...Texas’ Decision Should Texas have Medicaid or not? Texas has decided to refuse expansion of the Medicaid program under the Federal Affordable Texas Law. Now, the huge question remains, “Has Texas made the right decisions or did Texas move to fasting the decision making? “Medicaid helps the lower class families with the cost of Medicaid bills, but Medicaid is fun by states where coverage may vary. In an article “Texas”, Texas had 83.7% of people who participated in Medicaid in the year of 2015. There is Texas who support having Medicaid and people who is against Medicaid. I believe Texas should have expanded Medicaid because not everyone is fortune to pay out of pocket for medical emergency. Texas should have expanded Medicaid throughout the...
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...Part II: Medicaid Reimbursement: Cost of Patient Costs matter in healthcare industry, and often, Medicaid have cut the physicians’ charge down to forty percentage of Medicaid care. Nevertheless, Medicaid reimbursement cuts are even lower, in which have affect the physicians’ decision whether to accept new Medicaid patient or not. As this matter continues, solutions are needed to restraint these matters into hands and improves the quality of services and cares. First solution is the bottom-up approach, this method usually developed from the below where the manager and sub-unit departments level to review and identify the problems within the organization. For example, as insurers fire a reimbursement program to hospital and/or physician, they enquires them to down-charges or substitute the treatments, surgeries, or any services for patient, the physician seem to be discourages and refuses to negotiate. In this case, the cost seem to be the issue that cause a rift between physician and patient through the Medicaid Reimbursement program. If, it was accepted and treated, the quality of care and services may not be what patients wanted to be and lead to mistrust....
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...The “Common Sense Savings Act” HR 4725 and Medicaid Provider Taxes The US House of Representatives Energy and Commerce Committee voted on March 15th to approve HR 4725, named the Common Sense Savings Act. The bill now goes to the full House for consideration. Among a variety of provisions within the bill, HR 4725 would reduce the Medicaid provider tax hold harmless safe harbor level from 6% to 5.5% starting in fiscal year 2018. In this brief, we provide an explanation of provider taxes and additional information about HR 4725. Provider Tax Basics Medicaid programs are financed with a combination of funds from both the federal and state governments, and a state pays anywhere from 26% to 50% of the cost for its Medicaid programming depending on a state’s per capita income. In those states that have opted to expand Medicaid under the Affordable Care Act, the states pay even less than 26% of the total costs because the federal government is paying 100% from 2014-2016 of the costs for the expansion population. One way states may raise funds for their share of...
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...Decision-Making Case Study The looming changes in health care are a frequent topic in many meetings with health care providers. Budget cuts are not just a speculation but are a reality. Decision-making to provide quality patient care with less money is a challenge at best. The Informed Decisions Toolbox can assist administrators and managers with evidence-based decisions that will allow patients to receive the quality care they deserve while reducing expenses. The Informed Decisions Toolbox The Informed Decisions Toolbox (IDT) is the result of a research study to aid managers with making evidence-based decisions that improve organizational performance. The IDT has an approach of six steps to decision-making (Rundell, et al, 2007): (1) framing the management question, (2) finding sources of information, (3) assessing the accuracy of the information, (4) assessing the applicability of the information, (5) assessing the actionability of the evidence, and (6) determining if the information is adequate (p. 325). As a facilitator for the use of evidence-based research in decision-making, the IDT assists decision-makers with estimating how operational and strategic decisions will have an effect on the organization. Evidence-based decision-making is not new to the health care industry. Clinicians have incorporated evidence-based research for years when making patient treatment determination. The use of evidence-based research for decision-making in other realms of healthcare...
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...Case Study: Delia v. E.M.A. et al Xxxxxx X. Xxxxxxxx University of Maryland University College HCAD 650 Fall 2012 October 5, 2013 Case Study: Delia v. E.M.A. et al This paper reviews a case study of a medical malpractice suit that resulted in a claim against the North Carolina Department of Health and Human Services for their practice of recovering settlements paid for medical expenses. Legal controversies with medical impact rarely reach the United States Supreme Court because such cases must go through several levels of hearings and appeals before even being considered by the Supreme Court. Medical issues must involve interpretation of the US Constitution or federal law, and at least four of the nine justices must agree to accept a case. The Supreme Court reviews only a small percentage of the several thousand cases submitted each year. Consequently, most medical controversies at law take place in state courts. Subject United States Supreme Court Case No. 12-98. Albert A. Delia, Secretary, North Carolina Department of Health and Human Services v. E.M.A., a Minor, By and Through Her Guardian ad Litem, Daniel H. Johnson, et al. Later the case was changed to: No. 12-98. Aldona Wos, Secretary, North Carolina Department of Health and Human Services, Petitioner v. E.M.A., a Minor, By and Through Her Guardian ad Litem, Daniel H. Johnson, et al. The purpose of the case was to resolve the conflict between the opinions of the 4th U. S. Court of Appeals in this case...
