Medicare program; "without fault" and waiver of recovery from an individual as it applies to Medicare overpayment liability--HCFA. Proposed rule

This rule would amend the Medicare regulations governing liability for overpayments to eliminate application of certain regulations of the Social Security Administration and to replace them with HCFA regulations more specific to circumstances involving Medicare overpayments. The following specific changes are included in this rule. Explicit criteria and the circumstances under which a provider or supplier can be relieved of liability for an overpayment on the basis of being "without fault" with respect to the overpayment. Specific criteria and circumstances of the conditions under which a waiver of recovery for Medicare overpayments would apply to individuals. A provision to ordinarily consider it inequitable to recover an overpayment from a without-fault individual when an overpayment is made to a without-fault provider. Specific provisions that enable Medicare intermediaries and carriers to determine without fault in Medicare overpayments resulting from Medicare secondary payer conditional payments. Provisions that grant Peer Review Organizations the authority to make without-fault determinations. Provisions for an administrative appeals process for providers and suppliers with regard to a "not-without-fault" determination. We expect this rule would prevent some providers and suppliers from claiming without-fault status. This could reduce the number of overpayment liabilities passed on to individuals and result in a slight increase in the amount of money recovered.     

Speech, privacy, and the power of the purse: lessons from the abortion "gag rule" case.

In Rust v. Sullivan, 59 U.S.L.W. 4451 (1991), the US Supreme Court ruled that neither the privacy interests of family planning clients nor the 1st Amendment interests of their counselors prevented the government from banning all discussion of abortions in federally funded family planning clinics. In doing so, the Court also reaffirmed its view that the state and federal legislatures have virtually unlimited discretion in limiting or conditioning social welfare programs, a view having even greater long-term implications for American health policy than the implications of Rust for the constitutional protection of abortion. Rust upheld the Department of Health and Human Services' 1988 directive prohibiting the use of any funds from Title X of the Public Health Service Act (authorizing family planning programs) in programs where abortion is a method of family planning. This means that a clinician may lawfully respond to a client's inquiry about abortion only with a denial that abortion is an option. Thus, while allowing women the constitutional protection to chose an abortion, the Court has allowed the legislature to freely use the power of the purse to discourage or prevent the choice of abortion. Rust's greatest impact may well be in its acceptance of the enormous power wielded by the government over funded activities, especially in health policy. Justice Rehnquist believes there is not constitutional right to health, welfare, or any other government benefit; the legislative branches of the government cannot be required by judicial interpretation of the Constitution to provide any particular benefit or service to anyone. Even when the government chooses to fund a particular benefit, it is free to condition that benefit with virtually no judicially enforceable limits on that discretion.     

The standard of living of widows: Inventories as an indicator of the economic situation of widows

This article examines the standard of living of widows in two rural areas, South West Finland and Central Sweden, in the eighteenth and nineteenth century and among first generation migrants to Stockholm between 1680 and 1750. The principal sources used are the inventories of a person's possessions that were taken after their death, supplemented in the case of the rural populations by retirement contracts (which were not used by urban populations in the Nordic countries). Wealth is measured in three ways: examination of the type and value of the property listed in the inventory, calculating what goods might be purchased with a given inheritance, and a comparison of the inventories of widows with those of married women and with men. A range of factors, it was discovered, determined how much property a widow might own at her death. These factors included her age and whether there were children entitled to a share of the family's property but also the impact of inheritance law which awarded widows a larger share of marital property in towns than in the countryside and included the house which in rural areas was considered to belong to the family and not to any one individual. Analysis of this evidence suggests that the widows of farmers were likely to be economically secure due to the provisions in their retirement contracts which provided them with housing, food and care until their death. The situation of the widows of the landless was considerably more precarious. Some might even have nothing to inherit from their husbands.     

媒体消费语境中的“中产阶级”幻想——以《名牌》杂志叙述的男性精英形象为例

与传统的女性时尚类杂志紧盯职业女性或女性白领一样,男性时尚杂志也瞄准了中国社会的部分"有品味"人士和新富阶层,即所谓的中产阶级或伪中产阶级,通过精美的广告、成功的人生和奢华的生活方式叙述,传播着特定的消费暗示与阶层梦想.本文以《Mangazine·名牌》杂志为例,着重探讨了这本杂志是如何界定"精英"形象与阶层符号的,揭示了其既有中国式"中产阶级"的幻想,也存在着消费社会必然出现的媒体镜像偏差.成长中的中产阶级与中产读物需要超越消费主义的共谋.     

