Medical loss ratio requirements under the Patient Protection and Affordable Care Act. Final rule with comment period

This final rule with comment period revises the regulations implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act in order to address the treatment of "mini-med" and expatriate policies under these regulations for years after 2011; modify the way the regulations treat ICD-10 conversion costs; change the rules on deducting community benefit expenditures; and revise the rules governing the distribution of rebates by issuers in group markets.     

论行政规定的性质——从行政规范体系角度的定位

《行政复议法》中行政规定的法律属性是个看似简短实则极为复杂的问题。其简单之处在于将行政规范性文件中不属于法律规范的部分起了统一的名称 ,但这样的立法作业并不能回避从规范性的角度看行政规定时常难以将其与法律规范的作用相区别的困惑。本文通过对形式和实质判断标准以及这对标准依存的国家与社会关系的分析 ,指出形式判断标准无法准确定位在内外区别型的国家和社会关系基础上的行政规定的性质 ,同时通过对行政规定所产生的现实功能进行整理 ,力图为相关的制度建设奠定基础。     

规范之中的逻辑

法律能否或如何运用逻辑来对事实进行把握是一个永恒的话题。推理、推定和拟制的运用即是从不同程度上对逻辑在静态的规范意义上运用的清晰的反映。其具体表现形式在推理中表现为事实分类,在推定中为事实性规则的确立,在拟制中则是规则的变动。在这些具体的运用活动中,规则虽然始终保持着一种名义上的规范性,但其内容却已有了很大程度的不同。     

Medicare program; fee schedule for physicians' services--HCFA. Correction of final rule

In the November 25, 1991 final rule (56 FR 59624) on the Medicare fee schedule for physician services, we inadvertently set forth regulations on the fee schedule at 42 CFR, part 415. However, our plan for the recodification of HCFA regulations calls for general regulations on payment for Part B medical and other health services to be codified in part 414, with part 415 reserved for regulations on payment to teaching physicians, teaching hospitals, and provider-based physicians. Therefore, in this correction notice, we are redesignating in their entirety the physician fee schedule regulations contained in part 415, subpart A to part 414, subpart A, and reserving part 415 for future use. Also, this document corrects technical errors that appeared in the final rule published in the Federal Register on November 25, 1991 (56 FR 59502) entitled "Medicare Program; Fee Schedule for Physicians' Services".     

The new EMTALA regulations--introduction

This Introduction provides a broad overview of the new Emergency Medical Treatment and Labor Act (EMTALA) regulations and the changes they effected. The three Articles that follow discuss various aspects of the regulations in much greater detail. Health Lawyers Teleconference: EMTALA Update provides a commentary on the regulations from the perspective of representatives of the Centers for Medicare & Medicaid Services and the Department of Health and Human Services, followed by a critique of the regulations from a practitioner's standpoint. EMTALA: Dedicating an Emergency Department Near You analyzes the provisions of the regulations in detail and discusses their implications for hospitals and their counsel. Finally, The New EMTALA Regulations and the On-Call Physician Shortage: In Defense of the Regulations analyzes the on-call provisions of the regulations in light of the current shortage of on-call physicians.     

Federal Old-Age, Survivors, and Disability Insurance and Supplemental Security Income for the Aged, Blind and Disabled; representative payment--SSA. Final rule

These final regulations reorganize and restate in simpler language our regulations on representative payment under titles II, Old-Age, Survivors, and Disability Insurance (OASDI), and XVI, Supplemental Security Income for the Aged, Blind, and Disabled (SSI) of the Social Security Act. These regulations (1) explain representative payment; (2) state when title II and title XVI benefits will be paid to a representative payee rather than directly to the entitled person; (3) indicate the procedure we follow in selecting a representative payee; (4) specify the responsibilities of a representative payee; and (5) clarify our responsibilities to the beneficiary when we make payments to a representative payee on his or her behalf.     

