Paying for the Medicare program

Although the hospital insurance (HI) trust fund acted as a source of strength for the old-age, survivors, and disability insurance program during its recent financial crises, projections by HCFA and CBO reveal that the Medicare program will experience financing problems of its own within the next decade. No one would argue that Medicare's financing problems should be solved simply by raising more money. However, the prospect of insolvency in the HI trust fund and the increasing strain on general revenues from the Supplementary Medical Insurance trust fund require policymakers to survey the options for increasing Medicare revenues while cost-control devices are being developed. Indeed, even if cost-control efforts are completely successful, additional revenues may be needed in the future to finance new initiatives in the Medicare program. Therefore, this paper will look briefly at current efforts to regain control of soaring hospital and physician costs and then examine some of the more feasible options for increasing Medicare revenues.     

Physician recruitment after Hermann Hospital

The state of physician recruitment changed after the Internal Revenue Service required Hermann Hospital to publish its closing agreement with the IRS. The closing agreement released the long-awaited IRS "Hospital Physician Recruitment Guidelines." The IRS' recently proposed revenue ruling provides additional insight on acceptable physician recruitment practices as well.     

Troubled times for Canada's medical marijuana program

Health Canada finally produces a good marijuana crop, but its medical marijuana program is in a state of upheaval as it faces internal dissent regarding a crucial aspect of its mandate, as well as fundamental challenges from the courts. Meanwhile, the Justice Minister said that the government will introduce legislation to decriminalize the possession of small amounts of marijuana.     

Medicare program; Medicare and laboratory certification program; enforcement procedures for laboratories--HCFA. Final rule

These regulations set forth the rules for sanctions that HCFA may impose on laboratories that are found not to meet Federal requirements. These include the principal sanctions of suspending, limiting, or revoking the laboratory's certificate issued under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), and cancelling the laboratory's approval to receive Medicare payment for its services, and the alternative sanctions that may be imposed instead of or before the principal sanctions. These amendments are necessary to conform HCFA regulations to changes made in the law by the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) and the 1988 amendments to section 353 of the Public Health Service Act (PHS Act). The latter are commonly referred to as "CLIA 88". The purpose of the amendments is to ensure that functioning laboratories are capable of providing accurate and reliable test results and that the health of individuals served by the laboratory and that of the general public is not adversely affected by laboratory operations and by testing procedures that do not meet the standards set forth in other subparts of part 493 of the HCFA regulations.     

Evaluation of a treatment program for battered wives

Research shows that of the abused wives who remained in a women's protective agency for a period of at least 2 weeks, 50% return to their abusive situation. Several theorists have advocated that battered women remain in their abusive situation because they lack skills necessary to extricate themselves. A program was developed to provide personal and vocational counseling for abused women. Over a 2-week period, abused women who volunteered for the experiment were given the opportunity to participate in group counseling which provided cognitive restructuring therapy, self-assertiveness and communication skills training, problem solving training, body awareness, and vocational counseling. Three groups participated in the experiment: a control group, a group with the COPSystem Interest Inventory and the Sixteen Personality Factors Questionnaire, and a group with the COPSystem Interest Inventory without the Sixteen Personality Factors Questionnaire. The group with the COPSystem Interest Inventory administration and interpretation showed significant improvement within group measures from pre- to post-treatment in anxiety, depression, hostility, assertiveness, and self-esteem. The group with the COPSystem Interest Inventory and the Sixteen Personality Factors Questionnaire utilization showed no significant improvement in any of the measures. It can be concluded that the women in the experimental group with the administration of the COPSystem Interest Inventory benefited from the therapy provided more than the women in the experimental group with both the COPSystem Interest Inventory and the Sixteen Personality Factors Questionnaire administration and interpretation. Limitations and directions for future research are discussed.     

An examination of program integrity and recidivism of a cognitive-behavioral program for incarcerated youth in The Netherlands

The present study examined whether the cognitive behavioral program EQUIP for incarcerated youth would reduce recidivism and whether higher levels of program integrity – the extent to which a program is implemented as intended – would strengthen the effectiveness of EQUIP on recidivism. Program integrity was measured using a multifaceted program integrity instrument assessing the level of exposure, adherence, participant responsiveness, and quality of delivery. Participants (N = 133) were recruited from five juvenile correctional facilities in the Netherlands. The EQUIP program was implemented with low to moderate levels of program integrity (M = 54%). No differences were found between the experimental and control group in the prevalence, frequency, and seriousness of recidivism. In addition, within the experimental group, program integrity did not strengthen the effectiveness of EQUIP on the prevalence, frequency, and seriousness of recidivism. With these low-to-moderate levels of program integrity EQUIP did not reduce recidivism.     

