...April 21, 2014 Budgetary Analysis Each state offers Medicaid and CHIP programs. There is approximately sixty million Americans with this health care coverage. Individuals with disabilities, parents, seniors, pregnant women and children are all eligible to receive the Medicaid plan. With federal minimum standards in place each state sets there individual criteria. Some federal laws in place are to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). Medicaid, individuals must satisfy federal and state requirements regarding their current residency, immigration status, and documentation that they are a U.S. citizen. The Affordable Care Act of 2010 helped to expand Medicaid in 2014. “The Affordable Care Act provides Americans with better health security by putting in place comprehensive health insurance reforms that will: * Expand coverage, * Hold insurance companies accountable, * Lower health care costs, * Guarantee more choice, and * Enhance the quality of care for all Americans. Most recently, the MMA of 2003 included increases in DSH state allotments for 2004-2011 and added requirements for an independently certified annual audit. Figure 8.14 shows DSH funds as a percentage of the total Medicaid budget. The Affordable Care Act actually refers to two separate pieces of legislation — the Patient Protection and Affordable Care Act (P.L....
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...Timeline: History of Health Reform in the U.S. VIEW: Early 1900's 1930 – 1934 1935 – 1939 1940 - 1945 1945 - 1949 1950 - 1954 1955 - 1959 1960 – 1964 1965 – 1969 1970 - 1974 1975 – 1979 1980 - 1984 1985 - 1989 1990 – 1994 1995 - 1999 2000 – 2004 2005 – 2009 2010 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation 1912 Teddy Roosevelt and his Progressive party endorse social insurance as part of their platform, including health insurance. 1912 National Convention of Insurance Commissioners develops first model of state law for regulating health insurance. 1915 The American Association for Labor Legislation Early 1900's 1921 Women reformers persuade Congress to pass the Sheppard-Towner Act, which provided matching funds to states for prenatal and child health centers. Act expires in 1929 and is not reauthorized. (AALL) publishes a draft bill for compulsory health insurance and promotes campaigns in several states. A few states show interest, but fail to enact as U.S. enters into World War I. The idea draws initial support from the AMA, but by 1920 AMA reverses their position. 1927 Committee on the Costs of Medical Care forms to study the economic organization of medical care. Group is comprised of economists...
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...T ackling Fraud, Waste, and Abuse in the M edicare and Medicaid Programs: R esponse to the May 2 Open Letter to the Healthcare Community Dan Olson, CFE June 2012 Tackling Fraud, Waste, and Abuse in the Medicare and Medicaid Programs White Paper C ontents I. Introduction ............................................................................................................ 1 II. Recommendations................................................................................................... 3 Recommendation 1 – Expand the Medicare Fraud Strike Force Model....................................... 3 Potential Savings .......................................................................................................................... 4 Recommendation 2 – Expand Integrated Data Repository .......................................................... 4 Potential Savings .......................................................................................................................... 5 Recommendation 3 – Expand “Do Not Pay List” .......................................................................... 5 Potential Savings .......................................................................................................................... 6 Recommendation 4 – Publicize Drug Expiration Dates ................................................................ 6 Potential Savings ....................................................................
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...good medical practices, resulting in unnecessary costs or improper payments. Examples include the over-use of services or the providing of unnecessary tests. (Another area, "waste," refers to health care that is not effective, and will be the subject of a separate Health Policy Brief.)Endowed with new powers under the Affordable Care Act and the Small Business Jobs Act of 2010, the Centers for Medicare and Medicaid Services (CMS) has been adopting new tools to curb fraud and abuse in the Medicare and Medicaid programs. The new approach amounts to a paradigm shift from the earlier model, in which CMS paid providers first, then sought to chase down fraud and abuse after the fact--a process known as "pay and chase."This policy brief focuses on eliminating fraud and abuse in Medicare and Medicaid and explores the challenges involved in putting the new tools into place. | What's the background? | The true annual cost of fraud and abuse in health care is not known. In fiscal year 2011 Medicare spent $565 billion on behalf of its 48.7 million beneficiaries, while federal and state Medicaid agencies served 70 million people at a combined cost of $428 billion. CMS estimated that in fiscal year 2010 these two programs made more than $65 billion in "improper federal payments," defined as payments that should not...
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...Discuss the role of the federal, state, and local legislation related to health care? Give at least 2 examples for each level The United States government plays a major role in healthcare in many ways: it organizes finances and helps to deliver healthcare to all the citizens. The role of the federal government is to reform the growth of Medicare spending and they can make provisions to the healthcare system. The House of Representatives have control of the healthcare reform movement when it comes to planning and implementing throughout the approvals of committees, and advice from qualified healthcare teams. The United States federal government’s main role in health care is to introduce, organize, finance and oversee the health care policy and its delivery. It creates the blueprint for how the U.S. health care should be carried out on varies levels of U.S. legislation. Health care policies made at the Federal level become highest order of laws and guideline for which the state and local governments must comply for the implementation of the policies. The following two examples further explain the role of federal government in health care. The first example is the Medicare Modernization Act of 2003, which was introduced, and signed into law by President George W. Bush on December 8, 2003. Basically, this law gave our seniors citizens the right to prescription drug benefits and more choice in health care. It provided a must need relief to those who were struggling to...
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...Health Care Information Systems Terms LinetA HCS483 November 2, 2015 George DeRosa Health Care Information Systems Terms Health Insurance Portability and Accountability Act According to Wager, K. A., Lee, F. W., & Glaser, J. P. (2013), this federal legislation includes provisions to define, specify, and protect patient health information. This legislation formulates the processes for the use and de-identification of the data and authorization of that data's use in research and analytics. Healthcare "covered entities" are bound by the constraints of HIPAA to protect private health information. HIPAA training and enforcement is utilized throughout the health care industry, to include providers, payors, patients and a host of ancillary entities. These ancillary organizations can include the insurance industry, schools, employers, public health agencies, and various research organizations. Individuals, organizations, and agencies must comply with the regulations and rules to protect the “privacy and security of health information” (U.S. Department of Health & Human Services., n.d. pp.1). Electronic Medical Record An Electronic Medical Record (EMR) is the documentation, and utilization of a consumer’s health care encounter, created and managed by the providers and staff within one health care organization (Wager, K. A., Lee, F. W., & Glaser, J. P. 2013). The majority of health care records are currently in the format of EMRs. Basic office formatted...
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...individual independence. | |Space Exploration |It was a race between other counties to see who will go into space, and the first man on the moon. | |Marilyn Monroe |Was a beautiful famous woman, and actress of Hollywood, and inspired many. She lots of fans all over the | | |world. | |Jacqueline Kennedy | She played a historical role in the White House as being the First Lady with John Kennedy. She also was a | | |great writer. | |JFK’s Assassination |JFK’s assassination has devastated America. He has inspired, and helped Americans, and people all around | | |the world. Lyndon B. Johnson uses the nation’s anger to push through civil rights legislation in John | | |Kennedy’s Memory. | Johnson’s Presidency From the following...
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...UnitedHealthCare A deep dive into United States’ largest health carrier Report by : Guo F. Deng Jiarui Li Malavika Verma Srikanth S. Perinkulam : December’06, 2013 Published on afafaafa United Health Care Contents Company Profile and History ........................................................................................................................ 3 Financial Statement Analysis ........................................................................................................................ 5 Major Acquisitions ...................................................................................................................................... 11 Major Litigations and Public News.............................................................................................................. 13 The Patient Protection and Affordable Care Act (PPACA) .......................................................................... 15 Strategies and Foresight ............................................................................................................................. 18 Bibliography ................................................................................................................................................ 20 2 United Health Care Company Profile and History UnitedHealth Group is one of the largest health care companies in the United States. UnitedHealth Group is currently made of three entities which are UnitedHealthcare...
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...Chapter 3 The Evolution of Health Services in the United States Learning Objectives To discover historical developments that have shaped the nature of the US health care delivery system To evaluate why the system has been resistant to national health insurance reforms To explore developments associated with the corporatization of health care To speculate on whether the era of socialized medicine has dawned in the United States “Where’s the market?” 81 26501_CH03_FINAL.indd 81 7/27/11 10:31:29 AM 82 CHAPTER 3 The Evolution of Health Services in the United States Introduction The health care delivery system of the United States evolved quite differently from the systems in Europe. American values and the social, political, and economic antecedents on which the US system is based have led to the formation of a unique system of health care delivery, as described in Chapter 1. This chapter discusses how these forces have been instrumental in shaping the current structure of medical services and how they are likely to shape its future. The evolutionary changes discussed here illustrate the American beliefs and values (discussed in Chapter 2) in action, within the context of broad social, political, and economic changes. Because social, political, and economic contexts are not static, their shifting influences lend a certain dynamism to the health care delivery system. Conversely, beliefs and values remain relatively stable over time. Consequently, in the American health care...
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...Health Care in the Early 1960s Rosemary A. Stevens, Ph.D. My topic, health care in the early 1960s, has a double set of meanings for me. I am a historian, and the 1960s are now "history," ripe for new interpretations. Yet I was also an immigrant to the United States in 1961, fresh from working as an administrator in the British National Health Service. The period immediately before the Medicare legislation in 1965 shines in my memory with the vividness of new impressions: those of a young health care student trying to make sense of the U. S. health care system, and indeed, of the United States. The health care system and the United States as a society stand, in many ways, as proxy for each other, now as then: The whole tells you much about the part, and the part about the whole. In the early 1960s, health care was already a massive enterprise. By the late 1950s, hospitals employed far more people than the steel industry, the automobile industry, and interstate railroads. One of every eight Americans was admitted annually as an inpatient (Somers and Somers, 1961). To study health care, with all its contradictions and complexities, in the 1960s as in the present, is to explore the character and ambiguities of the United States itself, that vast, brash, divided yet curiously hopeful Nation. On the face of it, the United States was a country blessed by plenty in the 1960s, with hospitals and professionals that were the envy of the world. Among the marvels of modern hospitals that...