试论当代欧美反倾销法的贸易保护主义功能

当代欧美反倾销法的贸易保护主义功能越来越强。一方面 ,其反倾销法中不合理、不公平的规定仍然存在 ,同时 ,其内容越来越严密与完善。另一方面 ,欧美反倾销法的很多实体性规定弹性极大 ,增强了操作时的人为因素。此外 ,其反倾销法中严格的程序性规定也为其贸易保护主义政策的实现起到了推波助澜的作用     

交通事故立法疏漏之研究

在我国处理道路交通事故几乎都是依照国务院《道路交通事故处理办法》进行处理的 ,由于包含着民事赔偿规范 ,这一行政规范成为审判机关审理这类案件的主要依据 ,这显然是存在问题的 ;另外 ,在体系上和原则上严重违反了《民法通则》的精神 ,一些规范的设定存在重大疏漏。     

Social Security benefits; disability insurance benefits; deductions, reductions, and nonpayments of benefits--SSA. Final rules with comment period

These regulations amend the existing regulations under which Social Security benefits payable to a disabled worker and his or her family may be reduced because of the worker's concurrent entitlement to workers' compensation benefits. They provide that entitlement to certain other public disability benefits may reduce the disability benefits paid by Social Security; that the reduction applies to the first month of concurrent entitlement regardless of the month in which we are notified of entitlement to the public disability benefit; and that the reduction applies to all months of concurrent entitlement until the disabled worker attains age 65. These regulations also provide that where a public disability law or plan provides for reduction of the public disability benefit on the basis of entitlement to Social Security disability insurance benefits that provision will preclude reduction of the Social Security benefits but only if it was in effect on February 18, 1981. These regulations implement section 2208 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35).     

论企业知识产权能力的建设

提升企业知识产权能力是实施国家知识产权战略、实现创新型国家的重要路径。企业知识产权能力是指企业整合其资源,促进知识产权创造、运用与保护,提升市场竞争力、提高经营效益的能力集合;具有对象的专有性、属性的法律性、过程的多维性与价值的经济性等特征;是企业学习、内化知识产权制度,形成其知识产权理念、配置知识产权管理机构和人员与创设知识产权管理规章制度的知识产权能力结构,促进专利、商标、作品等创造、运用与保护并谋求市场优势的过程。为此,企业应当从服务主营业务、内化知识产权制度,形成知识产权主导理念、梳理与落实知识产权管理制度、构建知识产权专业团队等方面建设其知识产权能力。     

Standards applicable to owners and operators of hazardous waste treatment, storage, and disposal facilities: liability requirements. Environmental Protection Agency. Revised interim final rule

The Environmental Protection Agency is today revising regulations of January 12, 1981, on liability coverage requirements for hazardous waste facility owners or operators. Under these requirements, owners or operators must demonstrate liability coverage for bodily injury and property damage to third parties resulting from facility operations. The major revisions are: addition of the option of a financial test as a means of demonstrating liability coverage to satisfy the requirements; addition of the option of submitting a certificate of insurance as evidence of insurance; and changes in the requirements for the endorsement and certificate. In a future document, EPA will propose to delete two provisions of the January 12, 1981 regulations. These provisions are: the procedure to obtain a variance for liability coverage requirements; and the provision allowing an owner or operator to use State assumption of legal responsibility for liability coverage to satisfy the liability requirements. The January 12, 1981, regulations were issued under an accelerated schedule imposed by a court order. The revisions that are being made today are necessary to eliminate unworkable aspects of the previous regulations, improve their effectiveness, and allow reasonable flexibility in satisfying the requirements.     

关于我国金融法治重构的思考

我国已经初步形成基本适应社会主义市场经济和金融发展的金融法治框架;金融法治建设面临的新态势可以概括为金融服务现代化,其基本特征有金融政策自由化、金融服务网络化、金融企业巨型化和金融服务贸易全球化等;我国金融法治的重构,应以“推动金融服务现代化”为根本任务,并应遵循“法治先行、服务为本。整体设计、重点推进”的方针。     

Notes on public protection against hazards and nuisances: the Israeli experience

Scientific, detailed regulations for the abatement of noise, odour and air pollutants did not prove very successful; Israel reverted to the Subjective norm of 'disturbing'. Courts proved more adaptive to change than legislators, and made use of those regulations to shift the onus of proof in keeping balance between sanity and development.     

Adult day care regulation: "Déjà vu all over again"?

