Medicare program; home health prospective payment system rate update for calendar year 2012. Final rule

This final rule sets forth updates to the home health prospective payment system (HH PPS) rates, including: the national standardized 60-day episode rates; the national per-visit rates; and the low utilization payment amount (LUPA) under the Medicare PPS for home health agencies effective January 1, 2012. This rule applies a 1.4 percent update factor to the episode rates, which reflects a 1 percent reduction applied to the 2.4 percent market basket update factor, as mandated by the Affordable Care Act. This rule also updates the wage index used under the HH PPS, and further reduces home health payments to account for continued nominal growth in case-mix which is unrelated to changes in patient health status. This rule removes two hypertension codes from the HH PPS case-mix system, thereby requiring recalibration of the case-mix weights. In addition, the rule implements two structural changes designed to decrease incentives to upcode and provide unneeded therapy services. Finally, this rule incorporates additional flexibility regarding face-to-face encounters with providers related to home health care.     

National planning for locally controlled health systems: the Finnish experience

The World Health Organization considers Finland's health planning system to be among the most successful in the developed world. Despite tight resource constraints--symbolized by total health expenditures held consistently to less than 7 percent of gross domestic product--the Finns have built up a strong primary care sector and dramatically improved the overall availability and accessibility of needed services. This article compares the official health planning system with the actual planning process as experienced within one Finnish central hospital district. The official planning system seeks to integrate national strategic goals with local municipal ownership, administration, and funding of service delivery. The actual planning process within the studied district suggests that technically oriented civil servants at the regional level may be at least as important in the overall decisionmaking structure. The article concludes with a brief exploration of this finding's potential consequences for the long-term development of the Finnish health care system and for national health planning efforts generally.     

The devil is in the details: Managed care and the unforeseen costs of utilization review as a cost containment mechanism

This article addresses issues of liability when a single-payor in a national health care system makes a decision based on a utilization review program that injures the patient as a result. In Part I, the history of Managed Care Organizations (MCOs) is discussed to establish an understanding of the current health care landscape. Part II explains MCOs' use of utilization review to contain costs and analyzes the manner in which courts have addressed the issue of MCO liability for patient injuries sustained from denial ofcoverage. Finally, Part III concludes that current case law may limit a patient's access to a remedy for injuries sustained from a utilization review decision in a single-payor national health care system.     

Medicare program; home health prospective payment system refinement and rate update for calendar year 2008. Final rule with comment period

This final rule with comment period sets forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health services, effective on January 1, 2008. As part of this final rule with comment period, we are also rebasing and revising the home health market basket to ensure it continues to adequately reflect the price changes of efficiently providing home health services. This final rule with comment period also sets forth the refinements to the payment system. In addition, this final rule with comment period establishes new quality of care data collection requirements. Finally, this final rule with comment period allows for further public comment on the 2.71 percent reduction to the home health prospective payment system payment rates that are scheduled to occur in 2011, to account for changes in coding that were not related to an underlying change in patient health status (section III.B.6).     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.     

权力监督视阈下国家监察体制改革的实践指向

国家监察体制改革作为我国政治体制改革的一项重大举措,自实施以来就一直倍受学术界的关注。从历史层面上看,监察体制改革继承了我国古代监察思想的精髓;从现实层面上看,国家监察体制改革是适应新时代国家治理现代化的要求,进一步改善我国反腐败力量分散现状的实践探索。因改革刚刚起步,所以存在相关法律制度尚未健全、工作职能尚未细化、与其他部门配合不够等问题。未来国家监察体制改革应立足实践,突出问题导向,不断完善法律制度,规范运行机制,形成强而有效的监督合力,进一步推进党风廉政建设。     

Screening for mental disorder using the UK national offender assessment system

Probation officers have large caseloads with high levels of psychiatric morbidity but receive minimal training in recognising/managing mental health problems. In the UK, there is no national screening procedure for mental illness among offenders that is considered effective. This study’s aim was to develop a screening system for mental/personality disorders using the Offender Assessment System. Seven screens for mental disorder were developed using items from assessments on 574 prisoners: alcohol misuse, drug dependence, antisocial personality disorder, psychopathy, learning difficulties, psychosis and severe mood disturbance. Internal validation showed that the screens performed well across accuracy estimates. Prevalence of mental disorders identified with the screens in test and validation samples was similar. However, the psychopathy and severe mood disturbance screens may be more effective in screening for true negatives. The screens are an economical method for prioritising mental health needs of the UK prison and probation population using routinely collected data.     

