Special report on health care delivery systems. Trends in the integrated delivery of health care and the corporate practice of medicine

The prospects for federal legislation preempting state corporate practice restrictions are unclear. The health care reform bill originally introduced by President Clinton contained a provision that would have preempted "any state law related to the corporate practice of medicine" insofar as it applied to the arrangements between non-fee-for-service health plans and their participating providers. H.R. 3600/S. 1757, 103d Cong., 1st Sess. 1407(b) (1993). Whether and in what form a preemption provision may survive the legislative process and see a Presidential signature remains to be seen. The particular fate of the federal legislation notwithstanding, however, health care executives can nevertheless remain confident that the legal treatment of the "corporate practice" of medicine will continue to be of vital concern as the various forms of health care organizations evolve in the ongoing struggle to deliver quality medicine at affordable prices.     

Health Care Financing Administration--Adoption of the National Bureau of Standards fire safety evaluation system for health care facilities. Final notice

The Department of Health, Education, and Welfare proposed extending the new Fire Safety Evaluation sSystem (FSES) to all hospitals participating in the Medicare and Medicaid programs in a Notice of comment period publishedon June 28, 1979 in the Federal Register (44 FR 37818). The Department also sought public comment on whether to apply the FSES to skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) in this same Notice. After a careful review and analysis of the public comments received, the Department has decided to adopt the FSES as a means of evaluating alternative arrangements used to achieve compliance with the provisions of the Life Safety Code for hospitals, skilled nursing facilities, and intermediate care facilities participating in the Medicare and Medicaid programs.     

Health Care Financing Administration: adoption of the National Bureau of Standards fire safety evaluation system for health care facilities. Notice of comment period

The Department of Health, Education, and Welfare is proposing to extend use of the new Fire Safety Evaluation System (FSES) to all hospitals participating in the Medicare and Medicaid programs. We are seeking public comment on this proposal and on whether to apply the FSES to intermediate care and skilled nursing facilities. The Fire Safety Evaluation System (FSES) was designed by the National Bureau of Standards. It defines the combinations of widely accepted fire safety systems and structural arrangements which can be used by health care facilities to meet safety standards equal to or exceeding those in the Life Safety Code. The FSES provides a framework which guarantees that the high standards of fire safety necessary to protect patients will be met and which is flexible enough to allow for new advances in safety technology and practice. It is based on our experience, which clearly demonstrates that the Life Safety Code can be implemented more effectively and without waste if certain changes are made in the procedures for achieving these mandated levels of safety.     

Payment method for health care services under the Supplemental Health Care Program for Active Duty Members of the Uniformed Services; adoption of CHAMPUS procedures--DoD. Final rule

This final rule partially implements 10 U.S.C. 1074(c), as amended by section 729 of the National Defense Authorization Act for Fiscal Years 1990 and 1991, Public Law 101-189. The recent amendment authorizes the Department of Defense to establish for the active duty supplemental care program payment rules similar to those used under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). The supplemental care program is the program which provides for the payment to civilian (non federal-governmental) health care providers for care provided to active duty members of the uniformed services. This final rule would adopt CHAMPUS payment amounts for the supplemental care program.     

Public Health Service--Privacy Act of 1974. Notification of new system of records: "clinical research; records of subjects in intramural research, epidemiology, demography, and biometry studies on aging."

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to adopt a new system of records. "Clinical Research: Records of Subjects in Intramural Research, Epidemiology, Demography, and Biometry Studies on Aging." DHHS/NIH/NIA, 09-25-0142. These records will be used to accomplish scientific research conducted by intramural scientists employed by the National Institute on Aging (NIA), and by hospitals, universities, research centers and research foundation under contract with NIA. These research activities aim at determining the health status of individuals and changes in health status over time, the incidence and prevalence of certain diseases and problems of the aged in certain populations, and changes that take place as the individuals age who are under study.     

Payment method for health care services under the Supplemental Health Care Program for Active Duty Members of the Uniformed Services; adoption of CHAMPUS procedures--DoD. Final rule amendment

On May 24, 1991 (56 FR 23800), the Department of Defense published a final rule on "Payment Method for Health Care Services Under the Supplemental Health Care Program for Active Duty Members of the Uniformed Services" concerning discharges occurring on or after June 24, 1991. Through an administrative error the effective date for the regulation should have been June 24, 1991, instead of May 24, 1991. This document is published to suspend the regulation.     

Medicare program; establishment of an expedited review process for Medicare beneficiaries enrolled in health maintenance organizations, competitive medical plans, and health care prepayment plans--HCFA. Final rule with comment period

This final rule with comment period establishes a new administrative review requirement for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs). This rule implements section 1876(c)(5) of the Social Security Act, which specifies the appeal and grievance rights for Medicare enrollees in HMOs and CMPs. This rule requires that an HMO, CMP, or HCPP establish and maintain, as part of the health plan's appeals procedures, an expedited process for making organization determinations and reconsidered determinations when an adverse determination could seriously jeopardize the life or health of the enrollee or the enrollee's ability to regain maximum function. This rule also revises the definition of appealable determinations to clarify that it includes a decision to discontinue services.     

Interim final rules for nondiscrimination in health coverage in the group market. Internal Revenue Service, Department of the Treasury; Pension and Welfare Benefits Administration, Department of Labor; Health Care Financing Administration, Department of Health and Human Services. Interim final rules with request for comments

This document contains interim final rules governing the provisions prohibiting discrimination based on a health factor for group health plans and issuers of health insurance coverage offered in connection with a group health plan. The rules contained in this document implement changes made to the Internal Revenue Code of 1986 (Code), the Employee Retirement Income Security Act of 1974 (ERISA), and the Public Health Service Act (PHS Act) enacted as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).     

Freedom, Property and Equality in the Theory of `Fundamental Rights'. A Commentary on an Essay by Luigi Ferrajoli

The essay that Luigi Ferrajoli published inTeoria politica is a partial, althoughvery important, preview of an importanttheoretical work on which he has been labouringfor several years. Ferrajoli is knownto be aiming at achieving a rigorousformalisation of the theory of subjectiverights, an undertaking to which he first turnedhis hand at the beginning of the seventies,with the book Teoria assiomatizzata deldiritto, in which he laid the foundations forhis subsequent work, including his extensivetreatise of the theory of criminal law,Diritto e ragione.So it is quite natural that this new essaycontains a quantity of references to conceptualcategories that come together in a veritableWeltanschauung, as it used to be called at onetime, in addition to an epistemology and ageneral theory of law.In order to discuss all his theses in thisessay as seriously as they deserve, we reallyshould go back to that set of philosophicalpremises to which they refer – and whichFerrajoli tends to nurture in a sort oftheoretical latency – and try to focus on anddiscuss them. As this is not the place for such amassive task – for which I may not even havethe necessary competence – I shall restrictmyself to touching on just a few points thatconcern me more closely. I apologise for thisselective and thus not very systematicapproach, made necessary to some extent also bythe large numbers of theoretical and politicalquestions that Ferrajoli's essay tackles,raises or merely touches on. Nevertheless, myselection will be aided by the criticalsignificance that Ferrajoli dedicates to someof my opinions. In short, I shall not try to doany more than to respond indirectly to hiscriticisms. And I shall do so with the greatestof respect, as Ferrajoli well knows, for histheoretical work and for the profoundmotivations that inspire him.