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...Decision-Making Case Study HCS/514 Ed Paluch Decision-Making Case Study It has been estimated that approximately 75% of the average managers time is spent on the decision-making process (Free Case Study on Decision Making, 2011). A critical component in managing an organization, its staff and resources is successful decision-making. The quality and efficiency of those decisions will determine how well the manager is doing. Managers have plenty of responsibility because they are the ones that have to make the right decision when solving issues. Today, decision-making regarding health services for consumers and patients are becoming guided by evidence of need, effectiveness, and ways to use resources optimally. This is becoming a growing model among health care organizations and its managers. However, there are barriers for managers in using evidence decision-making. Time is a big barrier, there are deadlines that managers usually have to work with that is very time consuming. For instance, plenty of time is required to research, accessing relevant data, reliance on outside consultants and subordinates in acquiring quality information, politics, and lack of resources. The use of an sufficient decision-making tool that assists managers in efficiently making strategic, evidence based decision-making as well as improving the performance of their organizations is the Informed Decisions Toolbox as outlined by Thomas Rundall. The Informed Decisions Toolbox is...
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...Group 3 Presentation TABLE OF CONTENTS Chapter l- Introduction Introductory paragraphs Statement of the problem Purpose Significance of the study Research questions Chapter ll- Background or Review of Literature Literature review Definition of terms Chapter lll- Methodology Restate purpose and research questions Population and sampling Instrumentation Procedure and time frame Analysis plan Validity and reliability Assumptions Scope and limitations Chapter lV Results Chapter V – Conclusions and Recommendations Summary Discussions Recommendations References Appendix Chapter I Introduction The Department of Human Services in Arkansas offers a variety of services. Group 3 will focus on five specific services. These services include: Transitional Employment Assistance (TEA), Medicaid, Supplemental Nutrition Assistance Program (SNAP) formerly known as food stamps, Child Care Assistance (CCAP), and AR Kids First. The Department of Human Services is required by state law to: help individuals and families meet financial, medical, and social needs; assist people to become self-sufficient; and help protect children and adults from abuse, neglect and exploitation. Group 3 researched these services to investigate qualifications and use of these services. Statement of the Problem The researchers of this study discovered that residents in Arkansas are becoming more dependent on government assistance. Because of the continuous growth in dependency, tax payers...
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...Maine’s Medicaid Claims Processing System Maine’s Medicaid Claims Processing System: A Case Study about the Project Management Mistakes and Pitfalls Eric Sissom UNIV 4706 Managing Software Development, Section R50-M08C Professor Schaeffer August 9, 2008 Maine’s Medicaid Claims Processing System: A Case Study about the Project Management Mistakes and Pitfalls In the beginning of the year 2005, the state of Maine eliminated the old Medicaid claims processing system for a new web enabled, more secure, and faster system. This new system was $25 million and created a lot of problems for the state of Maine, doctors, hospitals, and patients. This analysis will discuss these problems and mistakes that were made as well as solutions that would have helped the situation in a desperate time. Maine had two bids for the project. Those were from Keane for $30 million and CNSI for $15 million. Keane had some experience in developing Medicaid systems while CNSI had no experience. Usually, organizations want to receive several bids within a close range. Since they only received two bids, this should have raised a clue that the requirements of the project were unreasonable. There first mistake is not revising the requirements in hopes of getting more bids. There second mistake is accepting the bid from CNSI because they had no experience with Medicaid systems. The...
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...Services Research r Health Research and Educational Trust DOI: 10.1111/j.1475-6773.2011.01274.x RESEARCH ARTICLE Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes John R. Bowblis Objective. To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design. Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but...
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... The old analogy of take two pills and call your doctor in the morning is becoming the norm in today’s society. This Reflective Paper will provide a multi-systemic approach which addresses the following topics: (1) the genetic link to ADHD, (2) population trends of psychotropic use, (3) concerns for the safety and efficacy of children have risen due to the lack of studies. The Genetic Link to ADHD Several decades of study has shown Attention Deficit Hyperactivity Disorder (ADHD) to be a neurobiological disorder. Research has shown other contributing causes of ADHD can be caused by environmental (home, school etc.), brain dysfunction and toxins found in food additives, yet strong supporting data can be found in genetic studies too. Researchers have concluded the phenotypic display of ADHD is attributed by the abnormal amounts of neurotransmitters such as serotonin, gamma-amino butyric acid (GABA) and dopamine which controls, sleep, learning, mood and attention (Faraone, & Asherson, P, 2005). Link between ADHD 3 Studies show that on the average, 25% of all families who have a member diagnosed with ADHD are usually...