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...Unemployment Rate FEBRUARY 2013 Notes Numbers in the text and tables may not add up to totals because of rounding. Unless otherwise indicated, years referred to in describing the budget outlook are federal fiscal years (which run from October 1 to September 30) and years referred to in describing the economic outlook are calendar years. The figures in Chapter 2 have white vertical bars that indicate the duration of recessions. (A recession extends from the peak of a business cycle to its trough.) The economic forecast was completed in mid-January 2013, and the estimates of 2012 values shown in tables and figures in Chapter 2 and Appendix B are based on information available at that time. Supplemental data for this analysis and the historical budget data that are usually included in this report are available on CBO’s Web site (www.cbo.gov). CBO Pub. No. 4649 Contents Summary 1 1 2 A B The Budget Outlook Key Budgetary Decisions Facing Lawmakers in 2013 Budgetary Outcomes in 2012 and the Outlook for 2013 BOX: 7 10 11 12 18 29 30 THE AMERICAN TAXPAYER RELIEF ACT OF 2012 CBO’s Baseline Budget Projections for 2014 to 2023 Uncertainty in Budget Projections Alternative Assumptions About Fiscal Policy The Economic Outlook The Economy in 2012 The...
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...Introduction: There has been an ongoing debate about whether or not health care in the United States is a right or a privilege but what should had never been in question, is the right that American Indians and Alaska Natives carry because they are the only true citizens of the United States who were born with a legal right to health care. Although this sentence carries truth from the very beginning in the making of what the United States is today, American Indians and Alaska natives are still labeled under the term as a “Vulnerable Population”. Funding: The term Vulnerable Population defined as, populations or groups whose needs are not fully addressed by traditional service providers. In short, the federal government was given an obligation to provide health care services to members of federally recognized tribes that were developed from a special relationship between the federal government and Indian tribes that was established in 1787. The federal government would exchange health care services for land and resources. Another exchange that the federal government failed to keep with American Indians was to provide quality education and health care to Indian people and tribes. The federal trust responsibility, has been defined in the U.S. Constitution, treaties, statutes, and in Supreme Court decisions and in efforts to fulfill the federal obligation, the Indian Health Service (IHS) was established within the Department of Health and Human Services (HHS) in 1955. Clearly...
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...History of Health Care Reform Transcribed from a talk given by Karen S. Palmer MPH, MS in San Francisco at the spring, 1999 PNHP meeting) Late 1800’s to Medicare The campaign for some form of universal government-funded health care has stretched for nearly a century in the US On several occasions, advocates believed they were on the verge of success; yet each time they faced defeat. The evolution of these efforts and the reasons for their failure make for an intriguing lesson in American history, ideology, and character. Other developed countries have had some form of social insurance (that later evolved into national insurance) for nearly as long as the US has been trying to get it. Some European countries started with compulsory sickness insurance, one of the first systems, for workers beginning in Germany in 1883; other countries including Austria, Hungary, Norway, Britain, Russia, and the Netherlands followed all the way through 1912. Other European countries, including Sweden in 1891, Denmark in 1892, France in 1910, and Switzerland in 1912, subsidized the mutual benefit societies that workers formed among themselves. So for a very long time, other countries have had some form of universal health care or at least the beginnings of it. The primary reason for the emergence of these programs in Europe was income stabilization and protection against the wage loss of sickness rather than payment for medical expenses, which came later. Programs were not universal to start...
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...provisions in the statute is designed to be effective beginning at the year 2020. b.) What is the nature of the problem being targeted by the policy? PPACA aims to improve the coverage of healthcare insurance. Thus, to achieve this, the policy targets people who do not have any health insurance. Unless exempted for the following reasons - religious beliefs, individuals who cannot afford the healthcare coverage, taxpayers whose income is below the income threshold, or any person deemed to belong from an Indian tribe- the statute requires individuals to avail a health care insurance plan or pay a penalty. II. Historical Analysis a.) What policies and programs were developed in the past to deal with the problem? Policies that were developed in the past to deal with the same problem of limited and reluctant healthcare coverage include the Medicare (1965), Consolidated Omnibus Budget Reconciliation Act (1985) Health Insurance Portability and Accountability Act (1996) and the Massachusetts Health Care Insurance Reform Law (2006). Very notable is the Massachusetts Health Care Insurance Reform Law as it was described as the model of the PPACA. b.) How has the specific policy/program under analysis developed over time? The PPACA Bill was...
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...Abstract Accountable Care Organization is a healthcare organization characterized by a payment and care delivery mode. lt seeks to tie provider reimbursements to a quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of payment methods, (e.g. capitation, fee-or-service with an asymmetric or symmetric shared savings). The ACO is accountable to the patients and the 3rd party payer for quality, appropriateness, and efficiency of the health care provided. The Centers for Medicare and Medicaid Services (CMS), an ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization...
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