The capacities of minors to exercise voluntariness in medical treatment decisions

The legal standard for informed consent to medical treatment requires that the consenter be informed, competent, and acting voluntarily. The voluntary requirement of a valid consent was investigated by comparing forty 9- and 10-year-old children and forty 14- and 15-year-old adolescents (both generally presumed to be incapable of voluntary consent) with 47 young adults ranging in age from 21 to 25 (legally presumed to be deciding voluntarily) on responses to three hypothetical medical decision vignettes. The degree of parental influence was varied within each vignette to study the salience of parental influence in medical decision making. In two of three medical decision vignettes, most participants were deferent to parental wishes and few differences were found between children, adolescents, and young adults in their responses to parental influence. Differences between age groups were found in response to a kidney donation vignette. Children were significantly more likely to defer to parents than either adolescents or young adults. Adolescents were more likely to defer to parents than young adults, although this finding only approximated statistical significance. Implications of these findings for legal authorities, social policy makers, and families are discussed.     

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.     

Reimbursement offsets for medical care or services. Final rule

This document amends the regulations of the Department of Veterans Affairs (VA) concerning the reimbursement of medical care and services delivered to veterans for nonservice-connected conditions. This rule applies in situations where third-party payers are required to reimburse VA for costs related to care provided by VA to a veteran covered under the third-party payer's plan. This final rule adds a new section barring offsets by third-party payers and requires that third-party payers submit a request for a refund for claims when there is an alleged overpayment.