Legislation and regulation

Publications

Alphabetical list. You can also view by publication date.

• Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
  Author(s): Michelle M. Casey, Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Legislation and regulation, Medicare Part D, Pharmacy and prescription drugs, Workforce
  Report Number: Working Paper No. 36
  Date: 07 / 2001
  Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
• Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
  Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 08 / 2000
  This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
• Assessment of Proposals for a Medicare Outpatient Prescription Drug Benefit: The Rural Perspective
  Author(s): Andrew F. Coburn, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare, Pharmacy and prescription drugs
  Date: 01 / 2003
  This Policy Paper assesses legislative proposals to add an outpatient prescription drug benefit to the Medicare program and their implications for the delivery of services and the welfare of beneficiaries in rural areas. Report produced by the RUPRI Rural Health Panel.
• Comments on Regulatory and Contractor Reform Legislation
  Author(s): Keith Mueller, Brandi Shay
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare
  Report Number: Rural Policy Brief Vol. 7, No. 1 (PB2002-1)
  Date: 01 / 2002
  Informs policy and reports back to the "field" regarding the rural issue of, and suggested modifications to, contractor reform following the passage of the Medicare Regulatory and Contracting Reform Act of 2001. Findings consist of responses from interviews with a range of health care professionals and experts.
• Definition of Rural in the Context of the MMA Access Standards for Prescription Drug Plans
  Author(s): Keith J. Mueller, Rebecca T. Slifkin, Michael D. Shambaugh-Miller, Randy K. Randolph
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Defining rural, Legislation and regulation, Pharmacy and prescription drugs
  Report Number: RUPRI Policy Paper P2004-7, North Carolina Working Paper No. 79
  Date: 09 / 2004
  Access to local pharmacy services is dependent upon the extent to which prescription drug plans offering the Medicare benefit incorporate local rural pharmacies into their provider networks. This will be based on market considerations and on the requirements for local access contained in the MMA and regulation, which in turn will be shaped by how "rural" is defined. This paper assesses how the definition of rural affects the potential impact of the specific access standards in the Proposed Rule to implement Title I of the MMA, and finds that the congressional objective to achieve convenient access to pharmacies (other than mail order) would be more fully realized if the Proposed Rule definition of rural is changed.
• Designing a Medicare Drug Benefit: Balancing Government-Based and Market-Based Approaches, the Implications for Rural Beneficiaries
  Research center: Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Date: 01 / 2003
  Examines the relationship between a variety of design characteristics of a Medicare prescription drug benefit and their likely impact on rural areas. The research is based on an analysis of three competing legislative proposals, the House passed proposal (HR 4954), the "Tripartisan" proposal (S 2729), and the Graham proposal (S 2625). In addition, there is an analysis of data from the Medicare Current Beneficiary Survey, pharmacy benefit managers, discussions with various state and federal policy makers, and reviews of published literature. The study finds that the different prescription drug proposals will have positive implications for rural areas and address the lack of access to Medicare+Choice drug coverage in rural areas. Rural pharmacies may see a change in revenue, but the actual result of the changes has not been studied.
• Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives for Legislative Proposals
  Author(s): Andrew F. Coburn, Erika Ziller, Charles W. Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller, Rebecca T. Slifkin, Mary K. Wakefield
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Pharmacy and prescription drugs
  Date: 06 / 2000
  This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare program. Our intent is to establish a framework for assessing the effects of proposals on rural beneficiaries. Report produced by the RUPRI Rural Health Panel.
• Indian Health Care Improvement Act: Implications for North Dakota Tribes
  Author(s): Francine McDonald
  Research center: Upper Midwest Rural Health Research Center
  Topics: American Indians and Alaska Natives, Legislation and regulation, Minority health
  Date: 11 / 2004
  Policy brief providing an overview of health care issues facing American Indians in North Dakota, with discussion of the impact of the Indian Health Care Improvement Act.
• Medicare Prescription Drug, Improvement, And Modernization Act Of 2003, (P.L. 108-173): A Summary Of Provisions Important To Rural Health Care Delivery
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Policy Paper P2004-1
  Date: 01 / 2004
  Provides a wide audience of rural health policymakers, advocates, and researchers a consolidated summary of legislative provisions contained in Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (P.L. 108-173) that have particular meaning to the delivery of services in rural areas. Includes information on how this Act will impact beneficiaries, health care access, and payments to rural health care providers.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Date: 01 / 2001
  Covers rural health policy, SCHIP Benefit Improvement Plan, and legislation.
• Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000: Concerns, Legislation, and Next Steps
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health policy, Legislation and regulation, Medicaid and S-CHIP, Medicare
  Date: 01 / 2001
  Overview of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) as it impacts rural health.
• Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA)
  Author(s): Curt Mueller, Keith Mueller, Janet Sutton
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Legislation and regulation, Medicare, Medicare Part D
  Report Number: Walsh W Series No. 6, RUPRI P2004-6
  Date: 08 / 2004
  Provides in chart form sections of the MMA which were identified as having special concern to rural Medicare beneficiaries, medical care providers, and policymakers. The particular sections are cited and implications for rural health services are indicated. Most of the sections identified are concerned with access to prescription drug coverage and the impact of the proposed legislation on rural pharmacies. The primary focus is on rules that will affect providers of drug coverage; this policy paper does not focus on rural dimensions of coverage from the insurance providers' perspective.
• State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
  Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
  Research center: Maine Rural Health Research Center
  Topics: Legislation and regulation, Mental health, Workforce
  Report Number: Working Paper No. 29
  Date: 05 / 2002
  Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
• Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff
  Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary K. Wakefield
  Research centers: Maine Rural Health Research Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Upper Midwest Rural Health Research Center
  Topics: Health policy, Legislation and regulation, Medicare, Pharmacy and prescription drugs
  Citation: Journal of Rural Health, 21(3), 194-197
  Date: 2005
  The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that congressional staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects.