Mental health parity and newborns' and mothers' health protection--HCFA. Solicitation of comments

This document is a request for comments regarding issues under the Mental Health Parity Act of 1996 (MHPA) and the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). The Department of Labor and the Department of Health and Human Services (collectively, the Departments) have received comments from the public on a number of issues arising under both MHPA and NMHPA. Further comments from the public are welcome.     

Interim rules for group health plans and health insurance issuers under the Newborns' and Mothers' Health Protection Act--IRS; DoL; HCFA. Interim rules with request for comments

This document contains interim rules governing the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA). The interim rules provide guidance to employers, group health plans, health insurance issuers, and participants and beneficiaries relating to new requirements for hospital lengths of stay in connection with childbirth. The rules contained in this document implement changes to the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act (PHS Act) made by NMHPA, and changes to the Internal Revenue Code of 1986 (Code) enacted as part of the Taxpayer Relief Act of 1997 (TRA '97). Interested persons are invited to submit comments on the interim rules for consideration by the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (Departments) in developing final rules.     

HIPAA Newborns' and Mothers' Health Protection Act--IRS. Notice of proposed rulemaking by cross-reference to temporary regulations

Elsewhere in this issue of the Federal Register, the IRS is issuing temporary regulations relating to minimum hospital length-of-stay requirements imposed on group health plans with respect to mothers and newborns. The hospital length-of-stay requirements were added to the Internal Revenue Code by section 1531 of the Taxpayer Relief Act of 1997. The IRS is issuing the temporary regulations at the same time that the Pension and Welfare Benefits Administration of the U.S. Department of Labor and the Health Care Financing Administration of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations relating to hospital length-of-stay requirements added by the Newborns' and Mothers' Health Protection Act of 1996 to the Employee Retirement Income Security Act of 1974 and the Public Health Service Act. The temporary regulations provide guidance to employers and group health plans relating to the new hospital length-of-stay requirements. The text of those temporary regulations also serves as the text of these proposed regulations.     

Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease

Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system''s focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body.     

SAME SEX,DIFFERENT RIGHTS: AMENDING U.S. IMMIGRATION LAW TO RECOGNIZE SAME‐SEX PARTNERS OF REFUGEES AND ASYLEES

Overcoming a long history of anti‐gay sentiment preserved in federal immigration law, the United States has made admirable advances during the past two decades in the protection it affords gay immigrants. Despite this promising progress, and in contrast to the practices of all other industrialized democracies, the United States remains firm in its refusal to federally recognize any form of same‐sex partnership, a decision which bears directly on those relationships considered valid for immigration purposes. The Uniting American Families Act (UAFA) represents the closest any proposed legislation has come to successfully granting immigration rights to gay immigrants. However, through its restrictive provisions, the UAFA fails to fully account for the needs of refugees, asylees, and their same‐sex partners. This Note argues that, while the UAFA is a step in the right direction, it does not go far enough to protect gay refugees and asylees. It further proposes that legislation be enacted which provides this unique segment of the immigrant population the opportunity to share their lives together, free from fear of persecution. It advocates for the use of the conjugal partner provision set out in Canada's Immigration and Refugee Protection Act as a template for changes to U.S. immigration law, thereby expanding the category of relationships viewed as valid for the purpose of immigration.     

Comparative effectiveness research under the Patient Protection and Affordable Care Act: can new bottles accommodate old wine?

The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.     

FROM THE INSIDE OUT: CALLING ON STATES TO PROVIDE MEDICALLY NECESSARY CARE TO TRANSGENDER YOUTH IN FOSTER CARE

It is well known that transgender youth in foster care often face egregious discrimination and victimization based on their gender identities. Unfortunately, transgender youth in foster care have also been deprived of transgender-specific medical care that is vital to their health and well-being. This Note advocates that child welfare agencies adopt legislation that will demonstrate their commitment to fulfilling their constitutional duty to provide medically necessary care to transgender youth in their custody. This Note examines recent case law on the topic and addresses counterarguments to the proposal, including risks associated with treatment, high cost, and the stigma of gender identity disorder. Ultimately, this Note concludes that adopting the proposed legislation is a necessary step toward securing health care rights for transgender foster care youth.     

A Need Not Being Met: Providing Paid Family and Medical Leave for All Americans

Many parents in the United States face the quandary of whether to take time off from work to care for themselves, their children, or other family member, understanding that their jobs may not be there upon return and they will receive no income during their leave. The Family and Medical Leave Act has not lifted this burden; it only provides for unpaid leave. Four states and several cities have implemented paid family and medical leave statutes with both employees and employers benefiting. This Note proposes a uniform paid family and medical leave statute based on other countries’ statutes; proposed federal legislation; and statutes in New York, California, and San Francisco.     

PROTECTING OUR CHILDREN FROM SEX OFFENDERS: HAVE WE GONE TOO FAR?

