VA payment for non-VA public or private hospital care and non-VA physician services that are associated with either outpatient or inpatient care. Department of Veterans Affairs. Final rule

This document amends our medical regulations concerning VA payment for non-VA public or private hospital care provided to eligible VA beneficiaries. This document also amends our medical regulations concerning VA payment for non-VA physician services that are associated with either outpatient or inpatient care provided to eligible VA beneficiaries at non-VA facilities. With certain exceptions, these payments have been based on Medicare methodology. Sometimes VA can negotiate contracts with hospitals or physicians or with their agents to reduce the payment amounts. This document amends these regulations to allow VA to make lower payments based on such negotiations.     

Hospital care and medical services in non-VA facilities--VA. Final rule and regulation

Department of Veterans Affairs (VA) is amending regulations which pertain to the authorization for contract non-VA hospital care and medical services for veterans. The Veterans Health Care Act of 1992 provides that veterans with a total disability permanent in nature from a service-connected disability may be authorized contract non-VA hospital care and medical services. Contract care may be authorized only if the VA facility is not capable of furnishing the care required, or is not capable of furnishing economical care or services because of geographical inaccessibility. This amendment will make the regulations consistent with the law.     

Payment of reimbursement for emergency treatment furnished by non-VA providers in non-VA facilities to certain veterans with service-connected or nonservice-connected disabilities. Final rule

This document amends the Department of Veterans Affairs (VA) medical regulations concerning emergency hospital care and medical services provided to eligible veterans at non-VA facilities. The amendments are required by section 402 of the Veterans' Mental Health and Other Care Improvements Act of 2008. Among other things, the amendments authorize VA to pay for emergency treatment provided to a veteran at a non-VA facility up to the time the veteran can be safely transferred to a VA or other Federal facility and such facility is capable of accepting the transfer, or until such transfer was actually accepted, so long as the non-VA facility made and documented reasonable attempts to transfer the veteran to a VA or other Federal facility.     

Payment for inpatient and outpatient health care professional services at non-departmental facilities and other medical charges associated with non-VA outpatient care. Final rule

This document affirms as final, with changes, a proposed rule that updates the Department of Veterans Affairs (VA) medical regulations concerning the payment methodology used to calculate VA payments for inpatient and outpatient health care professional services and other medical services associated with non-VA outpatient care. The rule has been designed to ensure that it will not have adverse effects on access to care.     

Payment for non-VA physician services associated with either outpatient or inpatient care provided at non-VA facilities--VA. Final rule

This document amends Department of Veterans Affairs (VA) medical regulations concerning payment for non-VA physician services that are associated with either outpatient or inpatient care provided to eligible VA beneficiaries at non-VA facilities. Generally, when a service-specific reimbursement amount has been calculated under Medicare's Participating Physician Fee Schedule, VA would pay the lesser of the actual billed change or the calculated amount. Also, when an amount has not been calculated or when the services constitute anesthesia services, VA would pay the amount calculated under a 75th percentile formula or, in certain limited circumstances, VA would pay the usual and customary rate. Adoption of this final rule is intended to establish reimbursement consistency among federal health benefits programs to ensure that amounts paid to physicians better represent the relative resource inputs used to furnish a service, and to achieve program cost reductions. Further, consistent with statutory requirements, the regulations continue to specify that VA payment constitutes payment in full.     

Payment or reimbursement for emergency services for nonservice-connected conditions in non-VA facilities. Final rule

This document amends the Department of Veterans Affairs (VA) ``Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities' regulations to conform with a statutory change that expanded veterans' eligibility for reimbursement. Some of the revisions in this final rule are purely technical, matching the language of our regulations to the language of the revised statute, while others set out VA's policies regarding the implementation of statutory requirements. This final rule expands the qualifications for payment or reimbursement to veterans who receive emergency services in non-VA facilities, and establishes accompanying standards for the method and amount of payment or reimbursement.     

Payment for non-VA physician services associated with either outpatient or inpatient care provided at non-VA facilities--VA. Proposed rule

This document proposes to amend Department of Veterans Affairs (VA) medical regulations concerning payment for non-VA physician services that are associated with either outpatient or inpatient care provided to eligible VA beneficiaries at non-VA facilities. We propose that when a service specific reimbursement amount has been calculated under Medicare's Participating Physician Fee Schedule, VA would pay the lesser of the actual billed charge or the calculated amount. We also propose that when an amount has not been calculated, VA would pay the amount calculated under a 75th percentile formula or, in certain limited circumstances, VA would pay the usual and customary rate. In our view, adoption of this proposal would establish reimbursement consistency among federal health benefits programs, would ensure that amounts paid to physicians better represent the relative resource inputs used to furnish a service, and, would, as reflected by a recent VA Office of Inspector General (OIG) audit of the VA fee-basis program, achieve program cost reductions. Further, consistent with statutory requirements, the regulations would continue to specify that VA payment constitutes payment in full.     

Medicare and Medicaid programs; civil money penalties for nursing homes. Final Rule

This final rule will revise and expand current Medicare and Medicaid regulations regarding the imposition and collection of civil money penalties by CMS when nursing homes are not in compliance with Federal participation requirements in accordance with section 6111 of the Affordable Care Act of 2010.     

