Special report on patient care. HCFA finally issues patient-dumping regulations

EMTALA has always been an especially worrisome law for providers because its requirements are both sweeping and vague, with potentially drastic penalties for violations. The new regulations remove only some of the law's vagueness. As with previous EMTALA amendments, all United States hospitals, as well as emergency department physicians and other doctors who see patients in the emergency department, should carefully review their internal policies regarding patient ++ transfers in light of the new regulations. For example, hospitals must have an internal policy for following up on suspicious transfers, as failure to detect an inappropriate transfer can now potentially result in a Medicare decertification action. Also, hospitals with specialized services (e.g., burn units or shock-trauma units) should review their policies on receiving transfer patients in light of the greater specificity of the new regulations. Finally, because of the confusing new requirements regarding ambulance services, all hospitals should review their relationships with and policies regarding, ambulance services and ambulance diversion.     

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.     

Technological Transfers from the European Space Programs: A Dynamic View and Comparison with Other R&D Projects

This article presents the results and lessons learned from a series of studies carried out by the BETA research team (University Louis Pasteur of Strasbourg, France) to measure the spin-offs and technological transfers that resulted from European space programs. Beyond the quantitative results that are analyzed in detail, the article examines some of the main qualitative characteristics that shape the technology transfer process generated by these programs. In particular, it is demonstrated that three main characteristics have a significant impact on the technology transfer process: the nature of the technologies at stake (their degree of maturity, their degree of diversity, the extent to which they are generic or specific), the nature of the network of participants to the programs (the degree of mutual trust, the existence of absorptive capabilities) and the nature of the organizational structure of those firms which participated in the projects (their degree of decentralization, their degree of vertical integration).The article concludes by discussing how these lessons learned could be used to shape the procurement policies to be followed by space agencies in order to favor a high potential for technological transfers arising from future space projects.     

Protection of human subjects; informed consent--FDA. Final rule

The Food and Drug Administration (FDA) is amending its current informed consent regulations to permit harmonization of the Department of Health and Human Services' (DHHS) policies on emergency research and to reduce confusion on when such research can proceed without obtaining an individual subject's informed consent. This regulation provides a narrow exception to the requirement for obtaining and documenting informed consent from each human subject, or his or her legally authorized representative, prior to initiation of an experimental intervention. The exception would apply to a limited class of research activities involving human subjects who are in need of emergency medical intervention but who cannot give informed consent because of their life-threatening medical condition, and who do not have a legally authorized person to represent them. FDA is taking this action in response to growing concerns that current rules are making high quality acute care research activities difficult or impossible to carry out at a time when the need for such research is increasingly recognized.     

我国反对家庭暴力地方法规、政策比较研究

我国有27个省、自治区、直辖市制定实施了反对家庭暴力的地方法规或文件。通过对这些地方法规和文件的比较分析可以发现,各地在界定家庭暴力概念、明确法规实施主体、规定举证责任、进行首问责任制等方面进行了积极的尝试,为反家暴工作的开展提供了重要依据。同时,地方性法规和政策的天然不足和相互间的差异,又迫切呼唤国家出台专门法律以及相关方面对若干法律问题做更加深入的研究论证。     

Globalization and extraterritorial application of economic regulation: crisis in international law and balancing interests

There are two developments the combination of which has led to new challenges to international law: the growth of economic regulations and globalisation. While the modern economies are associated with the proliferation of regulatory laws which are rooted in the national economic and social policies, the loosening of the national borders and globalisation has led to conflicts of economic regulations. Such developments have posed various risks of violations of national economic regulations by the economic actors and could lead to tension among national states which have jurisdiction over multinational enterprises in one way or another. The private parties involved in such a situation could somehow avoid such risks by their own initiatives and contractual arrangements but in most cases such measures do now work and the conflict has to be resolved through the cooperation between the countries involved. The paper investigates the potentials for public international law to come up with rules, principles and norms to resolve such complex disputes which touch up issues such as non-intervention, equality of sovereign states, state immunity, self-determination and other principles of international law. Unlike certain area of international law such as law of sea where a few factors involved and the disputes could be resolved by relying on simple facts and rules, the application of national economic regulations extraterritorially creates tensions among the nation states in respect of the demarcation of national jurisdictions. It is here that public international faces a new challenges and need to come up with new approaches such a balancing of interests of the states involved in the conflicts.     

Emergency powers,anti-corruption,and policy failures during the COVID-19 pandemic in Puerto Rico

This paper explores how the use of emergency powers by the US and Puerto Rican governments exacerbated the impact of the COVID-19 pandemic and manufactured the conditions for furthering the multilayered economic, legal, political, and humanitarian crisis affecting Puerto Rico since 2006. The paper discusses three cases. First, it examines how the multiple declarations of the state of emergency, and its constant renewals, produced contradictory public health policies. Since the start of the COVID-19 pandemic in March 2020, the Puerto Rican government has issued over 90 executive orders aimed at addressing the emergency, producing an unclear, contradictory, and unequal emergency management policy. Second, the paper focuses on the impact of the passing of Law 35 on April 5, 2020, which imposed severe penalties on those who disobeyed executive orders. As a result, hundreds of Puerto Ricans were arrested, fined, and incarcerated for violating the issued order. Third, the paper studies how, citing the presence of corruption, the Puerto Rican government implemented anti-corruption and anti-fraud policies that made it more difficult for those most in need of it—mainly poor and racialized individuals, as well as immigrants and working women—to access Pandemic Unemployment Assistance. Thus, the paper argues that emergency policies designed to address the pandemic, punitive governance, and anti-corruption and anti-fraud policies undermined Puerto Rico's capacity to handle the pandemic, exacerbated its impact, and created an unequal recovery scenario.     

