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Homework answers / question archive / Weekly Overview     Week Five   Overview   Federalism refers to the division of powers between the states and the federal government

Weekly Overview     Week Five   Overview   Federalism refers to the division of powers between the states and the federal government

Law

Weekly Overview  

 

Week Five

 

Overview

 

Federalism refers to the division of powers between the states and the federal government. The division of powers is evident in the development, creation, and implementation of policy. Demographic differences in states require states to implement federal laws differently. For example, each state’s Medicaid program abides by certain federal guidelines, but states have flexibility in other areas of the program’s management.

 

A state’s power in implementing health policy can be seen in its regulation of the health care industry. Each state has bodies and boards that regulate health care organizations, providers, and licensure. Each state has a health department, and while the exact role and function of these departments vary by state, these boards play a key role in implementing policy through the oversight of health care organizations and providers, including some hospitals and facilities, the monitoring and assessment of public health issues and disease, the creation of regulations, and the development of policy recommendations. Local health departments play an even more direct role in overseeing public health and monitoring compliance with regulations.  

Regulations directly and indirectly affect the provision of health care. There are various types of regulations, from market-based regulations that attempt to use payment incentives or published metrics to influence care delivery, to strict external oversight where strict guidelines must be followed. Private and public regulatory agencies influence health care delivery by developing voluntary or required standards. The regulatory process includes a public commenting opportunity. Key regulatory initiatives and developments can be found on the US Department of Health and Human Services website, which also includes a list of regulations open for public comment and opportunites to appeal regulations: http://www.hhs.gov/regulations/index.html.   

 

Once enacted, policies are challenging to overturn or change. Most policy modifications occur through regulation. Sometimes, the way that agencies or states implement policies affects the effectiveness of those policies, and modifies the policy. For example, states that opted out of the Medicaid expansion component of the Affordable Care Act limited the impact of the policy and created a modification to the policy that prevents the expansion of Medicaid services to certain demographic groups.

 

What you will cover

 

    1. Policy Implementation and Policy Modification
      1. Contrast local, state, and federal policy implementation processes.
        1. Federalism refers to the balance of powers between the states and the federal government
          1. This balance continues to evolve
          2. This balance is necessary because states face unique issues
        2. Federal Government supersedes
          1. Supersedes state authority/state and local laws in accordance with the Constitution
          2. Governs interstate interactions and sets certain criteria for state law
          3. Federal guidelines set basis for state policies and typically give high level requirements that states must follow
          4. Federal grants to states provide funding as a form of incentive and regulation
        3. States create specific methods for following federal policy and regulating policies   
          1. State laws cannot conflict with federal law
          2. Differences in states require flexibility in state law
            1. Demographic differences in states
              1. Poverty levels, race, immigration, and average age are examples of demographic differences that affect health status. States have a greater ability to analyze and respond to these issues in a specific way. How might a state with a high number of immigrants create a more detailed policy for providing health coverage for these individuals? For example, CA proposal to allow illegal immigrants to purchase health insurance. 
              2. Agricultural differences in states create different regulatory needs. For example, what specific public health needs might a state with a large mining industry need to consider that other states may not need to address?
              3. States can tailor policies, regulations, and interventions to address unique cultural attributes in states. For example, how might a state with a large Native American population develop interventions differently from a state with a less diverse demographic?
          3. States determine how to implement and regulate federal law
            1. States may add regulation
              1. Some states charge Medicaid beneficiary copays within federal Medicaid eligibility requirements
              2. Some states (such as California) impose higher environmental standards than those established by the EPA
            2. States prioritize different issues
        4. The action, or inaction, of a body at any level of government can affect implementation
          1. State funding allocation levels
          2. Regulatory focus of boards
          3. Political preferences and trends
        5. Sometimes policy requirements or goals conflict
          1. Example: HIPAA vs. background checks for firearms purchase
          2. Personal freedom vs. public safety
      2. Analyze the differing roles of public and private regulatory agencies as they relate to the implementation of health policy.
        1. Market-based regulation
          1. Payment incentives
          2. Definition of practice standards
          3. Publishing metrics
        2. Self-regulation
          1. Continuous improvement
          2. Peer review
          3. Seeking certifications and accreditation
        3. External Oversight
          1. Strict/Command and Control
            1. State or federal agency gives strict guidelines
            2. Agency specifies what standards must be met and how those standards must be met
            3. Legal requirements
          2. Loose
            1. Private or public agency monitors self-regulation
            2. Agency specifies what standard must be met, but now how the standard is met (example: hospital must have quality assurance program, but hospital may develop its own quality assurance processes)
        4. Private Regulatory Groups
          1. The Joint Commission
          2. Other accreditation and certification groups
        5. Public Regulatory Agencies
          1. Departments of Health and Human Services (HHS or DHHS)
          2. Centers for Medicare and Medicaid Services (CMS)
          3. Other federal agencies
      3. Explain how the rulemaking process relates to health care organizations.
        1. Rulemaking and regulation development is a crucial part of implementation
          1. Legislation rarely includes implementation guidance
          2. Rulemaking establishes how the law will be put into place
        2. Congress delegates implementation power to rulemaking organizations and oversees implementation
        3. President may delegate rulemaking power to an agency or department
        4. Public comment requirement as part of rulemaking process
        5. How are rules communicated and advertised?
        6. Rules and regulations enforced at multiple levels of government
      4. Analyze the factors that influence policy modification.
        1. Research and analysis can identify current or potential problems with a policy
        2. Funding issues may result in a need to modify a policy or regulation; defunding a policy may stop the policy entirely
        3. Public response may result in policy modification (example: “Keep Your Health Plan Act” delayed implementation of the Patient Protection and Affordable Care Act (PPACA) insurance plan criteria)
        4. Change in majority party may result in a policy or elements of a policy being repealed
        5. Court action may limit the reach of a policy or rule a policy unconstitutional

 

 

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