“产学结合”是高校协同创新的重要途径——以日本为例

协同创新是“高等学校创新能力提升计划”的核心概念,这一概念反映了当代科学研究发展的基本趋势.协同创新的“协同”可以有多个层面,多种形式,跨学科,跨部门乃至跨国界.这其中,高校与产业部门的协同,所谓“产学结合”显得尤为突出.“产学结合”在当代日本被看做是科技创新、高校自身发展以及高校为社会经济成长做贡献的重要途径之一.日本高校的产学结合主要包括两个层面:一是大学与企业联合开展研究活动,即研究过程的产学结合;二是大学的研究成果直接转化为技术、产品为企业所用,即研究成果的产学结合.日本政府在推动高校产学结合的发展过程中发挥着重要作用,其影响高校产学结合的手段方法主要有三个方面:通过法律,制定计划,投入经费.日本各高校在产学结合中扮演着主要角色,各高校通过成立负责产学结合的专门机构,将产学结合的活动落在实处,推向深入.     

残疾标准制定与实施中的基本问题研究 ——以《人体损伤致残程度分级》为例

《人体损伤致残程度分级》的制定凝聚了一代法医临床司法鉴定理论界和实务界专家的心血,它的实施能够规范和统一我国的残疾鉴定标准.与现行的其他同类标准相比,《伤残分级》对于残疾情形覆盖更加全面、分级更加合理,更便于实践操作.但是《伤残分级》的点、线、面结构特点也使得其存在无法穷尽所有损伤情形、易忽视损伤相对性等问题.笔者主要从《伤残分级》点、线、面的结构特点为视角对《伤残分级》进行了一些研究,并为实践中更好的适用《伤残分级》提出建议.     

Definitions of the Family as an Impetus for Legal Change in Custody Decision Making: Suggestions from an Empirical Case Study

Legal scholars and social scientists are increasingly calling on legislators, lawyers, and judges to recognize and embrace expanding definitions of the family. Implicit in such calls is the expectation that legal recognition of expanding definitions of the family will protect children's attachment relationships with adults, irrespective of their biological ties to those adults. Through a detailed, historical examination of custody decisions in disputes between biological and nonbiological parents in the state of Iowa, this research suggests that judicial recognition of more expansive definitions may not result in decisions that protect children's attachment relationships. This is true because the legal impact of family definitions appears to be contingent upon cultural and political factors that may undermine the expected effects of changing definitions. This research also suggests that judicial recognition of children's rights may be the most apt way to promote legal changes that will protect children's attachment relationships.     

Housing instability is as strong a predictor of poor health outcomes as level of danger in an abusive relationship: findings from the SHARE Study

Advocates, clinicians, policy makers, and survivors frequently cite intimate partner violence (IPV) as an immediate cause of or precursor to housing problems. Research has indicated an association between homelessness and IPV, yet few studies examine IPV and housing instability. Housing instability differs from homelessness, in that someone experiencing housing instability may currently have a place to live but faces difficulties with maintaining the residence. We present baseline findings from a longitudinal cohort study of 278 female IPV survivors with housing as a primary concern. Our analysis indicates the greater the number of housing instability risk factors (e.g., eviction notice, problems with landlord, moving multiple times), the more likely the abused woman reported symptoms consistent with PTSD (p < .001), depression (p < .001), reduced quality of life (p < .001), increased work/school absence (OR = 1.28, p < .004), and increased hospital/emergency department use (OR = 1.22, p < .001). These outcomes persist even when controlling for the level of danger in the abusive relationship and for survivors' drug and alcohol use. Importantly, both housing instability and danger level had stronger associations with negative health outcomes than other factors such as age, alcohol, and drug use; both make unique contributions to negative health outcomes and could contribute in different ways. Housing instability is an important and understudied social determinant of health for IPV survivors. These findings begin to address the literature gap on the relationship between housing instability, IPV, and survivors' health, employment, and utilization of medical care services.