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...Running head: DECISION MAKING CASE STUDY Decision Making Case Study Lisa Powers HCS 514 University of Phoenix Decision Making Case Study Today’s healthcare organizations have the difficult task of maintaining adequate operations in the economic climate we live in. Budget cuts have hit all organizations in corporate America as well as the healthcare industry. Staying afloat in these economic times requires the implementation of difficult decisions, often including reduction of services. This has never been more prevalent than in the health care industry. Healthcare organizations are being hit hard. Hospitals and outpatient clinics are operating with budget deficits. Many organizations are now required to cut or eliminate clinical services in order to remain operational. Determining which clinical services should be cut requires managerial staff to make the difficult decision. Managers require tools that enable them to best make that difficult decision to best address the health care needs of the community served. The New York State Medicaid program is the largest single payer of healthcare in the state of NY to the tune of about $47 billion dollars (“Advocates,” 2008). New York has the nation’s highest total and per-patient Medicaid spending and must link spending to healthcare priorities. The number of uninsured patients has steadily increased over the past few years. Funding losses and projected increased operating expenses have left...
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...Decision-making Case Study Tammy Paramore HCS/514 March 25, 2013 Norma Wright Decision-making Case Study Making decisions in the rapidly changing world of health care is stressful, possessing the correct information is crucial, determining the validity of information even more crucial. In addition, knowing where to obtain accurate information for making informed and reliable determinations will help make these decisions easier. A well informed decision made using the informed decision tool box increases the reliability for producing correct and profitable decisions. These actions will improve the efficiency of provided health care, increase stability, increase production, and decrease the amount spent on health care, in addition, improving the outcomes for both the organization and the patient. The Informed Decision Toolbox The informed decision toolbox (IDT), according to Rundell, et al, (2007), has six major steps to use when approaching difficult decisions. 1) framing the management question, 2) finding sources of information, 3) assessing the accuracy of the information, 4) assessing the applicability of the information, 5) assessing the actionability of the evidence, and 6) determining if the information is adequate (p. 325). The IDT system stems from a formal study to find ways to assist management in an efficient and more scientific approach to decision...
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...Running Head: Pennies from Heaven 1 Case Study 25: Pennies from Heaven By Tiffany Moore Dr.Heather. PSL5002 Capella University Running Head : Pennies from Heaven 2 A Medicaid spend down is a portion of health coverage that an individual must pay for before Medicaid coverage begins. The exact amount of the “spend down” varies depending on the state in which you live, medical bills you have each month and other factors such as a bingo winning. Individuals who receive any portion of their income from Supplemental Security Income through Social Security are not required to pay a “spend down” for Medicaid (nysed.gov, 2014). In my essay I will be rendering an synopsize of the Pennies for Heaven Case Study. To include identifying the leader, the issue he faces, and what I believe to be the cause of the issue and evaluating how effective this leader is in the ability to build relationships within the organization; to encompass how well the leader manages professional responsibilities and priorities and how well this leader communicates and resolve the issues. In the case study Pennies from Heaven Patrick Ulmer who would be the new Director of the state Department of Health and Human Services in two more weeks had been recruited from out of state and just arrived to meet with the governor and other cabinet members. Around lunchtime he sat next man named Henry Walsh, who was...
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...Assignment 2 Financing and Restructuring Health Care Dr. David Tataw HSA 500 Health Services Organization January 28, 2012 Abstract: This paper analyses the Financing and Structuring Health Care by analyzing four important notions. Firstly it Identifies and describe the three main types of health insurances in the U.S. Secondly it explains the three methods for categorizing health insurance in the U.S. This is followed by a synthesis of the pros and cons of managed health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs. Identify and describe the three main types of health insurances in the U.S. Rodts (2010) talks about the new Healthcare system in US and the challenges it brings for healthcare providers but there is always challenge when one has to select the certain type of health cover for himself. It is therefore important to understand main types of health insurance in the US. While Hall (2010) outlined the three different types of reinsurances brought about by the health reform, Health Insurance Info (2010) notes that are a number of different types of health insurance coverage designed to meet the needs and budget of a variety of individuals. In essence, health insurance is a risk management tool that ensures you and your family has access to the healthcare you need, when you need it without causing a tremendous financial burden. The cost of health insurance...
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...Decision-Making Case Study Bonny Kimberlin HCS/514 February 11, 2013 Vinnette Batiste Decision-Making Case Study The truth of the matter is there is no longer such a thing as “middle class” Americans. The sad reality is either one lives in the low-income bracket living check-to-check, or one lives with no worries in the world. Even more sad, is that the lower-income class bracket also includes the elderly, disabled, homeless, and unemployed. Not to sway away from subject but this country allows men and women to gross millions, some even billions of dollars to hit a ball-around a big stadium, or a puck around on an ice-rink; and yet government insurances scrutinize a doctor’s request for an elderly or disabled person to receive a wheelchair. There is something seriously wrong with this picture. Another perfect example a brain surgeon, and scientist making less salary than a baseball player and yet they save lives, and find cures. Many become angry at the mere thought of the homeless, disabled, and mentally ill leaving on the streets, and yet it seems the one program that helps the lower-income bracket Americans is the one program that keeps receiving budget cuts, restraints, and reduction in services. Affect of Budget Cuts According to Curry (2013), “The new health reform is said to bring “massive automatic cuts” and “deep indiscriminate cuts” too so many departments and programs it is a wonder doctors or...
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