DHHS human subjects protection: the new regulations revisited

In January of 1981 DHHS released its revised regulations for the protection of human subjects. These new regulations established five categories of federally funded research--primarily in the educational, social and behavioral sciences--which, at local Institutional Review Board (IRB) US ISSN (0193-7758) 1168 option, could be made exempt from mandated peer review. A survey of the 562 member IRB system was conducted to determine, among other things, what policies individual review boards had established with regard to these optionally exempted categories. 341 (61%) of the IRBs responded to the survey. Results indicate that the IRBs have overwhelmingly opted to maintain review procedures at some level in each of the "exempted" categories and that these procedures, as well as the other DHHS standards, are being applied almost universally to all research regardless of funding source. This article presents data on IRBs and their implications for the educational, social and behavioral sciences.     

Federal support for hospital construction in overbedded areas

This memorandum established policies and procedures to limit Federal financial support for the construction of hospitals in overbedded areas. The policy for Federal hospitals is that no new or replacement hospitals will be built in an overbedded area unless suitable, existing, non-Federal facilities cannot reasonably be acquired through purchase or lease. The policy for non-Federal facilities is that no Federal grants, loans, loan subsidies, or loan guarantees will be provided for hospital construction or renovation in an overbedded area, unless the proposed project is consistent with an approved local hospital facility plan or the Secretary of Health and Human Services (HHS) determines that it is necessary. In addition, legislation and regulations will be proposed to revise the current Medicare and Medicaid reimbursement policies for costs related to hospital construction or renovation. Finally, legislation will be proposed to revise Federal tax exempt bond financing for hospital construction and renovation in overbedded areas. This memorandum also prescribes agency responsibilities and procedures for implementing these policies.     

试论应对突发公共卫生事件的法制建设

本文简要介绍了有关国家在突发公共卫生事件方面的有效反应机制与立法 ,认真分析了《突发公共卫生事件应急条例》根据实践经验和借鉴国外有益做法 ,对突发公共卫生事件应急处理的新规定 ,并在此基础上对完善我国处理突发事件应急机制的法律制度提出了建议。     

The new EMTALA regulations and the on-call physician shortage: in defense of the regulations

This Article examines the new Emergency Medical Treatment and Labor Act (EMTALA) regulations, focusing on the on-call provisions, in light of the practical realities of the on-call physician shortage. It provides an historical account of issues surrounding the delivery of emergency care by on-call physicians and the legal background of EMTALA insofar as it relates to on-call physicians. Ultimately, the author concludes that, although the current shortage of on-call physicians has caused hospitals to anticipate EMTALA liability and advocate for more specific regulations, a closer look reveals that hospitals' fears are overstated. As long as hospitals have proper procedures in place, the new regulations will not put them in violation of EMTALA.     

Proposed regulations to govern private business use of tax-exempt bond financed facilities

For the most part, owners of tax-exempt hospitals and other health care facilities should welcome the issuance of the proposed regulations because they generally clarify and liberalize former law. As pointed out, however, in certain instances the proposed regulations do impose additional requirements not found in current law. Accordingly, in those instances in which exempt facility owners may elect to apply the proposed regulations prior to their finalization, a careful analysis needs to be made of whether the old or new regime would be most beneficial.     

Maladaptation of regulation to hybrid organizational forms

This paper argues that standard regulatory policies might be inadequate and may even introduce perverse effects when applied to hybrid organizational forms. Using the case of the “certifying system” adopted for several French agricultural products as a benchmark for the discussion, with particular insights provided by the label chicken case, the paper emphasizes the tight coordination process required by the characteristics of the transactions at stake as well as by the necessity to send adequate signals to consumers. However, unadapted regulations tend to misinterpret the resulting contractual arrangement as collusion. This interpretation is challenged here: The form adopted achieves a high degree of efficiency and reduces transaction costs without reducing competition. We conclude that a new approach to regulations may be required, combining two criteria: contestability and remediability.     