On July 27, 2006, U.S. President George W. Bush signed into law the Adam Walsh Child Protection and Safety Act. This federal statute was created to serve as a tougher, more modern improvement of its predecessor in the ongoing effort to protect children from dangerous sexual predators. However, the Act did not amend the controversial federal mandate that all 50 states include the crimes of kidnapping and false imprisonment against a minor, committed by a nonparent, and without any sexual motivation or misconduct, as a crime requiring a wrongdoer to register as a sex offender. This Note demonstrates how the kidnapping and false imprisonment requirements of the Adam Walsh Act have led to a misuse of state sex offender registries to the detriment of the children they claim to protect. The solution that this Note proposes will provide each individual state with the freedom to decide how, if at all, these contentious offenses will fit into its sex offender registry, taking into consideration the state's unique statutory language, available child protective resources, and constitutional limitations. As a result, petty criminals who do not pose any real or specific threat to children will no longer be grouped with the most dangerous and violent sexual predators, child protective funds will be better utilized, and the public's attention will be refocused on the real threats to children, thereby satisfying the spirit and purpose of the Adam Walsh Act.     

Age discrimination in retirement: in search of an alternative

American employers have traditionally relied on age as the criterion for mandatory retirement. Yet advances in medicine indicate the inadequacy of age as a measure of job competence and suggest the potential for a more reliable measure. With current social and economic conditions pressing many employees to seek to work beyond mandatory retirement ages set by their employers, transition to more reliable measures has become a vital matter. This Note explores the potential for implementing medically-based alternatives to the age proxy. It initially addresses problems of medical feasibility and economic practicality, and considers how the divergent interests of employees and employers can be accommodated. The balance of the Note examines the present roles of Congress, agencies, and courts in facilitating age-blind mandatory retirement policy. It suggests the need for reform of the federal Age Discrimination in Employment Act and recommends a more effective distribution of roles among governmental institutions.     

Protecting the rights of the developmentally disabled: alternatives to the existing statutory and regulatory scheme.

The Developmentally Disabled Assistance and Bill of Rights Act of 1975 and related HEW regulations require each state to establish a system for the protection and advocacy of the rights of developmentally disabled persons as a condition to receiving specified federal funds. This Note contends that, under the present statutory and regulatory scheme, states and governors have broad powers to interfere with the proper functioning of protection and advocacy systems. The Note examines the principal legal remedies, contractual and constitutional, presently available to parties interested in reducing or eliminating such interference, and concludes that such remedies are ineffectual. Instead, the author proposes, the HEW regulations should be revised to strengthen the autonomy of protection and advocacy systems or, alternatively, Congress should amend the 1975 Act to provide for federal administration of such systems.     

Differential effectiveness in patient protection laws: what are the causes? An example from the drive-through delivery laws

In the mid-1990s, many states as well as the federal government began to regulate early postpartum hospital discharge. Length-of-stay patterns changed markedly in response, but effects were much greater in some states than others. In particular, laws directly empowering patients appeared more effective than laws requiring providers to follow practice guidelines. In addition, the effectiveness of regulation could potentially be influenced by state environment, such as managed care penetration as well as exposure to media attention and public pressure on the issue, though these factors alone were insufficient to cause general behavior change. Furthermore, the 1996 federal law had little effect beyond state laws, suggesting that it did not provide substantial benefits to women in self-insured plans exempted from state law regulation by the Employee Retirement Income Security Act. Findings from this study could provide lessons for similar patient protection initiatives.     

Children's Health Insurance Program (CHIP); allotment methodology and States' fiscal years 2009 through 2015 CHIP allotments. Final rule

This final rule describes the implementation of funding provisions under Title XXI of the Social Security Act (the Act), for the Children's Health Insurance Program (CHIP), as amended by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), by other related CHIP legislation, and most recently by the Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act). Specifically, this final rule addresses methodologies and procedures for determining States' fiscal years 2009 through 2015 allotments and payments in accordance with sections 2104 and 2105 of the Act, as amended by CHIPRA and the Affordable Care Act.     

Patient dumping in the hospital emergency department: renewed interest in an old problem

Alarm about the adverse effects of transferring emergency patients for economic reasons has resulted in federal legislation aimed at curbing the practice. We review the history of common law hospital liability for denial of emergency care and analyze the federal legislation designed to restrict the transfer of medically indigent patients with emergency problems. We conclude that the currently proposed solutions to patient dumping will have limited effectiveness without more specific incentives for the provision of health care to the medically indigent.     

Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments

This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).     

Case Baiting

In 2014, New Jersey passed the Sports Wagering Act, permitting sports betting at state casino and racetrack venues, in direct conflict with the federal Professional and Amateur Sports Protection Act. In 2017, South Dakota passed Senate Bill 106, requiring that certain e-commerce retailers collect and remit sales tax, in violation of federal law. The two U.S. Supreme Court decisions arising from challenges to these state statutes—South Dakota v. Wayfair and Murphy v. NCAA—exemplify U.S. Supreme Court “case baiting.” Case baiting is a tactic states implement to challenge federal directives by passing state legislation that directly conflicts with federal law to lure the Court into granting certiorari and ruling in their favor. This article argues that South Dakota's and New Jersey's triumphs pave the way for other jurisdictions to pursue similar strategies across multiple legal issues such as abortion restrictions and immigration law. In addition, this article suggests that case baiting invites further scholarly exploration of important policy considerations, including the use of this tactic as a novel approach to the application of law and strategy, whether case baiting promotes the Court's progression toward a more quasi-legislative role, and whether passing conflict legislation violates state legislators’ oaths of office.