Health care for homeless veterans. Final rule

This final rule establishes regulations for contracting with community-based treatment facilities in the Health Care for Homeless Veterans (HCHV) program of the Department of Veterans Affairs (VA). The HCHV program assists certain homeless veterans in obtaining treatment from non-VA community-based providers. The final rule formalizes VA's policies and procedures in connection with this program and clarifies that veterans with substance use disorders may qualify for the program.     

论政府机构照章办事的“双刃剑”效应及对策思考

照章办事对我国政府机构具有"双刃剑"效应.一方面,照章办事是我国政府机构依法行政的根本要求,是其发挥效能的基础和关键性要素,也是遏制行政人员越轨行为的有效手段,具有正效应.另一方面,使政府机构忽视了效率原则、带来了资源浪费、扼杀了行政人员的创新精神并难以应对急剧变化的环境需求,具有负效应.因此,必须采取有效对策,趋利避害,在保证照章办事基本效能的同时,避免其所带来的低效率.     

Immigration and Naturalization Service--nonimmigrant alien (H-1) nurses; state license or examination requirements. Final rule

This final rule requires nonimmigrant nurses to possess a valid state license to practice nursing in the United States or to have successfully passed the screening examination given by the Commission on Graduates of Foreign Nursing Schools in order to qualify for an "H-1" nonimmigrant visa classification. Proof of having met either requirement is necessary before the Service will approve the visa petition. This amendment to the regulations is necessary to ensure that only those nonimmigrant nurses who are fully qualified to perform services of the "exceptional nature" required by section 101(a)(15)(H)(i) of the Act are admitted under this classification.     

Halfway Homeowners: Eviction and Forced Relocation in a Florida Manufactured Home Park

The last four decades of US housing policy have seen a shift from the federal allocation of affordable housing as a public good to the neoliberal model of private and for‐profit provision of affordable housing. This shift warrants a study of the link between the interests that now shape low‐income housing markets and the stability of the housing they provide. Nowhere are the effects of this shift more evident than in the homes of the 20 million Americans living in manufactured housing, which is installed largely on the private lands of for‐profit developers who can close mobile home parks and force residents to move themselves and their homes with as little as 30 days' notice. This ethnography of mass eviction in a Florida mobile home park examines state regulations intended to protect residents of closing parks and analyzes how private interests shape the implementation of these policies.     

Per diem for nursing home care of veterans in State homes. Department of Veterans Affairs. Final rule

This document amends regulations regarding the payment of per diem to State homes that provide nursing home care to eligible veterans. The intended effect of the final rule is to ensure that veterans receive high quality care in State homes.     

Contesting anticompetitive actions taken in the name of the state: state action immunity and health care markets

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses its application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that "the state itself" make the decision to do so. Partly on the basis of problems in the political environment, the article criticizes courts for using a mere "foreseeability" test to decide whether a state legislature sufficiently authorized competitors to act in contravention of clear federal policy: "Few things are more foreseeable than that a trade or profession empowered to regulate itself will produce anticompetitive regulations."     

Reasonable charges for medical care or services. Final rule

This final rule amends the Department of Veterans Affairs (VA) medical regulations concerning "reasonable charges" for medical care or services provided or furnished by VA to certain veterans for nonservice-connected disabilities. It changes the process for determining interim billing charges when a new Diagnosis Related Group (DRG) code or Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) code identifier is assigned to a particular type or item of medical care or service and VA has not yet established a charge for the new identifier. This process is designed to provide interim billing charges that are very close to what the new billing charges would be when the charges for the new identifiers are established in accordance with the regulations. This final rule also changes the regulations by removing all of the provisions for discounts of billed charges. This will eliminate or reduce duplicate discounting and thereby prevent unintended underpayments to the government.     

Beyond Punishment: The Penal State's Interventionist,Covert, and Negligent Modalities of Control

This article investigates the involvement of the penal state in the lives of criminalized people as a controlling force that takes multiple forms. We offer the concept of modalities of penal control and identify three such modalities in addition to expressive punishment: interventionist penal control is accomplished in extralegal ways; covert penal control is hidden from public view; and negligent penal control is characterized by the absence of action by state actors. This article illustrates empirical cases of each modality, using data from three distinct projects based in Chicago, southern Wisconsin, and nationwide. The data include observations of post‐prison groups and homes, interviews with criminalized people and nongovernmental organizational (NGO) staff, statutes, and regulations. This expanded understanding of penal state involvement extends beyond the understanding that characterizes discussions of mass incarceration and highlights the need for comprehensive reform.     

论法律保留对“校规”的适用边界——从发表论文等与学位“挂钩”谈起

大学并非一国之"租界",因此,大学事务亦有法律保留原则适用之必要,但是学术自由内在要求国家法律只能是宏观性和方向性的"框架立法",进而给大学自治这一制度性保障留足创制空间。大学"校规"与国家法律的关系,根据不同的"校规"类型有着很大的差异。对"学术性规则"而言,法律设定的"国标"只是学术的"最低标准",为教育质量计,各大学的"学术性规则"可以在法律之上设定更加严格的学术条件。而对"行政性规则",法律则是不可逾越的"上限"规范,只是就我国的法治实践现实观之,应破除"国家权力单一"的神话,确立"国家—社会"二元权力构造,进而给自治团体的自我型塑留下适当的裁量余地。当然,符合"法律保留原则",仅在宪法审查之路上迈出了"形式上"的第一步,"校规"要满足合宪要件,还必须存在"实质阻却违宪事由",这又要接受"比例原则"的合理性检验。