论应急预案的性质和效力——以国家和省级预案为考察对象

应急预案在本质上是各种应急法律规范的具体执行方案,但分析发现,目前的国家和省级预案却创制、补充了大量的法律规范用于弥补立法缺陷,事实上已使预案本身异化为应急法律体系的一部分。对于预案中暂时替代法律发挥作用的这些内容,为了保证其合法性,有必要在形式上将一定级别的预案上升为行政法规和规章,从而需要对预案的编制程序和内在结构进行必要的调整。     

The new economic credentialing: protecting hospitals from competition by medical staff members

This Article addresses hospitals' use of economic criteria to determine an individual's qualifications for staff privileges. Hospitals are resorting to economic conflict-of-interest credentialing policies in an attempt to ensure physician's loyalty and maintain their own economic viability. Physicians, however, argue that entrepreneurial activities are necessary for them to meet the economic challenges posed by declining reimbursements and rising insurance costs. The Article surveys the numerous legal theories that physicians (and, in some cases, the federal government) could employ in attacking these new types of credentialing policies and concludes that, on balance, hospitals should be able to implement their policies in ways that minimize liability in most jurisdictions. The Article concludes by discussing other issues that economic credentialing policies raise, including those implicating tax-exempt status and nonlegal considerations.     

National Security

If we are to devise foreign and defense policies for contemporary Russia, we must first make them reflect the new international realities that emerged in the wake of the collapse (destruction) of the international socialist system and the USSR. We must have new foreign and defense policies, for the international conditions of their implementation differ qualitatively from those that existed even in the eighties.     

多元的物权法源及其适用规律

从我国物权的立法、司法、交易等实践情况来看,我国的物权法源是多元的。在属于规范性法律文件的法源中,国家立法机构制定的物权法等狭义法律是核心,它们的位阶平等,相互间存在替代、细化、补充等关系。狭义法律之外的其他规范性法律文件,包括行政法规、地方性法规、没有变通规定的自治条例、单行条例或经济特区法规、司法解释、部门规章、地方政府规章,解释和细化了狭义法律,在不违背狭义法律目的的前提下,给物权内容提供了重要支撑。规范性法律文件所认可的法源包括国家有关规定或国务院的有关规定以及当事人订立的合同。在上述法源之外,习惯与物权法的根本宗旨、基本定位、整体风格、相关规定等高度契合,在无其他法源可供适用时起到补充作用。中国共产党的政策在农村土地物权领域发挥着重要作用,在它与狭义法律不一致时,承载基本政策和具体政策的党中央文件可作为法院裁判说理的依据.但不能成为裁判依据。     

Construction of the problem of Latin gangs in Spain and response of the law enforcement system

Recently, since their official recognition as criminal organizations by Spanish law enforcement authorities, stricter prosecution of Latin street gangs has been observed. The toughening of legal regulations, new models of police conduct and the increasingly active role of prosecutors have contributed to greater punitive pressure on the gangs. This article has two main objectives: first, to describe changes in Spanish criminal policies for the treatment of Latin American street gangs; second, to analyse to what extent these changes are in consonance with empirical findings on criminal involvement and the organizational nature of these groups. The results show that despite the recent increase in criminal activity these groups cannot be viewed as the only parties to blame for local street crime. The opinion of the law enforcement authorities that Latin American street gangs are a form of organized crime is far from reality. These groups do not have the required combination of characteristics inherent to criminal organizations, and their purposes are not always exclusively criminal.     

Modeling Facts,Culture, and Cognition in the Gun Debate

Can empirical data generate consensus about how to regulate firearms? If so, under what conditions? Previously, we presented evidence that individuals' cultural worldviews explain their positions on gun control more powerfully than any other fact about them, including their race or gender, the type of community or region of the country they live in, and even their political ideology or party affiliation. On this basis, we inferred that culture is prior to facts in the gun debate: empirical data can be expected to persaude individuals to change their view on gun policies only after those individuals come to see those policies as compatible with their core cultural commitments. We now respond to critics. Canvassing the psychological literature, we identify the mechanisms that systematically induce individuals to conform their factual beliefs about guns to their culturally grounded moral evaluations of them. To illustrate the strength and practical implications of these dynamics, we develop a series of computer simulations, which show why public beliefs about the efficacy of gun control can be expected to remain highly polarized even in the face of compelling empirical evidence. Finally, we show that the contribution culture makes to cognition could potentially be harnessed to generate broad, cross-cultural consensus: if gun policies can be framed in terms that are expressively compatible with diverse cultural worldviews, the motivation to resist compelling empirical evidence will dissipate, and individuals of diverse cultural persuasions can be expected rapidly to converge in their beliefs about what policies are best. Constructing a new, expressively pluralistic idiom of gun control should therefore be the first priority of policy-makers and -analysts interested in promoting the adoption of sound gun policies.     

The effect of state regulations on the quality and sale of insurance policies to Medicare beneficiaries

This paper examines the effects of state regulations on the quality of insurance policies sold to Medicare beneficiaries and on the amount of sales abuse reported in the sale of such policies. State regulations regarding such policies relate to policy content and format, minimum rates of return, sale of these policies related to disclosure requirements, consumer information activities, and penalties for agent and company abuse. This paper examines the impact of specific regulations on the ratio of the expected policy benefits per premium dollars and on the number and kind of abusive sales practices reported by purchasers and nonpurchasers in agent and mail sales. The study finds that loss ratio floors, minimum benefit standards, and the development of states of consumer information guides for prospective policyholders have a positive impact on the quality of the policies purchased. In addition, the study finds that the amount of abuse reported is less when insurance companies routinely issue press releases concerning agent or company misrepresentation and when consumer guides are developed and available from the state.