Medicare program; home health prospective payment system rate update for calendar year 2007 and Deficit Reduction Act of 2005 changes to Medicare payment for oxygen equipment and capped rental durable medical equipment; final rule

This final rule sets forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health services. In addition, this final rule sets forth policy changes related to Medicare payment for certain durable medical equipment for the purpose of implementing sections 1834(a)(5) and 1834(a)(7) of the Social Security Act, as amended by section 5101 of the Deficit Reduction Act of 2005. This final rule also responds to public comments on the August 3, 2006, proposed rule that pertain to a number of issues including the requirement that home health payments are based on the reporting of specific quality data by home health agencies.     

Transnationalism in the Regulation of Labor Relations: International Regimes and Transnational Advocacy Networks

This paper examines prospects for transnational advocacy and regimes as a way to buttress national labor laws and institutions in an interlocking mosaic and thus ensure the continuation of strong systems of industrial relations under conditions of increasing economic integration. We argue that there is a role for transnational solutions as a supplement to national systems, and we assess the conditions necessary to make this approach effective. We look at a variety of possible actors and arenas that could foster transnationalism and provide illustrations of transnational advocacy and regime building. We conclude that elements of a multilevel, public-private transnational regime are present in some parts of the world and that these elements can occasionally be knit together. We find that prospects for an effective and sustainable system of transnational multi-level regulation are greater when regional integration pacts such as the EU and NAFTA create transnational norms or forums. But, based on preliminary analysis of transnational advocacy and regulation in these two areas, we also conclude that no fully effective system has yet emerged.     

Health and Efficiency: Community Law and National Health Systems in the Light of Müller-Fauré

In Müller-Fauré the Court of Justice has made clear that restricting patients to receiving medical services from their domestic health systems is often contrary to EC Treaty rules on the free movement of services, particularly where the treatment is not in-patient. The patient should generally be able to go abroad for treatment at the expense of their national health authority. This has structural and financial repercussions for health care systems in several Member States, including the United Kingdom, whose systems are premised upon captive patients. It also has broader implications for welfare harmonisation and provision in the European Union. Exceptions are possible, where the implications for the national health system would be very serious, but Müller-Fauré indicates that the Court will not allow national courts or authorities to rely on these too freely.     

The regulation of dental licensing: the dark ages?

Current state laws regulating the licensure of dentists place severe restrictions upon the freedom of movement of practitioners. Most state laws were enacted during a period when a strong rationale for regulating public health and welfare existed. Today, these laws hamper the free movement of dentists and are anachronisms in an era of national standards and practices. The authors contend that the extant laws rest upon outdated assumptions and serve economic and protectionist goals rather than public health and safety. This Article examines the history and application of the traditional justifications for state licensure and their present ramifications. The authors suggest that replacing the current regulatory system with a national clinical examination and a national licensure program will best serve the interests of the public and the dental profession.     

Medicare program; home health prospective payment system rate update for calendar year 2011; changes in certification requirements for home health agencies and hospices. Final rule

This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the "skilled services" section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.     

Quarantine in times of emergency: the scope of s 51(ix) of the Constitution

This article explores the scope of s 51(ix) of the Constitution, the power of the Commonwealth to make laws with respect to "quarantine". While this power has sustained the Quarantine Act without a challenge since 1908, it may be that future national public health emergencies, such as epidemics or bioterrorism, will (as has happened in other countries) demand a level of federal preparedness that requires augmented public health powers at a national level. If so, will the scope of the quarantine power, as determined by the High Court, be wide enough allow the Commonwealth to implement these powers? While there is some advantage in a national approach, there is also some authority suggesting that the quarantine power could not extend to domestic public health controls. If there is uncertainty about the scope of the power, what are the options? Should there be another approach, with the States, Territories and the Commonwealth moving towards uniform legislation and co-operative arrangements?     