Medicare program; swing-bed program changes--HCFA. Final rule

This final rule responds to comments we received on an interim final rule relating to hospital swing beds that was published on September 7, 1989 (54 FR 37270). The interim rule expanded the swing-bed program to encompass rural hospitals with 50 to 99 beds. It established requirements that approved swing-bed hospitals with more than 49 beds must meet. This rule establishes the interim rules as final regulations with changes. These changes are based on our review and consideration of the public comments.     

Community residential care program and contract program for veterans with alcohol and drug dependence disorders--VA. Final rule

This document updates the Department of Veterans Affairs (VA) regulations concerning the Community Residential Care Program and the Contract Program for Veterans with Alcohol and Drug Dependence Disorders by incorporating by reference relevant portions of the latest editions of the National Fire Protection Association Life Safety Code entitled "NFPA 101, Life Safety Code" and "NFPA 101A, Guide on Alternative Approaches to life Safety." This is intended to ensure that buildings used for treatment and residential services for veterans meet appropriate fire and safety standards. Also, this document amends the regulations for such programs by delegating authority to each of the Veterans Integrated Service Network (VISN) Directors of the Veterans Health Administration to grant certain equivalencies or variances to building standards of the Life Safety Code. Further, this final rule does not adopt the portion of the proposed rule concerning the Adult Day Health Care Program since the Adult Day Health Care Program and the corresponding regulations are no longer in existence.     

The need for child maltreatment research and program evaluation

The knowledge base supporting child abuse treatment and prevention rests upon clinical experience and applied research. An analysis of program funding in the United States indicates that unevaluated clinical programs are funded rather than research or program evaluation projects. Grant funding patterns for the National Center on Child Abuse and Neglect were analyzed for 4 years. Overall, 66% of projects had no research or evaluation component. Without such programs, we cannot determine the effectiveness of treatment and prevention efforts that, while well intended, may have no effects on the participating parents and children, or, worse still, may have unintended negative consequences. Quality programs must be based on the maintenance of a balance between research and clinical efforts with evaluation being an important component of the latter.Portions of this paper were presented at the Seventh International Congress on Child Abuse and Neglect, Rio de Janeiro, Brazil, 27 September, 1988.     

Evaluation of a sexual abuse prevention program for preschoolers

Many sexual abuse prevention programs have no research basis to support their claims of effectiveness. The Sexual Abuse Prevention Program for Preschoolers (SAPPP) was developed by modifying a popular prevention program to include behavioral training and rehearsal, and evaluation components. Children were taught to identify different types of touch, to say “no,” and to “tell others.” Each of the six SAPPP lessons included a topic introduction, stories related to the topic, target behavior rehearsal: This was followed by class discussion. Four university preschool children, three females and one male, between the ages of 3 and 4 participated in the program. All of the children showed improvement from pretest to post-test. The improved post-test scores were the result of correct verbal responses. Correct behavior demonstration responses did not increase for any child. A successful child sexual abuse prevention program should train children to demonstrate appropriate preventive behaviors. Suggestions for improving preventive behavior skills demonstrations and increasing the number of children in future research are discussed.     

A cognitive therapy treatment program for repeat DUI offenders

Driving under the influence is a devastating problem in the United States, killing almost 17,000 people in 2005. The present article describes a cognitive treatment program aimed at repeat drinking and driving offenders. Sixty-three participants were court mandated to the four-month outpatient treatment program. Before entering and after completing treatment, participants were administered self-report instruments measuring alcohol problems, readiness to change, self-esteem/efficacy, and criminal thinking patterns. Additionally, arrest histories were examined. Findings suggested that participants were characterized not only by repeated arrests, but elevated blood alcohol content and high levels of self-reported alcohol dependency and problem-drinking behaviors. The majority of clients expressed a readiness to change their drinking and driving behaviors with 87 percent graduating from the program. A DUI recidivism rate of 13 percent was found for graduates of the program at a twenty-one month follow-up. The results demonstrate that the treatment program is a valuable tool in the battle to reduce criminal recidivism.     

Developing relevant data for a prison organizational development program

A project to develop a set of techniques for bringing about change in an existing prison is described. The effort concentrated primarily on the managers of the statewide system, and the staff and inmates of one prison were the focus of a set of intervention experiments. Methods for modifying the network of human and organizational relationships in that system were objects of this project. The research instruments used, their use, and some of the things learned about them is given in detail.