We investigate what aspects of adult day care are regulated by licensure and certification requirements, whether differences exist among centers according to their regulatory status, and the relationship between regulatory status and satisfaction. The data come from a national survey of adult day care center. We find that adult day care regulations are primarily structural in nature and that differences do exist among centers by regulatory status. Participants are very satisfied with the centers and their staff overall, especially at centers that are regulated; their satisfaction with milieu is less at regulated centers and with amenities is unaffected. Day care regulations have not been extended to the processes and outcomes of care as nursing home regulations recently have been. The choice that now faces policymakers is between increasing these regulations or relying on market mechanisms to protect day care participants.     

The role of government regulations in the adoption of cloud computing: A case study of local government

Cloud computing is a technology that facilitates improved productivity, improved efficiency and lower costs. This technology has the potential to improve the reliability and scalability of organizational systems and leads to an enhanced focus on core business and strategy. Despite the Australian Federal Government's ‘cloud-first’ strategy and policies and the Queensland State Government's ‘digital-first’ strategy, the adoption of cloud services at the local government level has been limited, largely due to a lack of specificity among government regulations and a lack of regulations that provide support to local governments. This empirical study deploys a mixed research method designed to develop a cloud regulations model to assist governments in adopting cloud computing services. By integrating Australian Cloud Policy Frameworks with the extant research on cloud computing, this study conducted 21 field interviews with Information Technology (IT) managers and surveyed 480 IT staff from Australia's 47 local governments. This research paper presents and validates a revised set of factors used to develop government regulations specific to cloud computing adoption. The factors that we found to be statistically significant were cost, quality of services, security, privacy, management, government-based facilitating conditions, and firm-based facilitating conditions regulations. Based on these findings, this research concludes that government regulation is a significant aspect in decision making for the adoption of any new technology such as cloud computing.     

著作权法借鉴国际条约与国外立法:问题与对策

在要求我国迅速建立与国际接轨的著作权制度的外部压力下,我国《著作权法》的制定及其后的修改大量借鉴了国际著作权条约和国外立法的规定,此种立法产生了三方面副作用:(1)"博采众长"造成了条文之间的逻辑矛盾;(2)直接照搬国际条约使得立法过时或过于粗糙;(3)对国际通行规则的改动导致立法目的无法实现。目前启动的《著作权法》第三次修改工作并无外部压力,建议按以下三种方式借鉴国际条约和国外立法:(1)以一个法系中一个主要国家作为借鉴的样板;(2)改对国际条约规定的直接照搬为根据国情、用本国立法语言重新制定精细化的规则;(3)除非有充分理由,不轻易改动国际通行的规则。     

行政立法效益评估——美国的做法及启示

行政立法效益评估是美国自上世纪70年代以后逐渐发展起来的通过运用成本——收益分析或成本——效果分析方法对行政立法进行评估以改善行政立法质量的一种制度。目前行政立法效益评估已经成为美国重要行政立法的必经程序之一,有效地促进了管制政策制定的科学性和合理性,对于提升行政效能起到了良好的推动作用。本文从美国行政立法效益评估兴起的背景、主要做法及其对我国行政效能监督的启示三个方面对美国行政立法效益评估进行了阐述,文章认为美国行政立法效益评估中立法谦抑的指导思想,集中统一的审查机制和科学合理的评估方法对于我国行政效能监督建设最具借鉴意义。     

农民平等就业权在《就业促进法》中的缺陷与完善

平等就业权是指劳动者依法享有平等就业机会及其排除各种就业歧视的权利,它既是生存权的延伸和具体化,也是劳动权体系的起点和基础。对农民平等就业权进行立法保护,既有可靠的宪法依据和坚实的理论基础,也有十分重要的现实意义。尽管我国《就业促进法》首次规定了农民平等就业权,但它在具体保护方面仍然存在诸多缺陷,促进就业的有关规定没有涵盖农村劳动者;反就业歧视的规定缺漏较多、可操作性差;法律责任的规定不完备、不匹配。为了有效保护农民平等就业权,必须全面贯彻城乡平等就业制度,进一步完善反就业歧视制度和法律责任制度。