National Solidarity,Global Impartiality,and the Performance of Philosophical Theory. The Example of Migration Policy

This paper explores the issue of whether an international system of nation-states can be defended from a global perspective of impartiality. At present, it seems as if the nation-state were the only suitable institutional location for the realization of effective systems of social justice. Provided that national politics is indeed disposed to promote the freedom and well-being of its citizens, a decentralized system of nation-states is likely to produce beneficial effects. Experience, however, teaches that national politics has in many instances had decidedly negative effects. For that reason, the existing system of nation-states cannot be defended from a global point of view. Hence, the question turns on whether a system of nation-states could conceivably find the support of rational persons if it incorporated substantive restrictions on national politics. This paper discusses the liberty to migrate as one of the many options potentially available for the correction of the existing international regime. As the closer inspection of the underlying philosophical question reveals, the problem can only be resolved with reference to a normatively relevant understanding of the kind of persons we take ourselves to be. From the conclusion that the freedom to migrate is to be understood as a fundamental liberty, the discussion then turns to the legitimate limitations that might be imposed by national immigration policies. It is argued that—in order to accommodate what is demanded by both global impartiality and national solidarity—open admission policies must not in effect place at a disadvantage those who are already relatively worse off under a present distribution, for this would violate basic conditions for the development and confirmation of socially acquired self-esteem     

公共卫生事件风险沟通中社会信任问题研究

在风险社会中,有针对性地进行风险沟通已成为应对风险不确定性的有效手段.随着我国经济的迅速发展,具有"脱域"特质的陌生人社会逐步形成,且移动智能终端进一步普及使得生活场景向虚拟化趋势发展,社会生活现状的改变对风险沟通提出了新要求.应从风险治理、立法完善、专家系统以及公众参与等方面着手完善公共卫生事件风险沟通中的社会信任机...     

The Hermeneutics of Jurisdiction in a Public Health Emergency in Canada

This paper investigates the state of the law in Canada in regards to a public health emergency, and in particular the jurisdictional logic that might come into effect were a public health emergency to occur. Although there has yet to be a national public health emergency in Canada, threats of such crises are likely to arise in the future. It is therefore recognised as necessary to address Canada’s legal preparedness for a public health emergency and evaluate proposed reforms to the legal structure that could facilitate response. This paper contributes to this goal by identifying multiple jurisdictional factors that could inform legal interpretations in a public health emergency. It considers how the legal system and the courts are dealing with public health as a national security issue (political and collective matter) while taking into account s. 7 of the Canadian Charter (individual rights). It also looks at the power of the government defined in the Emergencies Act [1985, c. 22] and a proposed legal reform that would make it easier for the government to act unilaterally in a public health emergency. The paper draws on the legal theory of Robert Cover to analyse the hermeneutics of jurisdiction that characterise legal interpretations of public health in Canada, as well as the relationship between jurisdiction and legal violence that these hermeneutics imply. It then develops a case study of the use of medical triage in a public health emergency to explore the possibility of holding the state liable under private law for harm caused to individuals by public health decisions. The paper concludes by suggesting that the state’s public health power can be conceptualised as a form of legal violence and that the courts in Canada should adopt a jurisgenerative approach to legal interpretation in the area of public health.     

The role of the psychiatrist in evaluating a prison mental health system in litigation

Federal courts during the past 14 years have recognized that many prisons in the United States have provided constitutionally inadequate medical and psychiatric services. Our recent national survey indicates that at least 20 states have had at least one part of their correctional system included in a certified class action suit that alleged insufficient mental health services for inmates. This article reviews the role of the expert psychiatric witness during the phases of litigation that involve proposed remedial plans and compliance in implementing remedial plans. Available epidemiologic data about psychiatric disorders among prison inmates, standards for correctional mental health care, and various mental health system models are briefly reviewed. A comprehensive approach to evaluating proposed remedial plans and assessing issues of compliance with accepted plans is described. Special attention is directed toward psychiatric issues unique to a correctional system.     

Medicare program; home health prospective payment system rate update for calendar year 2006. Final rule

This final rule sets forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health agencies. This final rule is the first update of the home health prospective payment system (HH PPS) rates that uses the revised area labor market Metropolitan Statistical Area designations for calendar year 2006. In implementing the new area labor market designations, we are allowing for a one-year transition period. This transition consists of a blend of 50 percent of the new area labor market designations' wage index and 50 percent of the previous area labor market designations' wage index. In addition, we are revising the fixed dollar loss ratio, which is used in the calculation of outlier payments.     

Infectious disease surveillance in the United States and the United Kingdom: from public goods to the challenges of new technologies

Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods.