Medicare and Medicaid programs; announcement of additional applications from hospitals requesting waivers for organ procurement service area--HCFA

This notice announces two additional applications that HCFA has received from hospitals requesting waivers from entering into agreements with their designated organ procurement organizations (OPOs) in accordance with section 1138(a)(2) of the Social Security Act. It supplements notices published in the Federal Register on January 19, 1996, May 17, 1996, November 8, 1996, April 21, 1997, and September 17, 1997, that announced hospital waiver requests received by us. This notice requests comments from OPOs and the general public for our consideration in determining whether these waivers should be granted.     

Making the Health Insurance Flexibility and Accountability (HIFA) waiver work through collaborative governance

This paper argues that collaborative governance should be an essential component in any HIFA waiver proposal, due to the fact that the health care system is moving away from a federal and hierarchical program design and implementation towards a more local, collaborative approach. As several current collaborative projects demonstrate, collaboration may overcome barriers to health expansion program success, such as stakeholder buy-in, notice, and state access to private health coverage information. Furthermore, collaboration within the context of the HIFA waiver process may maximize the strengths of current collaborations, such as providing: (a) access to greater and more stable funding sources; (b) access to a facilitator that can collect and distribute data; and (c) an avenue for accountability. Multiple challenges in ensuring collaborative governance are reviewed. Ms. Zabawa argues that these challenges are not insurmountable if states adopt a truly collaborative approach to designing and implementing programs under the HIFA waiver; there may be hope in expanding and improving health coverage, since collaboration is the most appropriate mechanism to address the complexity of health system reform.     

Privacy Act of 1974; system of records--PHS. Notification of a new system of records: 09-30-0046, "Survey of alcohol use among youth and young adults"

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new system of records entitled, "Survey of Alcohol Use Among Youth and Young Adults, HHS/ADAMHA/NIAAA," to create a single comprehensive research data base so that critical issues associated with alcohol use among 16- to 27-year-olds can be analyzed. PHS invites interested persons to submit comments on the proposed routine uses on or before March 19, 1984. DATES: PHS has sent a Report of a New System to the Congress and to the Office of Management and Budget (OMB) on Februrary 8, 1984 PHS has requested that OMB grant a waiver of the usual requirement that a system of records not be put into effect until 60 days after the report is sent to OMB and Congress (If this waver is granted, PHS will publish a notice to that effect in the Federal Register.)     

Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice

This notice announces the availability of HCFA funds for certain priority research and demonstration grants for fiscal year 1983. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of state plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing policy and program issues or to develop innovative methods for the administration of Medicare and Medicaid.     

Health financing research and demonstration grants; availability of funds for grants--HCFA. General notice

This notice announces the availability of HCFA funds for certain priority research and demonstration grants for the Federal fiscal year 1984. It contains information about the subject areas for grants that will be given priority, project requirements, application procedures, amounts and duration of grants, and waiver of State plan requirements for demonstration projects. HCFA makes funds available for activities that will help to resolve major health financing program issues or to develop innovative methods for the administration of Medicare and Medicaid.     

Medicare program; explanation of enrollee rights and other provisions applicable to health maintenance organizations and competitive medical plans--HCFA. Final rule

This rule revises current Medicare requirements relating to health maintenance organizations and competitive medical plans. It eliminates the requirement that an organization enroll two new Medicare beneficiaries for each present Medicare enrollee converted from a cost to a risk contract (the "two-for-one" rule), expands the amount and type of information which an organization must provide to enrollees, and requires annual notice of enrollees' rights under the plan. This rule also authorizes HCFA to terminate a contract with an organization for noncompliance with the composition of enrollment standard requiring that no more than 50 percent of an organization's membership be comprised of Medicare or Medicaid enrollees (hereinafter referred to as the "50/50 rule") and authorizes sanctions when an organization fails to comply with the 50/50 rule or the terms of any waiver or exception to that rule. These provisions conform our regulations with changes made by the Omnibus Budget Reconciliation Acts of 1986, 1987 and 1989.     

Juvenile Waiver 2003: Where Are We Now?

Juvenile waiver has received much attention from the public, practitioners, and scholars during the last decade. Prior studies have documented the increased use and effects of waiver. In this study we examine the current state of the law regarding juvenile waiver. We replicate a 1995 study of state waiver statutes and detail the changes in prosecutorial, judicial, and legislative waiver since 1995. While the juvenile crime rate has slowed, legislatures' fascination with waiver has increased. In less than 10 years, the number of states utilizing prosecutorial waiver has increased 25%, 27 states have modified their judicial waiver statutes, and 30 states have modified their legislative waiver statutes.     

Medicare program; changes to the hospital outpatient prospective payment system and calendar year 2003 payment rates; and changes to payment suspension for unfiled cost reports. Final rule with comment period

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In addition, it describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2003. This rule also allows the Secretary to suspend Medicare payments "in whole or in part" if a provider fails to file a timely and acceptable cost report. In addition, this rule responds to public comments received on the November 2, 2001 interim final rule with comment period (66 FR 55850) that set forth the criteria the Secretary will use to establish new categories of medical devices eligible for transitional pass-through payment under the Medicare's hospital outpatient prospective payment system. Finally, this rule responds to public comments received on the August 9, 2002 proposed rule for revisions to the hospital outpatient prospective payment system and payment rates (67 FR 52092). CMS finds good cause to waive proposed rulemaking for the assignment of new codes to Ambulatory Payment Classifications and for the payment of influenza and pneumococcal vaccines under reasonable cost; justification for the waiver will follow in a subsequent Federal Register notice.     

Autonomy,paternalism, and institutional interest: why some conflicts can't be waived

This paper asks the question of why, in some cases, a client is precluded from demanding of their lawyer that they act for them and their adversary simultaneously. We accept that in numerous instances a lawyer can act for clients whose interests may diverge (or in some cases do in fact diverge) providing informed consent has been obtained. This paper enquires as to why the line between waivable and non-waivable conflicts is drawn where it is, and examines the theoretical underpinning of the waiver rule and its boundaries. It does so by first looking at the client autonomy argument for allowing waivers. It then turns to explore the paternalistic justifications for rendering a consensual waiver of a conflict inoperative. Finally it looks at those cases where a waiver is not permitted that are left unexplained by paternalism. It argues that paternalism, properly understood, is a legitimate justification for most refusals to accept a waiver of conflict. However, a residual body of cases remain unexplained by paternalism. Those cases are best explained by the propensity of the law and the legal profession to protect its institutional values and interest.     

Juvenile Waiver 2014: A Review of State Statutes

Juvenile waiver has received much attention from the public, practitioners, and scholars. Prior studies have documented the increased use and effects of waiver. In this study we examine the current state of the law regarding juvenile waiver. We replicate 1995 and 2003 studies that examined state waiver statutes and detail the changes in prosecutorial, judicial, and legislative waiver since 2003. While the juvenile crime rate has dropped dramatically, it is unclear why legislatures’ fascination with juvenile waiver has also decreased. In this study we determine that juvenile waiver remains popular with legislatures, although there are signs of change.     

Do Criminal Court Outcomes Vary by Juvenile Transfer Mechanism? A Multi-Jurisdictional,Multilevel Analysis

In recent decades, the number of juvenile defendants transferred to criminal court has increased dramatically, in large measure due to an expansion of available transfer mechanisms. While transfer traditionally occurred by judicial waiver of jurisdiction, alternatives have emerged and eclipsed judicial waiver as the primary route to adult court. The present study examines whether the mechanism of waiver—judicial, prosecutorial, or legislative—affects sentencing outcomes for juvenile defendants transferred to adult court. Results from multilevel models that control for state-level variation indicate that sentencing outcomes are inextricably tied to method of transfer. Most notably, non-criminal outcomes are most likely for cases that arrive in criminal court by legislative waiver. This suggests that legislative waiver is an ineffective means of sending juvenile offenders to criminal court, and provides some empirical support for the notion that judicial waiver is the most appropriate method of transfer.     

Medicare program; additions to and deletions from the current list of covered surgical procedures for ambulatory surgical centers--HCFA. Final notice with comment period

This final notice with comment period implements section 1833(i)(1) of the Social Security Act, which requires, in part, that the list of covered ambulatory surgical center (ASC) procedures be reviewed and updated at least every 2 years. This notice announces the specific additions to and deletions from the list of surgical procedures for which facility services are covered when the procedures are performed in a Medicare-participating ASC, as well as the assigned payment groups for each addition. The notice also announces a change in our criteria for deleting procedures from the ASC list. This notice also responds to public comments received in response to our proposed notice published December 14, 1993 (58 FR 65357). In that notice, we requested comments on the proposed additions to and deletions from the list of covered surgical procedures for ASCs; the proposed quantitative change in our deletion criteria; the development of alternatives to the proposed quantitative deletion criteria; and the assignment of payment groups for each addition. Finally, this notice solicits public comment on certain additions to and deletions from the ASC list that had not been suggested in our December 1993 proposed notice. It also solicits public comment on the assignment of payment groups for certain new procedure codes.     

Medicaid program; home and community-based services waivers for individuals age 65 or older--HCFA. Interim final rule with comment period

This interim final rule amends current Medicaid regulations to permit States to offer, under a Secretarial waiver, a wide array of home and community-based services to individuals age 65 or older who are determined, but for the provision of these services, to be likely to require the level of care furnished in a skilled nursing facility (SNF) or intermediate care facility (ICF) (nursing facility (NF) effective October 1, 1990). The rule allows Federal payment for these and other long term care services, up to an amount specified in section 1915(d)(5)(B) of the Social Security Act, subject to HCFA's approval of the States' requests for waivers and certain assurances made by the States. Once granted, waivers are in effect for 3 years, unless terminated by the State with notice to the Secretary, and are renewable for periods of 5 years. Periodic evaluation, assessment, and review of the care furnished under the waivers is required. This rule implements section 4102 of the Omnibus Budget Reconciliation Act of 1987, as modified by section 411(k) of the Medicare Catastrophic Coverage Act of 1988, section 8432 of the Technical and Miscellaneous Revenue Act of 1988, and section 4741(b) of the Omnibus Budget Reconciliation Act of 1990. This rule is being issued in final and, for the most part, without a delay in the effective date for the reasons explained in section IV, "Waiver of Proposed Rulemaking and Delay in the Effective Date."     

Unanticipated consequences of unanticipated outcomes disclosures

This article discusses the complex legal and operational issues related to the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) unanticipated outcomes disclosure standard. The author examines case law on the discoverability of hospital quality improvement efforts and information submitted to the JCAHO, and considers whether submitting this information to JCAHO amounts to a waiver of privilege. The author concludes disclosure of an unanticipated outcome should not give rise to a waiver if the hospital and physician are careful in making the disclosure.     

Medicare program; update of ambulatory surgical center payment rates and additions to and deletions from the current list of covered surgical procedures--HCFA. Notice with comment period

This notice implements section 1833(i)(2)(A) of the Social Security Act, which requires that the payment rates for ambulatory surgical center (ASC) services be reviewed and updated annually, and responds to the public comment we received concerning the ambulatory surgical center payment rate update notice with comment period published on July 5, 1990 (55 FR 27690). It also implements section 1833(i)(1) of the Social Security Act, which requires, in part, that the list of covered ambulatory surgical center procedures be reviewed and updated at least every 2 years. This notice announces additions to and deletions from the list of surgical procedures for which facility services are covered when the procedures are performed in an ASC. This notice also announces the assignment of payment groups for each procedure and responds to public comments received in response to the notice proposing additions to and deletions from the list of covered surgical procedures that was published on December 7, 1990.     

Waiver of the two-year home country physical presence requirement for certain foreign medical graduates--INS. Interim rule with request for comments

This rule amends the Immigration and Naturalization Service (Service) regulations by allowing certain foreign medical graduates who entered the United States in J-1 status, or who acquired J-1 status after arrival in the United States, to obtain a waiver of the 2-year home country residence and physical presence requirement under section 212(e)(iii) of the Immigration and Nationality Act (Act) pursuant to a request by a State Department of Public Health, or its equivalent. The waiver is intended to permit these foreign medical graduates to work at a health care facility in an area designated by the Secretary, Health and Human Services (HHS), as having a shortage of health care professionals ("HHS-designated shortage area"). This interim rule also contains provisions which will permit these foreign medical graduates to change their nonimmigrant status in the United States from J-1 exchange visitor to H-1B specialty occupation worker.     

Legislative Waiver Reconsidered: General Deterrent Effects of Statutory Exclusion Laws Enacted Post‐1979

In recent years, the juvenile justice system has undergone a “get tough” transformation. One component of the system which has experienced substantial alteration is the mechanism by which states allow for the waiver of juvenile offenders to adult criminal court. Most of the state systems now have some form of transfer procedure in place and many allow for the automatic transfer (or statutory exclusion) of juveniles who have been charged with certain offenses. Although the effects of waiver laws on individuals have received much empirical attention, their effects on the respective states’ aggregate level violent juvenile crime rates are less understood. In this study, we examine the relative effects of legislative waiver laws in 22 states that have added statutory exclusion provisions since 1979. In doing so, we assess whether legislative waiver should be reconsidered.     

Constitutional protection of confessions made by mentally retarded defendants

Criminal confessions made in response to custodial questioning are excluded from evidence unless a defendant voluntarily, knowingly and intelligently waived his Miranda rights. In Connelly, the Supreme Court erred by holding that, absent explicit police coercion, a mentally ill individual's waiver is valid. The Court failed to consider the defendant's subjective impairments that might invalidate his waiver. By contrast, the Patterson Court suggested that a defendant's right to counsel may attach at an early stage in a criminal proceeding if the defendant has a significant need for counsel. This Note addresses the special needs of a mentally retarded person in the criminal justice system. The Note argues that mentally retarded suspects require careful explanation of Miranda rights in order to understand them. The intellectual and adaptive deficiencies which characterize mental retardation also necessitate an inquiry into a valid waiver that accounts for these disabilities. Furthermore, the special needs of the mentally retarded mandate that the right to counsel attach as early as the precustodial stage of an investigation. Early access to counsel most effectively assures that a mentally retarded person's waiver of constitutional rights is voluntary, knowing and intelligent.     

Clinical Laboratory Improvement Act program fee collection--HCFA. Final rule with comment

This rule implements provisions of section 353 of Public Health Service Act (as amended by the Clinical Laboratory Improvement Amendments of 1988). Those provisions require laboratories to pay fees for issuance of registration certificates, certificates of waiver, certificates of accreditation, or certificates and to fund activities to determine compliance with the requirements established by the Department of Health and Human Services for laboratory testing. It also establishes the policy that laboratories licensed by and located in States with licensure programs approved by HHS may be exempt from the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This rule also establishes the methodology used to determine the amount of the fees charged for certificates of waiver, registration certificates, certificates of accreditation, or certificates and activities to establish application procedures and determine compliance with applicable certification requirements.     

PPS waivers: implications for Medicare, Medicaid, and commercial insurers

This paper compares the Medicare prospective payment system (PPS) to four all-payer rate-setting systems that operated under HCFA waiver authority. The study examines the experience of Medicare, Medicaid, and commercial insurers under the two approaches. Data from several American Hospital Association surveys and from Medicaid 2082 report forms are analyzed. The paper concludes that the all-payer waiver programs have been as successful as PPS in controlling the rate of growth in Medicare costs. In addition, Medicaid programs are more successful in controlling their outlays in all-payer rate-setting environments than when they "go alone." Finally, there is no evidence to suggest that hospitals can increase charges in response to greater financial need under either PPS or the state waivers. Nevertheless, it appears that commercial insurers are better able to compete with Blue Cross plans in all-payer rate-setting states than elsewhere.