs are grant funded, and when the funding ends, the program ends.


Making The Case For Sustainable Funding For Community Health Worker Services: Talking To Payers And Providers, Katharine London Jan 2018

Making The Case For Sustainable Funding For Community Health Worker Services: Talking To Payers And Providers, Katharine London

Commonwealth Medicine Publications

In this presentation, Katharine London of the Center for Health Law and Economics makes her case for offering sustainable funding for community health worker services. Research has shown community health workers can have a distinct impact on health systems, helping them improve population health and contain costs, while also promoting health equity and community engagement.

This presentation was designed to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work. It was presented as part of a CHW Sustainability event held at the Families USA’s ...


The Kentucky Medicaid Waiver Penalizes Enrollees For Emergency Room “Misuse”, Rebecca Laes-Kushner Jan 2018

The Kentucky Medicaid Waiver Penalizes Enrollees For Emergency Room “Misuse”, Rebecca Laes-Kushner

Commonwealth Medicine Publications

Kentucky’s 1115 Medicaid Waiver, approved by CMS on January 12, 2018, uses small financial incentives and punishments to try to change the behavior of enrollees.

Enrollees in Kentucky’s Medicaid program, Kentucky HEALTH (Helping to Engage and Achieve Long Term Health), will receive virtual accounts, called a My Rewards Account, into which credits will be placed for their positive activities related to health (completing health risk assessment - $25) and careers (passing the GED - $50). The credits can be used to pay for certain services not covered by health plans, such as vision and dental services.

However, members’ accounts will ...


Baby M Turns 30: The Law And Policy Of Surrogate Motherhood, Eric A. Feldman Jan 2018

Baby M Turns 30: The Law And Policy Of Surrogate Motherhood, Eric A. Feldman

Faculty Scholarship at Penn Law

This article marks the 30th anniversary of the Supreme Court of New Jersey’s Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature.

First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can ...


Implementing A Public Health Perspective In Fda Drug Regulation, Patricia J. Zettler, Margaret Foster Riley, Aaron S. Kesselheim Jan 2018

Implementing A Public Health Perspective In Fda Drug Regulation, Patricia J. Zettler, Margaret Foster Riley, Aaron S. Kesselheim

Faculty Publications By Year

There is, without question, a public health crisis in the United States arising from both illicit and prescription opioid misuse, addiction, and overdose. The Food and Drug Administration (FDA) is one regulator with an important role to play in minimizing the harms associated with prescription opioids, while also ensuring that prescription opioids are available for the evidence-based management of pain. One question, however, is to what extent the agency can consider in its decisions to approve opioids and keep existing ones on the market the provider and patient behaviors contributing to the epidemic. This is, in part, because FDA’s ...


Health Policy And The Tax Cuts And Jobs Act, Rachel Gershon Dec 2017

Health Policy And The Tax Cuts And Jobs Act, Rachel Gershon

Commonwealth Medicine Publications

Congress passed the Tax Cuts and Jobs Act. What does the Act mean for health policy?


Pipeline Trends - December 2017, Nicole M. Trask, Sage Bagwell Dec 2017

Pipeline Trends - December 2017, Nicole M. Trask, Sage Bagwell

Commonwealth Medicine Publications

Pipeline Trends is produced by UMass Medical School’s Clinical Pharmacy Services and is distributed annually. This edition provides a comprehensive overview of:

  • Promising New Agents
  • Projected Generic Entry
  • Investigational Indications
  • FDA Updates
  • Industry Trends


Leveraging Ehrs And Hies For Hepatitis C Surveillance, Prevention And Management:, Michael Chin Oct 2017

Leveraging Ehrs And Hies For Hepatitis C Surveillance, Prevention And Management:, Michael Chin

Commonwealth Medicine Publications

This presentation for the National Alliance of State and Territorial AIDS Directors explores the ways public health departments can use electronic health record (EHR) or health information (HIE) exchange data for Hepatitis C surveillance, prevention and management.


Data Sharing Agreements 101: What Hepatitis Programs Need To Know, Deborah Drexler Oct 2017

Data Sharing Agreements 101: What Hepatitis Programs Need To Know, Deborah Drexler

Commonwealth Medicine Publications

This presentation for the National Alliance of State & Territorial AIDS Directors walks through the steps Hepatitis programs must follow before accessing and using health care data. Considerations include HIPAA rules and other regulations.

A technical report accompanies this presentation.


Key New Hampshire And Federal Statutes Regulating Health Care Delivery And Payment, Lucy Hodder Oct 2017

Key New Hampshire And Federal Statutes Regulating Health Care Delivery And Payment, Lucy Hodder

Law Faculty Scholarship

A summary of New Hampshire and federal regulations by subject matter, chart of New Hampshire state agency responsibilities, federal laws and regulation: An index


Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer Sep 2017

Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer

Law Faculty Scholarship

[Excerpt]: "INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects.

A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD ...


Integrating Third Party Liability (Tpl) Across Medicaid Operations And Enterprise Systems In Massachusetts, Jenifer Hartman Aug 2017

Integrating Third Party Liability (Tpl) Across Medicaid Operations And Enterprise Systems In Massachusetts, Jenifer Hartman

Commonwealth Medicine Publications

This poster highlights the results of a UMass Medical School partnership with MassHealth, the Massachusetts Medicaid program, to integrate third party liability (TPL) activities across all aspects of the Medicaid program. By embedding TPL at all stages of Medicaid operations and interfacing with all Medicaid systems, the partners optimized identification of and access to TPL sources for all Medicaid members.

The TPL activities include eligibility coordination, coverage coordination, payment coordination and recovery coordination. The partnership has achieved over $40 million in cost avoidance through the identification of missed Medicare benefits, over $64 million in cost avoidance over enhanced coordination of ...